Longitudinal links between maternal factors and infant cognition: Moderation by infant sleep

Impact of sleep on postpartum health outcomes: a systematic review and meta-analysis

OBJECTIVE

To examine the impact of postpartum sleep interventions and postpartum sleep on maternal health outcomes.

DESIGN

Systematic review with random-effects meta-analysis. Online databases were searched on 12 January 2024.

STUDY ELIGIBILITY CRITERIA

Studies of all designs (except case studies and reviews) in all languages were eligible if they contained information on the population (individuals up to 1-year post partum), sleep interventions/exposures including (type, duration, frequency, alone or in combination with other components), comparator (control or different duration, frequency or type of sleep intervention) and outcomes: mental health, cardio-metabolic, postpartum weight retention (PPWR), low back pain and pelvic girdle pain, breastfeeding and urinary incontinence.

RESULTS

60 studies (n=20 684) from 14 countries were included. 'High' certainty of evidence showed that sleep interventions were associated with a greater decrease in depressive symptom severity compared with no intervention (five randomised controlled trials; n=992; standardised mean difference -0.27, 95% CI -0.40 to -0.14; small effect). Sleep interventions had no impact on the odds of developing depression ('moderate' certainty of evidence) or anxiety or anxiety symptom severity ('low' certainty of evidence). Additionally, 'low' certainty of evidence demonstrated no effect on cardiometabolic outcomes (systolic blood pressure, diastolic blood pressure, mean arterial pressure), anthropometric measures (maternal weight, body mass index) or prevalence of exclusive breastfeeding. 'Low' certainty of evidence from observational studies found that high-quality sleep reduces the odds of developing anxiety and reduces the severity of depression and anxiety symptoms. 'Low' and 'very low' certainty of evidence from observational studies found that shorter sleep duration is associated with greater PPWR.

CONCLUSIONS

Postpartum sleep interventions reduced the severity of depression symptoms.

[Cross-sectional study on the sleep status and risk factors for sleep problems in infants and young children in Jilin Province]

OBJECTIVES

To explore the sleep status and risk factors for sleep problems in infants and young children in Jilin Province.

METHODS

A total of 1 080 healthy infants and young children aged 0-3 years from eight prefecture-level cities and one autonomous prefecture in Jilin Province were selected as subjects. A self-designed questionnaire was used to collect the general information of the subjects, and the Brief Infant Sleep Questionnaire was used to understand the sleep status of the subjects. Multivariate logistic regression analysis was used to analyze the risk factors for sleep problems.

RESULTS

The total detection rate of sleep problems in the infants and young children was 38.24% (413/1 080). The total sleep time in the 4-11 month, 12-24 month, and 25-36 month age groups was higher than the recommended total sleep time (P<0.05). Multivariate logistic regression analysis showed that full-term birth, higher educational level of the main caregiver, and higher daytime activity intensity were protective factors for sleep problems in the infants and young children (P<0.05), while lower frequency of vitamin D supplementation, frequent night feeding, and maternal snoring were risk factors for sleep problems (P<0.05).

CONCLUSIONS

The total sleep time of infants and young children over 4 months old in Jilin Province is higher than the recommended total sleep time, but the prevalence rate of sleep problems is higher. The occurrence of sleep problems is related to various factors. Strengthening follow-up on preterm infants, providing education on infant sleep knowledge to primary caregivers, and regularly supplementing with vitamin D can be beneficial in reducing sleep problems in infants and young children.

The Brain and Early Experience Study: Protocol for a Prospective Observational Study

BACKGROUND

Children raised in conditions of poverty (or near poverty) are at risk for nonoptimal mental health, educational, and occupational outcomes, many of which may be precipitated by individual differences in executive function (EF) skills that first emerge in early childhood.

OBJECTIVE

The Brain and Early Experience study considers prenatal and postnatal experiences that may mediate the association between poverty and EF skills, including neural substrates. This paper described the study rationale and aims; research design issues, including sample size determination, the recruitment strategy, and participant characteristics; and a summary of developmental assessment points, procedures, and measures used to test the study hypotheses.

METHODS

This is a prospective longitudinal study examining multiple pathways by which poverty influences normative variations in EF skills in early childhood. It is funded by the National Institute of Child Health and Human Development and approved by the institutional review board.

RESULTS

Recruitment is complete with a sample of 203 participants, and data collection is expected to continue from September 2018 to February 2024. Of those recruited as low socioeconomic status (SES), 71% (55/78) reported income-to-needs (ITN) ratios of <2.0, and 35% (27/78) reported ITN ratios of <1.0. Among participants recruited into the not-low SES stratum, only 8.8% (11/125) reported ITN ratios of <2.0, and no participant reported ITN ratios of <1.0. The average ITN ratio for participants recruited into the low-income stratum was significantly lower than the average for the high-income recruitment cell (P<.001). Comparable recruitment outcomes were observed for both Black and non-Black families. Overall, the sample has adequate diversity for testing proposed hypotheses, with 13.3% (27/203) of participants reporting ITN ratios of <1 and >32.5% (66/203) reporting ratios of <2.0.

CONCLUSIONS

Preliminary results indicate that the recruitment strategy for maximizing variation in family SES was successful, including variation within race. The findings of this study will help elucidate the complex interplay between prenatal and postnatal risk factors affecting critical neurocognitive developmental outcomes in early childhood.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34854.

Concordance between subjective and objective measures of infant sleep varies by age and maternal mood: Implications for studies of sleep and cognitive development

Infant habitual sleep has been proposed as an important moderator of development in domains such as attention, memory or temperament. To test such hypotheses, we need to know how to accurately and consistently assess habitual sleep in infancy. Common assessment methods include easy to deploy but subjective parent-report measures (diary/sleep questionnaire); or more labour-intensive but objective motor movement measures (actigraphy). Understanding the degree to which these methods provide converging insights is important, but cross-method agreement has yet to be investigated longitudinally. Moreover, it is unclear whether concordance systematically varies with infant or maternal characteristics that could represent confounders in observational studies. This longitudinal study (up to 4 study visits/participant) investigated cross-method concordance on one objective (7-day actigraphy) and three commonly used subjective (7-day sleep diary, Brief Infant Sleep Questionnaire, Sleep & Settle Questionnaire) sleep measures in 76 typically developing infants (age: 4–14 months) and assessed the impact of maternal characteristics (stress, age, education) and infant characteristics (age) on cross-method concordance. In addition, associations between objective and subjective sleep measures and a measure of general developmental status (Ages & Stages Questionnaire) were investigated. A range of equivalence analyses (tests of equivalence, correlational analyses, Bland-Altman plots) showed mixed agreement between sleep measures. Most importantly, cross-method agreement was associated with maternal stress levels and infant age. Specifically, agreement between different measures of night waking was better for mothers experiencing higher stress levels and was higher for younger than older infants; the reverse pattern was true for day sleep duration. Interestingly, objective and subjective measures did not yield the same patterns of association with developmental domains, indicating that sleep method choice can influence which associations are found between sleep and cognitive development. However, results converged across day sleep and problem-solving skills, highlighting the importance of studying day sleep in future studies. We discuss implications of sleep method choice for investigating sleep in the context of studying infant development and behaviour.

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A range of equivalence analyses showed mixed agreement between subjective and objective sleep measures.

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Cross-method agreement was associated with maternal stress levels and infant age.

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Objective and subjective measures did not yield the same patterns of association with developmental domains except for day sleep duration.