Change in Sleep and Depressive Symptoms in The Perinatal Periode: A Case Series of Four Japanese Mothers

Kumiko Kido (Kagawa Prefectural University of Health Sciences)
Mari Matsuo (Bokko Birth Home)
Yuko Uemura (Kagawa Prefectural University of Health Sciences)
Atsuko Shiota (Kagawa University)
Satoshi Tada (Kagawa Prefectural University of Health Sciences)

Women Midwives and Midwifery
Vol. 2 No. 2 (2022): Women, Midwives and Midwifery journal

Background: Late maternal deaths have been associated with psychiatric disorders such as perinatal depression and their prevention is an important issue within perinatal healthcare. Sleep disturbance can be a chronic stressor, and chronic stress can lead to depression. Sleep disturbances during pregnancy, as a lifestyle factor, are associated with postpartum depression. Depression could be assessed using prostaglandin D2 (PGD2) levels. Compared to sleep prior to pregnancy, shorter sleep duration and poorer sleep efficiency in the postpartum period have been reported. The association of breastfeeding, sleep habits, baby care, stress and depressive symptoms have not been examined. Purpose: This case series describes changes in sleep quality, stress, and depressive symptoms of perinatal women. Methods: This was a longitudinal case study. Pregnant women, who consented to participate, were followed between the third trimester of pregnancy and four month postpartum. This study was approved by the Ethical Review Committee of the Kagawa Prefectural University of Health Sciences (No.350). Results: The Japan Pittsburgh Sleep Quality Index (JPSQI) scores decreased over the postpartum period. However, there were temporarily higher JPSQI scores in the early postpartum period. Sleep duration and sleep efficiency improved two months postpartum. No participant scored ?9 on the Japanese version of the Edinburgh Postnatal Depression Scale (J-EPDS) from the third trimester of pregnancy to four months postpartum. Two samples had temporarily higher J-EPDS scores from two weeks to one month postpartum, showing a sharp drop at two months postpartum. The Patient Health Questionnaire-9 (PHQ-9) scores and urine biopyrin (UBP) levels decreased, while PGD2 levels increased over the postpartum period. Conclusion: Sleep quality and depressive symptoms improved over time postpartum. Improved sleep quality reduces stress, as shown by decreased levels of an oxidative stress marker with improved sleep quality. PGD2 and UBP are useful biomarkers to assess sleep quality and stress, respectively.