According to a recent study, employing cognitive behavioral therapy for insomnia (CBT-I) as the first-line therapy may enhance sleep quality in pregnant females struggling with insomnia. The study aims to evaluate the efficacy of CBT-I in expectant mothers  and identify the effective components, modalities, and doses of the intervention. This study analyzed 10 databases (six English and four Chinese) for CBT-I randomized controlled trials in pregnant women.

Outcomes focused on insomnia severity (Insomnia Severity Index) and sleep quality (Pittsburgh Sleep Quality Index; PSQI). Two reviewers independently managed selection, extraction, and quality assessment. Pooled analyses, using fixed- or random-effect models, included subgroup analyses based on delivery types and intervention duration. Utilizing the GRADE approach, the certainty of evidence was examined. When meta-analysis was not applicable, narrative analyses were utilized. The main outcomes were mean differences with 95% confidence intervals, where higher scores indicated greater severity.

In this systematic review and meta-analysis, nine RCTs (978 participants) met inclusion criteria, employing individual (n=6) or group-based (n=3) interventions, using face-to-face (n=5), digital (n=3), or telephone and e-mail (n=1) formats. Six studies specified interventions for pregnant women. CBT-I showed immediate post-intervention (<1 month) improvements in insomnia severity (MD =−2.69, 95% CI: −3.41 to −1.96, high-quality evidence; MD = −3.69, 95% CI: −5.91 to −1.47, moderate quality evidence)  and short-term (≥1 to <6 months) improvements in sleep quality (MD=−2.85, 95% CI: −4.73 to −0.97, moderate quality evidence; MD =−1.88, 95% CI: −2.89 to −0.88, moderate quality evidence).

Two RCTs stated no effectiveness at medium-term (≥6 to <12 months) follow-up for insomnia severity. At long-term (≥12 months) follow-up, only one trial demonstrated decreased insomnia severity. Sleep quality efficiency at medium-term follow-up was inconclusive, and long-term follow-up was not illustrated. These findings suggest that CBT-I could be beneficial for pregnant women in addressing short-term insomnia, but its effectiveness appears to be limited in the long term.