Effects of Journal Therapy Counseling with Pregnant Women’s Anxiety on their Infants’ Sleep Quality: A Randomized Controlled Clinical Trial

Abstract

Abstract: Background: Sleep is very important for infants, due to the development of neural connections in some areas of the brain. Psychological stress such as anxiety could affect sleep quality. The aim of this study was to determine the effect of journal therapy with anxious pregnant women on the quality of their infants' sleep (primary outcome), maternal anxiety, anthropometric and developmental indices of infancy and the frequency of exclusive breastfeeding (secondary outcomes). Method: This randomized controlled clinical trial (RCCT) was performed on 70 healthy women with gestitional age of 28-21 weeks. The participants were randomly divided into intervention and control groups using randomized block design. The intervention group received three in-person counseling sessions for writing therapy, two telephone counseling sessions between in-person sessions, and one telephone counseling session one month after delivery, while the control group only received routine care. The Infant Sleep Questionnaire (ISQ), Exclusive Breastfeeding Checklist, and Infant Anthropometric Parameters Checklist were completed at two and four months postpartum. The Beck Anxiety Inventory (BAI) was completed during pregnancy, at the end of the intervention, and at two and four months postpartum, and the Ages and Stages Questionnaire (ASQ) was completed at 4 months postpartum. Data were analyzed using chi-square and independent t-tests, as well as repeated measure ANOVA. Findings: There was no significant statistical difference between the two groups in demographic characteristics and baseline anxiety scores. The mean sleep quality score in two months of age (MD = -4.2, 95% CI -1.1 to -7.2, p = 0.007) and four months of age (MD = -5.5, 95% CI: -8.4 to -2.7 ،p <0.001) in the intervention group was significantly lower than of those in the control group. Based on the repeated measure ANOVA results with adjusting the baseline scores, the mean postpartum anxiety score of mothers in the intervention group was significantly lower than that of those in the control group (adjusted mean difference = -7.7 ؛95% CI = -5.5 to -10.1; P <0.001). There was no significant statistical difference between the two groups regarding other outcomes including the frequency of exclusive breastfeeding, and anthropometric and developmental parameters (P >0.05). Conclusion: Journal therapy can improve infants’ sleep quality and reduce maternal anxiety. However, further studies are required before drawing any definitive conclusion.