Do behavioral mother-infant sleep interventions in the first six months affect maternal sleep, anxiety, and fatigue? A randomized controlled trial

Background: Sleep problems, fatigue, and mental health challenges are common among mothers due to infants' frequent nighttime wakings. This study examined the impact of the mother-infant behavioral sleep interventions (BSIs) on maternal sleep/health (primary) and infant sleep (secondary) in mothers of infants under six months. Methods: A multi-center randomized controlled trial in Iran (August 2018-April 2019) included 82 mothers and their 2-4-month-old infants, randomized into intervention and control groups. The intervention group received Mother-Infant BSI through face-to-face classes, a booklet, weekly calls, and voice/text messages, while the control group attended an infant safety class. Maternal and infant sleep index, tiredness, and anxiety were assessed before and eight weeks post-intervention using sleep diaries and validated questionnaires. Results: After eight weeks, intervention-group mothers gained +63 min of nighttime sleep (7.0 vs 5.9 h, p < .001, d = 1.11) with +69 min of longer uninterrupted sleep (p < .001, d = 0.90). Duration of nighttime wakefulness decreased by 21 min (34.2 vs 55 min, p < .001, d = -1.01), though wake frequency remained unchanged. Maternal outcomes improved: anxiety scores (10.7 vs 11.7, p < .05, d = 0.23) and morning tiredness (2 vs 3, p < .001, d = 0.50). Infant outcomes showed an 84-min increase in 24-h sleep (13.7 vs 12.3 h, p < .001, d = 1.05) and 104-min earlier bedtimes (21:3 vs 23:1, p < .001), with no change in daytime sleep. Conclusion: Mother-infant healthy sleep habits improved maternal health in mothers with infants under six months, aligning with interventions that adhered to safety protocols. Achieving optimal intervention outcomes requires developmentally appropriate timing, personalized approaches, consistent follow-up, and culturally tailored implementation strategies.