The Effect of Sleep Disturbance during Pregnancy and Perinatal Period on Postpartum Psychopathology in Women with Bipolar Disorder

Abstract

Background: Postpartum psychosis is a severe condition that usually requires hospital admission as result of the highly disturbed behaviour with potential risks for the mother and her newborn child. Women with bipolar disorder have a high risk of relapse related to childbirth, with up to 67% experiencing an episode in the postpartum period, including psychosis. There is much evidence for a relationship between sleep disruption and mood disorders in the perinatal period. Sleep loss has been suggested as a final common pathway in the development of psychosis in vulnerable women, i.e., women with bipolar disorder or a history of psychosis after childbirth. Prospective studies monitoring sleep and mood are scarce. The purpose of this study is to investigate the relationship between sleep disruption during pregnancy and the perinatal period and postpartum psychopathology in women with bipolar disorder. Methods/design: This is a prospective, observational, naturalistic, non-intervention study in pregnant women with an established diagnosis of bipolar disorder. The period of observation will be from week 13 of pregnancy until 12 weeks postpartum. Mood changes will be assessed using the Life Chart methodology throughout the whole study period. Sleep patterns will be assessed by a sleep diary and actigraphy in week 13 and week 26 of pregnancy and from two weeks before the expected delivery until four weeks after. Data will be collected on demographics, diagnosis, medical history, clinical management, clinical, functional, and obstetrical outcomes. In the weeks mentioned before additional data on mood and life-events will be collected. Primary outcomes are the occurrence of psychiatric symptoms during the first four weeks postpartum, and the number and type of any intervention started for impending psychiatric symptoms during the first four weeks postpartum. Discussion: We hypothesize that sleep disturbances during pregnancy and the perinatal period is associated with increased postpartum psychopathology. If so, intervention strategies aimed to improve sleep patterns may decrease the risk for postpartum psychopathology in women with bipolar disorder or a history of postpartum psychosis. Early treatment of sleep disturbance could be a cost-effective method for the prevention of postpartum mood disorders. This research protocol was approved by the Medical Ethics Review Committee of the VU University Medical Center (2012/3).