Effectiveness of preventive parental education delivered from pregnancy to 1 month postpartum for improving infant sleep and parental sleep and depression: a systematic review

OBJECTIVE

This review aimed to evaluate the effectiveness of preventive parental education about infant sleep problems, delivered from pregnancy to 1 month postpartum, for improving infant sleep and parental postpartum sleep and depression.

INTRODUCTION

Many parents of an infant experience infant sleep problems, which have numerous adverse effects on infants' physical and cognitive development, as well as on parental sleep and postpartum mood. Preventive parental education targeting these problems is intended for parents of infants under 6 months of age. However, providing education earlier may help foster healthy infant sleep patterns, thus positively affecting parental sleep and mood.

ELIGIBILITY CRITERIA

This review considered studies that included healthy infants and their parents to evaluate the effectiveness of preventive parental education on infant sleep problems, involving any behavioral or psychoeducational intervention for parents in which education was first provided from pregnancy to 1 month postpartum. Comparators included standard care, waitlist control, or alternative interventions. Outcomes were infant sleep and parental postpartum sleep and depression, measured from postpartum to 12 months thereafter.

METHODS

Ten databases were searched without language or date restrictions: 5 databases for published and unpublished studies (MEDLINE, CINAHL, PsycINFO, Cochrane CENTRAL, and Igaku Chuo Zasshi); 3 databases for gray literature (MedNar, ProQuest Dissertations and Theses, and Google Scholar); and 2 databases for unpublished studies (ClinicalTrials.gov and UMIN-CTR). Study selection, critical appraisal, and data extraction were conducted independently by 2 reviewers. Studies were pooled using statistical meta-analyses where possible; otherwise, the findings were presented narratively. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.

RESULTS

Twenty studies were included: 7 focused on infant sleep, 1 on parental sleep, 5 on depression, 1 on infant and parental sleep, 1 on infant sleep and parental depression, and 5 on all the outcomes. Nineteen studies were randomized controlled trials, and 1 was a before-and-after study. Stratified analyses showed that preventive parental education significantly improved nighttime sleep duration of infants younger than 6 months and decreased infants' nighttime awakenings at 6 months. Among primiparous mothers, the intervention was associated with fewer infant nighttime awakenings at 3 to 5 months. The intervention also reduced parental nighttime awakenings at 3 to 5 months. However, effect sizes for infants' and parents' nighttime awakenings were small, and their clinical relevance at the individual level remains uncertain. When educational materials addressed both infant sleep and postpartum depression, a moderate reduction in maternal depression was observed at 0 to 2 months postpartum. The overall quality of evidence was low.

CONCLUSIONS

Providing preventive parental education on infant sleep problems for parents from pregnancy to 1 month postpartum may contribute to modest improvements in infant sleep during the first 6 months of life. Evidence for benefits on parental sleep and partners' postpartum outcomes remains limited. Educational programs that include information on postpartum depression in addition to infant sleep may be more effective in improving maternal postpartum depression. Further high-quality studies are needed to clarify the clinical significance and long-term effects of the intervention.

REVIEW REGISTRATION

PROSPERO CRD42023430562.

SUPPLEMENTAL DIGITAL CONTENT

A translation of the review abstract is available in Japanese [http://links.lww.com/SRX/A131].