Consistent with the NINR strategic plan to identify strategies that will reduce the long-term adverse consequences of poor maternal and reproductive health in minorities and underserved populations, this proposal aims to evaluate a primary care based intervention for maternal insomnia disorder (MID) among economically, educationally, racially, and ethnically diverse samples of pregnant women. MID, which encompasses insomnia during pregnancy and postpartum, is associated with adverse consequences to the mother and her family. These include increased risk for preterm birth, births of infants small for gestational age, cesarean birth, poor maternal infant attachment, worsening of the marital relationship, and increased risk for perinatal depression. Cognitive Behavioral Therapy for Insomnia (CBTI) is an effective treatment for insomnia even when factors outside of an individual's control interfere with sleep. CBTI is effective for postpartum insomnia, despite sleep disruption caused by the need to attend to an infant at night. TIPS (Tips for Infant and Parent Sleep) is a two- session, nurse-administered educational intervention aimed at optimizing infant sleep. We propose to evaluate the efficacy and effectiveness of an integrated CBTI+TIPS treatment. To maximize the public health impact, improve access, and reduce treatment barriers (stigma and transportation issues), treatment will be delivered by nurses in community obstetrical clinics, where women receive care during their pregnancy until six weeks postpartum. This will be the first study to test the efficacy of CBTI for the treatment o MID. Primary outcomes, for which the study is optimally designed and sufficiently powered, are maternal sleep and infant sleep. Secondary outcomes, for which we are either unable to estimate power or expect to be under powered, are pregnancy outcomes (proportion of infants who are small for gestational age), maternal-infant attachment and its biological marker, oxytocin, and maternal wellbeing (depressive symptom severity and quality of life).
The Aims of this research are to: (1) evaluate the efficacy of CBTI+TIPS in terms of a) maternal sleep during pregnancy and b) maternal and infant sleep during the postpartum;(2) evaluate the effectiveness of CBTI+TIPS on measures beyond sleep, including number of infants born small for gestational age, b) maternal-infant attachment (based on observations of a parent-child interactions with the NCAST), c) oxytocin levels, d) maternal depressive symptom severity, and (e) maternal quality of life.

Public Health Relevance

The reduction of long-term adverse consequences of poor maternal and reproductive health in minorities and underserved populations is a high priority in NINR. Poor sleep is one such health issue, associated with adverse consequences to the mother and her family, including increased risk for preterm birth, infants small for gestational age, cesarean birth, poor maternal infant attachment, worsening of the marital relationship, and increased risk for perinatal depression. We propose to test the effectiveness of a culturally sensitive primary care based, nurse-delivered, non-pharmacological intervention to improve maternal sleep during pregnancy and the postpartum.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR013662-02
Application #
8522239
Study Section
Nursing and Related Clinical Sciences Study Section (NRCS)
Program Officer
Matocha, Martha F
Project Start
2012-08-03
Project End
2017-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
2
Fiscal Year
2013
Total Cost
$518,333
Indirect Cost
$107,129
Name
Stanford University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305