ANZCTR - Registration

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Trial registered on ANZCTR

Registration number

ACTRN12616001462471

Ethics application status

Approved

Date submitted

12/10/2016

Date registered

19/10/2016

Date last updated

21/04/2021

Date data sharing statement initially provided

28/10/2019

Type of registration

Retrospectively registered

Titles & IDs

Public title

The SEED Project (Sleep, Eat, Emotions, and Development): Enhancing sleep and wellbeing in mothers and infants.

Scientific title

The SEED Project (Sleep, Eat, Emotions, and Development): A randomized controlled pilot study of a perinatal sleep intervention on sleep and wellbeing in mothers and infants.

Secondary ID [1]

Nil known

Universal Trial Number (UTN)

Nil

Trial acronym

SEED (Sleep, Eat, Emotions, and Development)

Linked study record

Nil

Health condition

Health condition(s) or problem(s) studied:

Sleep disturbance

Insomnia

Mood disturbance

Condition category

Condition code

Reproductive Health and Childbirth

Normal pregnancy

Mental Health

Other mental health disorders

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

A summary of the Sleep SEED core content is as follows:
a) general information and skills for better sleep (e.g., typical sleep patterns of new parents and infants, sleep hygiene, relaxation and mindfulness exercise, dealing with nighttime worries);
b) fostering healthy attitudes and expectations about sleep during perinatal periods;
c) managing sleep challenges specific to perinatal period (e.g., physical discomfort, pain, sleep deprivation, daytime consequences of poor sleep);
d) infant sleep and settling skills;
e) identifying and managing symptoms of insomnia (e.g., self-monitoring, stimulus control, sleep scheduling, bed restriction).

At program entry, participants will receive a one-on-one program orientation (up to 1 hour) via telephone (recorded for quality control) by a registered psychologist or clinical psychology trainee under regular supervision of a registered clinical psychologist. The individual delivering the orientation will be trained by the chief investigator to follow pre-scripted protocol, which covers the following aspects:
a) overview and rationale of the program, including an introduction to the program's core principles (e.g., cognitive behavioral principles), an overview of topics covered, and introduction to the core components;
b) structure of the program and logistics;
c) importance of practice and regular strategies.

Following the program orientation, participants will receive intervention materials via emails at 6 different time points:
T1: 26-32 weeks gestation
T2: 35-36 weeks gestation
T3: 2 weeks postpartum
T4: 1.5 months postpartum
T5: 3 months postpartum
T6: 6 months postpartum

The intervention materials are tailored to, and delivered at, critical perinatal milestones that have specific challenges to sleep (e.g., physical discomfort in late pregnancy). The emails will contain text, graphics, and audio download links on relevant information. Adherence to the intervention is assessed after each intervention phase via self-report surveys.

If participants require additional information or support with the program, telephone consultation will be available from a clinical psychologist.

Intervention code [1]

Behaviour

Intervention code [2]

Prevention

Comparator / control treatment

Diet SEED has been adapted from the current consumer information fact sheets at the Royal Women's Hospital, in Melbourne, Australia.

A summary of the Diet SEED core content is as follows:
a) Nutrient required in greater amounts during the third trimester of pregnancy;
b) Symptoms that can become more severe towards the end of pregnancy, getting organised for the birth, and bringing a new baby home;
c) Nutrition for breast-feeding;
d) Weight management;
e) Introducing solid food for the baby;
f) Family eating.

At program entry, participants will receive a one-on-one program orientation via telephone (up to 1 hour, recorded for quality control) by a dietician, which covers the following aspects:
a) overview and rationale of the program, including an introduction to the program's core principles (e.g., cognitive behavioral principles), an overview of topics covered, and introduction to the core components;
b) structure of the program and logistics;
c) importance of practice and regular strategies.

Following the program orientation, participants will receive intervention materials via emails at 6 different time points:
T1: 26-32 weeks gestation
T2: 35-36 weeks gestation
T3: 2 weeks postpartum
T4: 1.5 months postpartum
T5: 3 months postpartum
T6: 6 months postpartum

The intervention materials are tailored to, and delivered at, critical perinatal milestones for diet (e.g., nutrient requirement in late pregnancy). Content will be delivered in a combination of text, graphics, and links to external nutrition guidelines. Adherence to the intervention is assessed after each intervention phase via self-report surveys.

If participants require additional information or support with the program, telephone consultation will be available from a dietitian.

Control group

Active

Outcomes

Primary outcome [1]

Maternal sleep quality will be assessed using a) self-reported sleep behaviors over the past week (Carney et al., 2012), and b) PROMIS Sleep Disturbance instrument (Yu et al., 2012).

Timepoint [1]

T1: 26-32 weeks gestation (Immediately before intervention materials)
T2: 35-36 weeks gestation (I week after intervention materials)
T4: 1.5 months postpartum (I week after intervention materials)
T5: 3 months postpartum (I week after intervention materials)
T6: 6 months postpartum (I week after intervention materials)

Primary outcome [2]

Symptoms of insomnia will be measured using Insomnia Severity Index (Bastien, Vallieres, & Morin, 2001), and the Insomnia module of the Duke Structured Interview for Sleep Disorders (Edinger et al., 2009).

Timepoint [2]

Primary outcome [3]

Feasibility of the program and acceptability to patients (composite outcome) will be assessed implicitly via recruitment/dropout rates, and explicitly via the Client Satisfaction Questionnaire (Attkisson & Zwick, 1982) and qualitative feedback in post-intervention questionnaires from patients.

Timepoint [3]

T1: 26-32 weeks gestation (Immediately before intervention materials)
T6: 6 months postpartum (I week after intervention materials)

Secondary outcome [1]

Maternal sleep-rated impairment will be assessed using PROMIS Sleep Related Impairment

Timepoint [1]

Secondary outcome [2]

Maternal mental health will be measured with PROMIS Depression and Anxiety

Timepoint [2]

Secondary outcome [3]

Maternal health-related quality of life will be assessed by EQ-5D-5L

Timepoint [3]

Secondary outcome [4]

Relationship satisfaction will be assessed using the brief Dyadic Adjustment Scale

Timepoint [4]

Secondary outcome [5]

Attachment quality will be measured with the a) Prenatal Attachment Inventory, b) the Mother to Infant Bonding Scale, and c) the Emotional Availability Scale (free play video).

Timepoint [5]

T1: 26-32 weeks gestation (Immediately before intervention materials) - a) only
T2: 35-36 weeks gestation (I week after intervention materials) - a) only
T4: 1.5 months postpartum (I week after intervention materials) - b) only
T5: 3 months postpartum (I week after intervention materials) - b) only
T6: 6 months postpartum (I week after intervention materials) - b) and c)

Secondary outcome [6]

Dietary intake (this is an exploratory aim) of the mother will be assessed using Australian Eating Survey,

Timepoint [6]

T1: 26-32 weeks gestation (Immediately before intervention materials)
T6: 6 months postpartum (I week after intervention materials)

Secondary outcome [7]

Weight status (also an exploratory aim associated the diet intervention), including
BMI, gestational weight gain, postpartum weight retention will be measured using self-reported a) weight and b) height.

Timepoint [7]

T1: 26-32 weeks gestation (Immediately before intervention materials) - a) and b)
T2: 35-36 weeks gestation (I week after intervention materials) - a) only
T4: 1.5 months postpartum (I week after intervention materials) - a) only
T5: 3 months postpartum (I week after intervention materials) - a) only
T6: 6 months postpartum (I week after intervention materials) - a) only

Secondary outcome [8]

Timepoint [8]

1 and 2 years postpartum.

Eligibility

Key inclusion criteria

a) Nulliparous (first time mothers);
b) Age >= 18;
c) Singleton pregnancy;
d) Able to understand intervention materials in English and complete surveys in English;
e) Have regular accessing to email and internet.

Minimum age

18 Years

Maximum age

No limit

Sex

Females

Can healthy volunteers participate?

Yes

Key exclusion criteria

a) Participants who use medication or substances that directly affect sleep;
b) Unstable medical conditions that directly affect sleep;
c) Participants who show the following symptoms of sleep disturbance: sleep apnea, previously diagnosed Periodic Limb Movement Disorder, Restless Legs Syndrome;
d) Circadian rhythm disorders (based on DUKE): Irregular Sleep Wake Disorder, Non-24-Hour Sleep-Wake Syndrome, Advance Sleep-Phase Syndrome, Delayed Sleep-Phase Syndrome, Fixed night shift work between midnight and 5 a.m. or rotating work scheduled that required night shifts during course of pregnancy or participation;
e) Other previously diagnosed sleep disorders;
f) Mental health conditions as determined by the M.I.N.I. International Neuropsychiatric Interview 7.0 (referred for appropriate management): Major depressive disorder (current), posttraumatic stress disorder (current), panic disorder if associated with nocturnal panic attacks >4 times in the past month, bipolar disorder (lifetime), psychotic disorders (lifetime), substance abuse/dependence disorders (during pregnancy).

Study design

Purpose of the study

Prevention

Allocation to intervention

Randomised controlled trial

Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)

Expectant mothers enrolled in Childbirth Education at the Royal Women's Hospital, Melbourne, Australia will be invited to participate in a research project that "aims to evaluate the benefits of two wellbeing programs for new mothers". Eligibility will be assessed via a structured interview. Treatment allocation will be conducted using computerized central randomization. Individual participant's allocation based on this plan will be stored in sealed envelopes, and will only be revealed immediately before randomization.

Methods used to generate the sequence in which subjects will be randomised (sequence generation)

Eligible participants will be randomized into either the intervention or comparison condition using block randomization with random block sizes, which ensure equal sample sizes between groups over time. Randomization plan will be generated using an online tool (www.randomization.com), which generates permutations of group assignment in random blocks with equal numbers of either condition in each block.

Masking / blinding

Blinded (masking used)

Who is / are masked / blinded?

The people assessing the outcomes

Intervention assignment

Parallel

Other design features

Phase

Not Applicable

Type of endpoint/s

Efficacy

Statistical methods / analysis

All analyses will be conducted on an intention-to-treat basis. Missing data will be assessed using full information maximum likelihood when structural equation modeling (SEM) frameworks are applied, and multiple imputation in other analyses.

To assess feasibility and acceptability of the program, descriptive statistics will be used to characterize recruitment/dropout rates and patient satisfaction/feedback data.

To examined group differences in primary and secondary outcomes at baseline and each subsequent time point, multiple regression analyses will be conducted with treatment condition (along with relevant covariates) as independent variables, and the outcome of interest as dependent variable. Changes in outcomes over time will be examined using latent growth models based on SEM; potential predictors of treatment response will be incorporated as relevant time-invariant and/or time-varying covariates in these models, so their effects on change trajectories can be examined.

Participants will be 150 expectant mothers, and their infants (150 mother-infant dyads, total N = 300). Mothers (n = 150) will be randomized. Assuming 5% missing data at T1 and 15% at each follow-up, the study is powered adequately at 80% (two-tailed alpha=0.05) to detect a moderate sized difference; moderate to large sized are expected for primary outcomes.

Recruitment

Recruitment status

Completed

Date of first participant enrolment

Anticipated

Actual

16/05/2016

Date of last participant enrolment

Anticipated

15/05/2017

Actual

11/01/2017

Date of last data collection

Anticipated

31/12/2019

Actual

15/12/2019

Sample size

Target

150

Accrual to date

Final

163

Recruitment in Australia

Recruitment state(s)

VIC

Recruitment hospital [1]

The Royal Women's Hospital - Parkville

Recruitment postcode(s) [1]

3052 - Parkville

Funding & Sponsors

Funding source category [1]

Charities/Societies/Foundations

Name [1]

Australasian Sleep Association Rob Pierce Grant-in-Aid

Address [1]

114/30 Campbell St.
Blacktown 2148
New South Wales

Country [1]

Australia

Funding source category [2]

University

Name [2]

Monash University Strategic Grant Scheme

Address [2]

Faculty of Medicine, Nursing, and Health Sciences
10 Ancora Imparo Way,
Monash University
Clayton Victoria 3800

Country [2]

Australia

Funding source category [3]

Hospital

Name [3]

Royal Women's Hospital Foundation

Address [3]

The Royal Women's Hospital
Locked Bag 300
Grattan St & Flemington Rd
Parkville VIC 3052 AUSTRALIA

Country [3]

Australia

Funding source category [4]

Government body

Name [4]

NHMRC Health Professional Research Fellowship

Address [4]

National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601

Country [4]

Australia

Funding source category [5]

Government body

Name [5]

Australian Postgraduate Award

Address [5]

Department of Education and Training
GPO Box 9880
Canberra ACT 2601

Country [5]

Australia

Primary sponsor type

University

Name

Monash University

Address

Wellington Rd.
Clayton, VIC, 3800

Country

Australia

Secondary sponsor category [1]

Hospital

Name [1]

Royal Women's Hospital

Address [1]

Cnr Grattan St & Flemington Rd.
Parkville VIC 3052

Country [1]

Australia

Secondary sponsor category [2]

University

Name [2]

Stanford University

Address [2]

401 Quarry Rd
Stanford, CA 94305

Country [2]

United States of America

Secondary sponsor category [3]

Commercial sector/Industry

Name [3]

Smiling Mind

Address [3]

15/644 Chapel Street
South Yarra VIC 3141
Australia

Country [3]

Australia

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

Royal Women's Hospital Research Ethics Committee

Ethics committee address [1]

Cnr Grattan St & Flemington Rd 
Parkville VIC 3052

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

Approval date [1]

04/05/2016

Ethics approval number [1]

16/01

Ethics committee name [2]

Monash University Human Research Ethics Committee

Ethics committee address [2]

Human Ethics Office
Monash University 
Room 111, Chancellery Building E
24 Sports Walk, Clayton Campus, Wellington Rd, Clayton 
VIC 3800

Ethics committee country [2]

Australia

Date submitted for ethics approval [2]

Approval date [2]

17/05/2016

Ethics approval number [2]

CF16/1561-2016000815

Summary

Brief summary

Sleep disturbance is experienced by the majority of child-bearing women during the pregnancy and post-partum periods.  Physiological changes related to pregnancy and birth-giving (e.g., hormonal changes), and post-partum nighttime infant care are common factors that reduce/disrupt sleep opportunity.  In addition, some women (~17%) experience clinically significant insomnia symptoms.  The resulting sleep complaints have been associated with a range of poor maternal outcomes (e.g., mood disturbance, worse birth outcomes, poorer maternal-infant attachment).  
Integrated behavioral and educational interventions have been consistently shown to improve sleep, and have lasting effects on sleep and wellbeing.  Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective insomnia treatment, and recently has been tailored to, and piloted on, women with comorbid postpartum depression and insomnia with significant improvements to sleep and mood.

Given the proven efficacy of CBT-I and the need to prioritize treatment accessibility in the community, the lack of a flexible delivery service platform for healthy sleep strategies represents a significant gap in clinical translation.  Given the high prevalence of sleep disturbance in perinatal periods, a platform that can be easily integrated into routine perinatal care, as well as being accessible to a broad community is desirable.  However, expectant mothers in most of Australia are not currently receiving evidence-based information and recommendations to prepare and support them through the many changes to sleep/wake cycles during the transition into motherhood.
This study will adapt an existing evidence-based perinatal sleep intervention for use in an Australian public hospital setting and include features that allow for sustainable integration into routine care, promoting eventual wider dissemination.            

The primary aims of the study are to obtain pilot data on 1) the feasibility of integrating this adaptation in outpatient perinatal care, and 2) its treatment effect on sleep and wellbeing in mothers and infants.  To achieve this aim, a comparison group, Diet SEED will be used.  

A secondary aim of the study is exploratory, and assesses potential benefits of Diet SEED on participants' diet.  From a diet perspective, the Sleep SEED group will be treatment as usual (as outpatients).  Currently, diet related information is given to women in a text-dense booklet. By adapting content of this booklet to digestible sizes that are delivered at important perinatal milestones, Diet SEED has the potential to improve women's diet behaviors significantly compared to treatment as usual.  Therefore, to achieve this aim, dietary measures will be compared between Sleep and Diet SEED groups.

Trial website

Trial related presentations / publications

Public notes

Contacts

Principal investigator

Name

Dr Bei Bei

Address

Monash Institute of Cognitive and Clinical Neurosciences
Sleep Program
School of Psychological Sciences
Monash University
18 Innovation Walk
Clayton Campus, Clayton VIC 3800

Country

Australia

Phone

+61 3 9905 3903

Fax

bei.bei@monash.edu

Contact person for public queries

Name

Bei Bei

Address

Monash Institute of Cognitive and Clinical Neurosciences
Sleep Program
School of Psychological Sciences
Monash University
18 Innovation Walk
Clayton Campus, Clayton VIC 3800

Country

Australia

Phone

+61 3 9905 3903

Fax

bei.bei@monash.edu

Contact person for scientific queries

Name

Bei Bei

Address

Monash Institute of Cognitive and Clinical Neurosciences
Sleep Program
School of Psychological Sciences
Monash University
18 Innovation Walk
Clayton Campus, Clayton VIC 3800

Country

Australia

Phone

+61 3 9905 3903

Fax

bei.bei@monash.edu

Data sharing statement

Will individual participant data (IPD) for this trial be available (including data dictionaries)?

No/undecided IPD sharing reason/comment

Consent for IPD use not explicitly sought. However, an application for waiver will be made in the future, and if approved, IPD will be made available.

What supporting documents are/will be available?

No Supporting Document Provided

Results publications and other study-related documents

Documents added manually

No documents have been uploaded by study researchers.

Documents added automatically

Source	Title	Year of Publication	DOI
Embase	A scalable cognitive behavioural program to promote healthy sleep during pregnancy and postpartum periods: Protocol of a randomised controlled trial (the SEED project).	2019	https://dx.doi.org/10.1186/s12884-019-2390-8
Embase	Differentiating perinatal Insomnia Disorder and sleep disruption: A longitudinal study from pregnancy to 2 years postpartum.	2022	https://dx.doi.org/10.1093/sleep/zsab293
Dimensions AI	Does breastfeeding influence sleep? A longitudinal study across the first two postpartum years	2022	https://doi.org/10.1111/birt.12625

N.B. These documents automatically identified may not have been verified by the study sponsor.

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