Kudos to Jihye Scroggins, DNP student, her sponsor Debra Brandon, associate professor, and co-sponsor Karin Reuter-Rice, associate professor, for the submission of her NIH NRSA Fellowship application entitled: "Trajectories of Sleep Disturbance among Healthy Mothers in the Fourth Trimester." This proposal requests funds for a three-year period with a start date of July 1, 2021.

Two in five mothers with new infants experience sleep disturbance in the fourth trimester (12 weeks following birth). Sleep disturbance, defined as poor sleep quality and/or quantity is one of the most commonly experienced postpartum symptoms. It is reported that 60 to 88% of mothers have poor sleep quality and quantity of less than 6 hours per night. Maternal sleep disturbance has been linked to health conditions such as postpartum weight retention and postpartum depression, which have subsequent impacts on the short- and long-term health of mothers and infants. For example, postpartum depression has been associated with longterm depression in mothers and long-term motor, cognitive, and behavioral developmental problems in their infants. Although research suggests that mothers’ trajectories of sleep disturbance may vary based on diverse maternal characteristics (demographic, clinical, and behavioral/social), no studies have explored whether mothers fit into distinct trajectories of sleep disturbance over the 4th trimester based on these characteristics.

This gap has limited our understanding of maternal sleep disturbance, thereby hindering the ability to develop targeted interventions. Therefore, the purpose of the proposed study is to explore the distinct trajectories of sleep quality and quantity over the 4th trimester and the associated diverse maternal characteristics among healthy mothers with healthy term infants. An exploratory prospective descriptive longitudinal study will be conducted using mixed-methods design to collect quantitative data from self-reported measures and electronic health records (N=65) and qualitative data from individual semi-structured interviews with sub-sampled mothers (n=15-20) based on their sleep data. Sleep quality and sleep quantity will be collected at four time points (at pre-delivery, 2-3, 6-7, and 11-12 weeks postpartum) using PROMIS sleep disturbance and sleep diary.

To explore the distinct trajectories of sleep quality and quantity, latent class growth analysis will be used. Once distinct trajectories of sleep quality and quantity are identified, a bivariate analysis will be conducted to explore the association between each trajectory and maternal demographic, clinical, and behavioral/social characteristics data collected at pre- or post-delivery. After sleep data collection is completed at 11-12 weeks postpartum, individual semi-structured interviews will be conducted to explore mothers’ perceived influences on their sleep in the 4th trimester. Mothers will be sub-sampled based on their PROMIS sleep disturbance score. Qualitative interviews will provide rich information and unique insights into mothers’ experiences of sleep and contributing factors to their sleep from a mother’s lens.

The findings of this exploratory study will provide important knowledge that can advance our understanding of maternal sleep disturbance in the 4th trimester, thereby informing future research to develop targeted interventions to improve maternal sleep disturbance. Study findings may also inform the role of maternal sleep disturbance in other postpartum symptoms and infant sleep.