Moe Kura: a longitudinal study of mother and child sleep and well-being in Aotearoa New Zealand

Maternal depressive symptoms in and beyond the perinatal period: associations with infant and preschooler sleep

STUDY OBJECTIVES

(1) To describe sleep in infancy and early childhood among children born to mothers with and without clinically significant depressive symptoms, and (2) to explore the relationships between maternal depressive symptoms and sleep patterns and problems during infancy and early childhood.

METHODS

Secondary analysis of longitudinal data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study. Data were collected in pregnancy (T1), 12 weeks postpartum (T2), and 3 years post-birth (T3). Participants were 262 Māori and 594 non-Māori mother-child dyads. Chi-square and independent t-tests measured bivariate associations between maternal mood (T1, T2, and T3) and child sleep characteristics (T2 and T3). Binary logistic regression models examined longitudinal and concurrent associations between maternal depressive symptoms and infant and preschooler sleep. Adjusted models accounted for key socio-demographic variables, as well as infant sleep variables in preschooler models.

RESULTS

Bivariate associations were found between prior and concurrent depressive symptomology and many of the infant and preschooler sleep outcomes. In adjusted models, prenatal depressive symptoms remained independently associated with shorter-than-recommended sleep durations in preschoolers. In these models, concurrent depression was also associated with night waking, night LSRSP, and perceived sleep problems at 12 weeks postpartum, and CSHQ-determined and perceived sleep problems at 3 years post-birth.

CONCLUSIONS

Longitudinal and cross-sectional associations were found between maternal depressive symptoms and child sleep. Sleep appears to be one pathway by which maternal depression confers risk for suboptimal child health outcomes. Findings support the need for earlier and better maternal mental health services.

Characterizing the sleep location, patterns, and maternally perceived sleep problems of the infants of Māori and non-Māori mothers in Aotearoa New Zealand

OBJECTIVES

To investigate potential sleep inequities between the infants of Māori and non-Māori mothers in Aotearoa New Zealand, identify socio-ecological factors associated with infant sleep, and determine features of infant sleep that contribute to a mother-perceived infant sleep problem.

DESIGN

Secondary analysis of longitudinal data from the Moe Kura: Mother and Child, Sleep and Well-being in Aotearoa New Zealand study when infants were approximately 12 weeks old.

PARTICIPANTS

383 Māori and 702 non-Māori mother-infant dyads.

METHODS

Chi-square and independent t-tests measured bivariate associations between maternal ethnicity and infant sleep characteristics. Multivariable and ordinal logistic regression models assessed the relative impact of different socio-ecological factors on infant sleep outcome variables.

RESULTS

Key developmental markers of infant sleep did not differ by maternal ethnicity. There were some ethnicity-based differences in sleep location. Maternal ethnicity, maternal age, parity, maternal depression, maternal relationship status, life stress, breastfeeding, work status, and bedsharing were related to different dimensions of infant sleep, and to maternal perceptions of a sleep problem.

CONCLUSION

Sleep at 12weeks is highly variable between infants and is associated with numerous socio-ecological factors. Findings support a social determinants explanation for sleep health inequities seen later in childhood.

Tawhiti nui, tawhiti roa: tawhiti tūāuriuri, tawhiti tūāhekeheke: a Māori lifecourse framework and its application to longitudinal research

Māori hold unique views on the lifecourse but there has been limited Māori-led longitudinal research to date. There is a particular need for kaupapa Māori and interface longitudinal research that generates mātauranga Māori and enables Māori-initiated transformative action. In this paper, we identify key features of a Māori lifecourse framework and its application to longitudinal research at the interface of mātauranga Māori and Western science. We describe how these features are applied in the Taranaki Māori-led longitudinal research programme Te Kura Mai i Tawhiti. Māori will benefit from a regionally-focussed Māori approach to lifecourse research at the interface. This approach can be applied directly in future localised research led by Māori and other Indigenous peoples. Māori-led longitudinal research will inform effective interventions to lift Māori wellbeing and prospects throughout all stages of life and strengthen Māori contributions to wider society. Māori approaches to longitudinal research will help shape new futures for Māori and a brighter future for all peoples of Aotearoa New Zealand. Glossary of Māori words: ao Māori: Māori world; Aotearoa: Māori name for New Zealand; hāngī: an earth oven or food cooked in such an oven; hapū: subtribe (also meaning to be pregnant); iwi: tribe, people; kaitiaki: guardian (also meaning teacher); kaupapa Māori: Māori paradigm; based within a Māori worldview; Māori: indigenous peoples of Aotearoa New Zealand; mātauranga Māori: Māori knowledge; mokopuna: grandchildren; ōhākī: parting wishes before death; Pākehā: primarily referring to New Zealand Europeans; reo Māori: Māori language; tamariki: children; Tangi te Kawekaweā: study title (the call of the kawekaweā, long-tailed cuckoo, heralds spring and the opportunity for growth); Taranaki: a tribal nation and region of Aotearoa New Zealand; Te Kura mai I Tawhiti: research programme title (sacred legacy of an ancient era); tauiwi: outsider, commonly referring to non-Māori; tuakiri: identity; wānanga: forum for sharing knowledge/learning; whakapapa: genealogy; whanau: extended family.

The role of sleep in health and health inequities in early childhood in Aotearoa New Zealand

This research investigated associations between multiple aspects of sleep health and child health, and the role of sleep in ethnic health inequities in early childhood. Questionnaire data on sleep and health of 3-year-old children (340 Māori, 570 non-Māori) in the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study were analysed cross-sectionally. Logistic regression models investigated associations between poor sleep and health; and the contribution of socioeconomic deprivation, racism, and poor sleep to ethnic inequities in health (socioemotional difficulties; overweight/obesity; and asthma/eczema/allergy). Sleep measures included weekday and weekend sleep duration (per 24h), differences between weekday and weekend sleep duration and sleep timing, and sleep disturbance. Multiple aspects of sleep were associated with socioemotional or physical health outcomes. Ethnic health inequities existed, with Māori children having higher odds of poor health for all health measures. In sequential logistic regression models, socioeconomic deprivation attenuated ethnic health inequities, as did further adjustment for racism, and for sleep. Findings indicate that poor sleep health may be a pathway linking social disadvantage to ethnic inequities in health outcomes in early childhood. Results provide support for tackling systemic drivers of racism, and social and sleep inequities, to achieve health equity in early childhood.