| |

Sleep and fatigue according to baby feeding method in postpartum women

Picture of Assoc. Prof. Dr. An Mariman

Assoc. Prof. Dr. An Mariman

As a psychiatrist and ESRS- certified somnologist (Tallin 2014), I was trained in sleep medicine at Ghent University, Belgium and at the Center for Sleep Medicine in Kempenhaeghe, Heeze, the Netherlands. My main research interests are in the field of sleep in chronic fatigue and pain syndromes, resulting in a PhD on ‘The role of sleep in the chronic fatigue syndrome’. My clinical work and teaching focuses on these themes but also on insomnia with and without psychiatric comorbidities and ethics in care. Further research objectives include sleep in sports and the interaction between nocturia and sleep fragmentation. More on Research Gate.

Fatigue in late pregnancy and depressive symptoms at early postpartum impact on breastfeeding initiation and maintenance

Poor subjective sleep quality, depressive symptoms and fatigue occur frequently in postpartum. In earlier postpartum cross-sectional studies no differences were found in fatigue levels between breastfeeding and bottle feeding. However, the dynamics of their respective associations from prepartum throughout the maternity period in function of baby feeding method have not been fully elucidated. 

 We conducted a prospective, longitudinal study using validated questionnaires probing for sleep quality (Pittsburgh Sleep Quality Index or PSQI) , insomnia (Insomnia Severity Index), fatigue (Fatigue Severity Scale) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) at 35-37 weeks of gestation and at 2 and 8 weeks and 6 months postpartum in the obstetric departments of two Flemish hospitals.  Appropriate statistical methods were used to compare asymmetrical groups changing in composition between sequential time points, as mothers switch from breastfeeding to bottle feeding in early and late postpartum, introducing the concept of harmonic mean as an estimate for minimal sample size to allow comparison. 

The study included 188 women indicating a choice for either bottle or breastfeeding in prepartum (27-35 weeks’ gestation) with high participation rates at 2 and 8 weeks postpartum. Higher fatigue assessed through the Fatigue Severity Scale within late pregnancy was moderately associated with primary bottle feeding choice. Fatigue decreased at early and late postpartum in bottle feeding (-0.38 ± 1.04; p = 0.110 and -0.31 ± 1.01; p = 0.642 respectively), but remained unchanged from late pregnancy through early and late postpartum in breastfeeding (0.04 ± 1.21; p = 0.110 and -0.27 ± 0.96; p = 0.642 respectively), resulting in similar fatigue in both feeding methods in early through late postpartum. There were no differences in sleep quality or insomnia symptoms at all time points. Presence of postpartum depressive symptoms was associated with early switching to bottle feeding (Somers’ d correlation .11 (p=.021). 

Hence, fatigue and depressive symptoms have a negative impact on breastfeeding initiation or maintenance and influence feeding method dynamics. Breastfeeding is not associated with increased postpartum fatigue or increased insomnia, as demonstrated in earlier cross-sectional studies, indeed showing that different components of the PSQI are affected differently by either breast- or bottle feeding, with better sleep quality in breastfeeding in spite of sleep disruption. This supports the need for active screening for depressive symptoms and fatigue in late pregnancy and early postpartum, in order to improve the goals of breastfeeding initiation and avoid early withdrawal. 

Recent publications from ESRS members

  1. Biscarini et al (2024), The actigraphic evaluation of daytime sleep in central disorders of hypersomnolence:
    comparison with polysomnography. Sleep
  2. Palagini et al (2024),  Insomnia and circadian rhythms dysregulation in people who have attempted suicide: correlations with markers of inflammation and suicidal lethality. World J Biol Psychiatry.
  3. Doghman et al (2024), Factors predictive of extensive use of CPAP treatment in obstructive sleep apnoea. Sleep Breath
  4. Mogavero et al (2024). Sex-based disparities in dopamine agonist response in patients with restless legs syndrome. J Sleep Res.
  5. Breda et al (2024). A cross-sectional study on the relationship between infant sleep, temperament and bedtime practices. J Clin Sleep Med
  6. DI Milia et al (2024), The relationship between shift work, sleep, and work hours on wellbeing.Ind Health. 
Are you an ESRS member and have just published an article?  
Want your research to be featured in a Sleep Science Friday publication? 
Or, if just have a good idea for an article / saw something that sparked your interest,