Effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) During the Perinatal Period: A Systematic Review and Meta-Analysis of Prenatal and Postnatal Interventions

The perinatal period, spanning from conception to 12 months post-birth, is a high-risk period for developing insomnia due to the physiological and psychological changes experienced by perinatal women, such as hormone secretions, physical discomfort, and concerns about parenthood, compounded by the caregiving demands during the postpartum period. Insomnia is significantly more prevalent in perinatal women compared to the general population of women of childbearing age (40-60% versus 11%). Perinatal women with insomnia are at a high risk for medical complications, including preterm birth, gestational hypertension, and maternal psychiatric illnesses, particularly depression and anxiety. All of these factors can contribute to adverse outcomes for both the mother and the infant. While several systematic reviews have shown that cognitive behavioral therapy for insomnia (CBT-I) delivered during the perinatal period could improve maternal insomnia, depression, and anxiety, none has differentiated and specifically examined the interventions delivered during the prenatal vs. postnatal stages. This distinction is crucial because the needs and challenges differ between the prenatal and postnatal stages, and the effectiveness of targeted treatments may vary between the prenatal and postnatal periods. Additionally, the long-term effectiveness of prenatal CBT-I on maternal depression and anxiety during the postnatal period remains unclear. Specifically, it is not clear whether the improvements in depression and anxiety achieved through treating insomnia during pregnancy can be maintained after childbirth and throughout the postpartum period. Furthermore, the impact of such interventions on infant outcomes remains uncertain. This systematic review and meta-analysis aim to evaluate the effectiveness of prenatal and postnatal CBT-I on maternal insomnia and mental health at both short-term (prenatal) and long-term (up to 12 months postnatal), as well as postnatal infant sleep, thereby providing a more comprehensive understanding of the timing and impact of CBT-I interventions during the perinatal period.