Infant sleep and negative reactivity: The role of maternal adversity and perinatal sleep

Diary- and actigraphy-estimated nighttime sleep during the perinatal period: A multimethod study

Accurate estimation of perinatal sleep is important for informing future research and multigenerational health interventions. We compared diary- and actigraphy-estimated sleep parameters during pregnancy and postpartum. We informed our interpretation of these analyses with participants' feedback about these sleep estimation methods. This preregistered study ( https://doi.org/10.17605/OSF.IO/UZFRD ) included 92 English-speaking, women-identified birthing parents who completed sleep diaries and wore wrist actigraphs for 7 days during the 3rd trimester of pregnancy, 6 weeks postpartum, and 16 weeks postpartum. Sleep parameters included total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL), and wake after sleep onset (WASO). Multilevel models tested associations between diary and actigraphic sleep over time. Results indicated that diary and actigraphic sleep parameters were significantly associated over time, although actigraphic TST, SE, and SOL tended to be lower-and WASO longer-than diary estimations. WASO estimations were significantly more discrepant during 6 weeks postpartum than during the 3rd trimester or 16 weeks postpartum. Using conventional content analysis, three primary themes emerged from participants' feedback about sleep diaries and wrist actigraphs that enriched our interpretation of multilevel model results: (1) Wearability, (2) Functionality/Ease of Use, and (3) Measurement Accuracy. This study was the first to implement a multimethod design supplemented by qualitative data to investigate not only the association between diary and actigraphic perinatal sleep, but what it is like for birthing parents to engage with these sleep estimation methods. This study has important implications for behavioral medicine research and practice with perinatal populations.

Evaluating Associations Among Maternal ACEs, Perinatal Depression, and Infant Experiences of Adversity

OBJECTIVE

The growing literature on the intergenerational transmission of childhood adversity highlights the need to identify potential mechanisms underlying the relationship between maternal and infant adversity. This study examines prenatal and postpartum depressive symptoms as mediators between maternal ACEs and postpartum infant experiences of adversity.

METHODS

A diverse sample of 168 low-income, pregnant women (39% white) were recruited from urban prenatal clinics and followed for one-year post childbirth. Maternal childhood adversity and prenatal depressive symptoms were assessed during pregnancy, postpartum depressive symptoms were assessed at 6 months postpartum, and infant experiences of adversity at 12 months postpartum.

RESULTS

The total indirect effect of maternal ACEs on infant experiences of adversity through prenatal and postpartum depressive symptoms was significant, indicating that these symptoms collectively mediate this relationship. Additionally, our results demonstrated a mediated pathway in which maternal ACEs contributed directly to prenatal depression, which in turn indirectly influenced postpartum depression and infant experiences of adversity.

CONCLUSION

Findings provide evidence for perinatal depressive symptoms as a potential mechanism that influences infant exposure to adverse experiences. Future research should explore these pathways in larger, more robust samples to clarify the role of postpartum depressive symptoms.

The association between maternal sleep and circadian rhythms during pregnancy and infant sleep and socioemotional outcomes

Studies have established that maternal sleep and circadian rhythm disturbances during pregnancy are associated with poor prenatal and perinatal outcomes for mothers and offspring. However, little work has explored its effects on infant sleep or socioemotional outcomes. The current study examined the relationship between maternal sleep and circadian rhythm disturbances during pregnancy and infant sleep and socioemotional outcomes in a diverse sample of N = 193 mothers and their infants (51% White; 52% Female; Mage = 11.95 months). Maternal sleep and circadian rhythms during pregnancy were assessed using self-reports and actigraphy. Mothers reported on infants' sleep and socioemotional outcomes when infants were one year old. When controlling for infant sex, age, gestational age at birth, family income-to-needs ratios, and maternal depression, mothers who reported more sleep problems during pregnancy had infants with more sleep disturbances when they were one year old. Moreover, mothers who had later sleep timing (i.e., went to bed and woke up later, measured via actigraphy) during pregnancy had infants with more dysregulation (e.g., increased feeding difficulties, sensory sensitivities) and externalizing problems, and mothers with increased intra-daily variability in rest-activity rhythms (as measured via actigraphy) had infants with more externalizing problems. Findings suggest that maternal sleep and circadian rhythm disturbances during pregnancy may be a risk factor for infant sleep problems and socioemotional difficulties.

Prevalence and determinants of sleep disturbances among pregnant women: an Indian community-based cross-sectional study

Our study aimed to assess the prevalence and determinants of sleep disturbances among pregnant women in Kolar District, Karnataka, India. It focused on specific disturbances, such as obstructive sleep apnea (OSA), insomnia, restless leg syndrome (RLS), excessive daytime sleepiness (EDS), and poor sleep quality across pregnancy trimesters. A cross-sectional community-based study among 251 pregnant women was conducted. Sleep disturbances using validated tools, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI), STOP-Bang and single-question RLS screener tool were measured. Bivariate logistic regression was followed by multivariate logistic regression identified significant predictors. Sleep disturbances were highly prevalent, with poor sleep quality being most common (39.84%), followed by OSA (13.55%), EDS-moderate and severe category (11.56%), insomnia (9.6%), and RLS (6.80%). Proportion of pregnant women who screened positive for any sleep disturbance was 49.4%. Disturbances increased as pregnancy progressed, particularly in the third trimester. Significant predictors included increased neck circumference (aOR 1.08; p = 0.003), high-risk pregnancy (aOR 3.37; p < 0.001), and pregnancy trimester. Primigravida women were less likely to experience sleep issues compared to multigravida women (aOR 0.54; p = 0.034). High-risk pregnancies were associated with increased odds of OSA, insomnia, and EDS. Our study highlights the significant burden of sleep disturbances among pregnant women, with poor sleep quality being the most prevalent. High-risk pregnancies, increased neck circumference, and multigravida status were key determinants. Our findings emphasize the need for targeted interventions to improve maternal sleep quality and reduce potential adverse outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-024-00556-7.

Systematic review: the impact of maternal pre-and postnatal cannabis use on the behavioral and emotional regulation in early childhood

Prenatal exposure to alcohol and tobacco has been associated with child regulatory abilities and problems, but less is known about the associations with cannabis exposure. This review seeks to address this gap primarily focusing on the effects of maternal cannabis use on the child. Thus, we investigate the association between pre- and postnatal cannabis exposure of the child and regulatory abilities and problems, as well as the underlying neurobiological mechanisms potentially mediating the associations. According to the PRISMA guidelines, a systematic literature review was performed based on a systematic literature search through Medline (PubMed), Web of Science and PsycInfo, including studies assessing children aged 0-6 years with cannabis exposure in the preconception, pre-or postnatal period (preconception, pre- and postnatal cannabis exposure [PCE]) and investigating child regulatory abilities, regulatory problems or neurobiological mechanisms. Of n = 1061 screened articles, n = 33 were finally included. Diminished regulatory abilities are more likely to be found in infants after PCE, while specific regulatory problems tend to be more frequently found after two years of age. Possible mechanisms are related to changes in methylation and expression of key genes involved in endocannabinoid, dopaminergic and opioid systems, increased cortisol reactivity and altered Secretory Immunoglobulin A levels. Furthermore, PCE has been associated with changes in brain structure and connectivity. Current findings indicate that PCE is associated with both age-dependent alterations in self-regulation and neurobiological changes in young children. However, evidence is limited due to the number of studies, small sample sizes and lack of control for maternal psychopathology. Longitudinal studies including psychometric data from mothers are needed in order to further understand the implications of PCE.Trial registration: The review is registered with PROSPERO (ID: CRD42023425115).

Sleep During Pregnancy and Offspring Outcomes From Infancy to Childhood: A Systematic Review

OBJECTIVE

Prenatal sleep problems have been previously linked to poor birth outcomes. However, much less is known about the associations between poor prenatal maternal sleep and offspring outcomes after birth. The purpose of this systematic review was to synthesize the findings linking prenatal maternal sleep health and offspring health and development during infancy and childhood.

METHODS

A total of 4650 nonduplicate articles were identified via PsycInfo and PubMed databases. After screening and full-text review, 34 articles met the inclusion criteria and were extracted for information.

RESULTS

The bulk of studies in this review (n = 19; 76.5%) were published between 2019 and 2024. Measures of prenatal sleep included sleep timing, quality, sleep disorders and/or symptoms of disorders, and daytime sleepiness. Offspring outcomes were categorized as follows: a) sleep health (e.g., nighttime sleep duration, night wakings), b) physical health (e.g., body mass index, hospitalizations), c) child developmental outcomes (e.g., global development, negative affect, executive functioning), and d) brain structure and function (e.g., brain volume, event-related potentials). Evidence consistently links poor prenatal sleep health to poorer offspring sleep, higher body mass index, higher prevalence of physical health conditions, poorer global development, and more behavioral problems. Emerging evidence also links prenatal sleep to differences in offspring brain structure and function.

CONCLUSIONS

Poor prenatal maternal sleep health may be an environmental signal that informs offspring health. Future studies are needed to fully understand the pervasive, intergenerational, and long-lasting effects of sleep across pregnancy.

The role of sleep disturbances in associations between early life adversity and subsequent brain and language development during childhood

Sleep disturbances are posited to play a key role in the development of poor mental and physical health outcomes related to early life adversity (ELA), in part through effects on brain development. Language development is critically important for health and developmental outcomes across the lifespan, including academic achievement and emotion regulation. Yet, very little research has focused on the dynamic contributions of ELA, sleep, and brain development on language outcomes. In this mini review, we summarize the current pediatric literature independently connecting ELA and sleep to language development, as well as the effects of ELA and sleep on language-relevant aspects of brain structure and function. We then propose a framework suggesting that sleep disturbances and subsequent effects on brain structure and function may act as key mechanisms linking ELA and language development. Future research investigating the associations among ELA, sleep, brain, and language development will refine our proposed framework and identify whether sleep should be included as an intervention target to mitigate the effects of early life adversity on language development.

Association between prenatal maternal sleep quality, neonatal uncinate fasciculus white matter, and infant negative emotionality

BACKGROUND

Poor prenatal maternal sleep is a pervasive, yet modifiable, health concern affecting maternal and foetal wellbeing. Experimental rodent studies demonstrate that prenatal maternal sleep deprivation affects offspring brain development and leads to adverse outcomes, including increased anxiety-like behaviour. We examined the relation between prenatal maternal sleep quality and neonatal white matter development and subsequent infant negative emotionality.

METHODS

Participants included 116 mother-infant (53% female) dyads. Prenatal sleep quality was prospectively assessed three times during gestation (16, 29, and 35 gestational weeks) using the Pittsburgh Sleep Quality Index. Neonatal white matter, as indexed by fractional anisotropy (FA), was assessed via diffusion weighted magnetic resonance imaging. Negative emotionality was measured via behavioural observation and maternal report when the infant was 6-months of age.

FINDINGS

More prenatal sleep problems across pregnancy were associated with higher neonatal FA in the uncinate fasciculus (left: b = 0.20, p = .004; right: b = 0.15, p = .027). Higher neonatal uncinate FA was linked to infant negative emotionality, and uncinate FA partially mediated the association between prenatal maternal sleep and behavioural observation of infant negative emotionality.

INTERPRETATION

Findings highlight prenatal sleep as an environmental signal that affects the developing neonatal brain and later infant negative emotionality.

FUNDING

National Institutes of Health (R01MH109662, R01HL155744, P50HD103573, K12AR084226, F32 Training fellowships MH125572, HL165844, MH106440, and diversity supplement R01HL155744-01S1).

Infant and early childhood physical health assessments in the HEALthy Brain and Child Development (HBCD) Study

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social and emotional development beginning prenatally and planned through early childhood. Many prenatal and early childhood exposures impact both later physical health and development. Moreover, early deficits in physical health, such as growth and vision, are associated with differences in brain development, language and cognitive functioning. For these reasons, the HBCD Study includes measures of early childhood physical health, many of which have clinical relevance, and are applicable for use as both predictors and outcomes. Study measures assess a broad range of physical health domains and include both objective measurement of child growth and health and subjective caregiver report of behaviors and attitudes about constructs known to influence growth and physical development. Lastly, we obtain caregiver report of the child's routine medical care as well as acute and chronic medical issues. We anticipate that these data will contextualize the impact of child physical growth and health on child brain development and function. In this report we present the rationale for each domain and an overview of the physical health measures included in the current HBCD Study protocol.

Relationship between maternal postpartum depression, fatigue, sleep quality and infant growth: A cross-sectional study

BACKGROUND

Current research separately analyzed the connection between postpartum depression, fatigue, sleep and infant development. However, depression, fatigue and sleep quality often coexisted as adverse symptoms in postpartum women and influenced infant development together. This study explored the maternal postpartum symptoms on infant growth.

METHODS

Our study included 224 pairs of singleton full-term mothers and their infants who underwent routine pediatric outpatient clinics. Latent profile analysis was applied to identify the latent classes based on mothers' postpartum depression, fatigue and sleep profile characteristics. We evaluated the maternal adverse symptoms and infant development using multivariable logistic regressions.

RESULTS

Totally, 224 pairs of eligible mothers (28.85 ± 4.43 years) and infants (30.93 ± 3.26 days) participated in this study. Latent profile analysis identified 3 latent groups: mild (58.04%), moderate (34.37%), and severe (7.59%) postpartum adverse symptoms. Postpartum adverse symptoms were associated with delayed development in the baby's motor level (χ2 = 6.572, p = .037) and weight-for-length (χ2 = 9.652, p = .008). After controlling for mother and infant related factors, postpartum adverse symptoms remained a risk factor for infant motor level (odds ratio [OR]: 4.35; 95% confidence interval [CI]: 1.25-15.08) and weight-for-length (OR: 5.53; 95% CI: 1.55-19.74).

CONCLUSIONS

Maternal postpartum depression, fatigue and sleep quality are associated with infant development. Clinically, mothers with these symptoms should be intervened timely to avoid the aggravation of maternal symptoms, which affect baby's development.