Impact of sleep on postpartum health outcomes: a systematic review and meta-analysis

Objective To examine the impact of postpartum sleep interventions and postpartum sleep on maternal health outcomes. Design Systematic review with random-effects meta-analysis. Online databases were searched on 12 January 2024. Study eligibility criteria Studies of all designs (except case studies and reviews) in all languages were eligible if they contained information on the population (individuals up to 1-year post partum), sleep interventions/exposures including (type, duration, frequency, alone or in combination with other components), comparator (control or different duration, frequency or type of sleep intervention) and outcomes: mental health, cardio-metabolic, postpartum weight retention (PPWR), low back pain and pelvic girdle pain, breastfeeding and urinary incontinence. Results 60 studies (n=20 684) from 14 countries were included. ‘High’ certainty of evidence showed that sleep interventions were associated with a greater decrease in depressive symptom severity compared with no intervention (five randomised controlled trials; n=992; standardised mean difference −0.27, 95% CI −0.40 to –0.14; small effect). Sleep interventions had no impact on the odds of developing depression (‘moderate’ certainty of evidence) or anxiety or anxiety symptom severity (‘low’ certainty of evidence). Additionally, ‘low’ certainty of evidence demonstrated no effect on cardiometabolic outcomes (systolic blood pressure, diastolic blood pressure, mean arterial pressure), anthropometric measures (maternal weight, body mass index) or prevalence of exclusive breastfeeding. ‘Low’ certainty of evidence from observational studies found that high-quality sleep reduces the odds of developing anxiety and reduces the severity of depression and anxiety symptoms. ‘Low’ and ‘very low’ certainty of evidence from observational studies found that shorter sleep duration is associated with greater PPWR. Conclusions Postpartum sleep interventions reduced the severity of depression symptoms.