Comparative effectiveness of non-pharmacological interventions on postpartum maternal sleep quality: a systematic review and network meta-analysis

Poor sleep quality is prevalent among postpartum women and can negatively impair maternal and family health. Non-pharmacological interventions are preferred approaches over pharmaceutical methods for improving postpartum sleep, though their comparative effects remain unclear. This study aimed to systematically compare and rank the effects of various non-pharmacological interventions on maternal sleep quality at different postpartum stages. A systematic review and network meta-analysis was conducted. Electronic databases were systematically searched from their inception to July 2024. Randomized controlled trials of non-pharmacological interventions for postpartum sleep were included. Random-effects network meta-analyses were adopted. In total, 19 randomized controlled trials involving 1826 participants examined 13 non-pharmacological interventions for postpartum sleep quality. Foot reflexology demonstrated the largest effect size (standardized mean difference [SMD] = -3.5), followed by progressive muscle relaxation (SMD = -3.2), and massage (SMD = -2.0) compared to usual care during the first three months postpartum. Cognitive behavioral therapy for insomnia (CBTi; SMD = -1.7) and light-dark therapy (SMD = -1.3) are effective during 4-12 months postpartum. Non-pharmacological interventions effectively improve postpartum sleep, with foot reflexology being the most effective in early postpartum period and CBTi optimal for 4-12 months. Health professionals can incorporate these promising interventions into postpartum sleep care. Future research evaluating the direct comparisons of non-pharmacological interventions for postpartum sleep is warranted. Registry: PROSPERO; Identifier: CRD42022335715.