Association between maternal stress and child sleep quality: A nationwide ECHO prospective cohort study

Authors: GEIGER, SARAH - University Of Illinois; CHANDRAN, ARUNA - Johns Hopkins School Of Public Health; CHURCHILL, MARIE - Johns Hopkins School Of Public Health; MANSOLF, MAXWELL - Northwestern University; ZHANG, CAI - University Of Illinois; MUSAAD, SALMA - Children'S Nutrition Research Center (CNRC); BLACKWELL, COURTNEY - Northwestern University; EICK, STEPHANIE - Emory University; GOIN, DANA - University Of California San Francisco (UCSF); KORRICK, SUSAN - Brigham & Women'S Hospital; ALSHAWABKEH, AKRAM - Northeastern University; BRENNAN, PATRICIA - Emory University; BRETON, CARRIE - University Of Southern California; CORDERO, JOSE - University Of Georgia; DEONI, SEAN - Warren Alpert Medical School Of Brown University; D'SA, VIREN - Warren Alpert Medical School Of Brown University; DUNLOP, ANNE - Emory University, School Of Medicine; ELLIOTT, AMY - Non ARS Employee; FERRARA, ASSIAMIRA - Kaiser Permanente Research; KEDDIE, ARLENE - Northern Illinois University; LEBOURGEOIS, MONIQUE - University Of Colorado; LEWINN, KAJA - University Of California San Francisco (UCSF); KOINIS-MITCHELL, DAPHNE - Warren Alpert Medical School Of Brown University; LUCCHINI, MARISTELLA - Columbia University - New York; NOZADI, SARA - University Of New Mexico; O'CONNOR, THOMAS - University Of Rochester; ZHU, YEYI - Kaiser Permanente Research; ZIMMERMAN, EMILY - Northeastern University; SCHANTZ, SUSAN - University Of Illinois

Submitted to: Pediatric Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/15/2024
Publication Date: 10/11/2024
Citation: Geiger, S.D., Chandran, A., Churchill, M.L., Mansolf, M., Zhang, C., Musaad, S., Blackwell, C.K., Eick, S.M., Goin, D.E., Korrick, S., Alshawabkeh, A., Brennan, P.A., Breton, C.V., Cordero, J.F., Deoni, S., D'Sa, V., Dunlop, A.L., Elliott, A.J., Ferrara, A., Keddie, A., LeBourgeois, M., LeWinn, K.J., Koinis-Mitchell, D., Lucchini, M., Nozadi, S.S., O'Connor, T., Zhu, Y., Zimmerman, E., Schantz, S.L. 2024. Association between maternal stress and child sleep quality: A nationwide ECHO prospective cohort study. Pediatric Research. https://doi.org/10.1038/s41390-024-03542-4.
DOI: https://doi.org/10.1038/s41390-024-03542-4

Interpretive Summary: Childhood sleep quality is associated with physical and behavioral health and predicts later sleep quality; it has many causes that can happen early in life. This large US based study of mothers followed since pregnancy explored the relationship between how mothers experience stress during pregnancy (prenatal) and their child's sleep problems. We found that the mothers' prenatal stress was significantly related to more child sleep problems and disturbances at ages 4–8 years. Part of this relationship was affected by whether mothers had ongoing stress after giving birth. The biological mechanism underlying this relationship is still not well understood, but may include the housing conditions or living situation. Even a small effect of a prevalent issue like mothers' stress may have important public health implications at the population level.

Technical Abstract: Childhood sleep quality is associated with physical, cognitive, and behavioral health and predicts later sleep quality; it has many determinants, including developmental exposures. Our objective was to examine associations between maternal stress during pregnancy and childhood sleep quality and determine whether postnatal stress mediates the association. Data from the Environmental Influences on Child Health Outcomes cohort were used. Perceived Stress Scale (PSS) T-scores were the exposure measure. Outcome measures were preschool Child Behavior Checklist (CBCL) sleep syndrome scale and Patient-Reported Outcomes Measurement Information System Sleep Disturbance Parent Proxy short form 4a (PSD4a) T-scores at ages 4–8 years. Linear mixed-effects regression modeling was performed for each sleep outcome, adjusting for maternal age at delivery and education and child sex, gestational age at birth, and age at outcome ascertainment, with random intercepts for cohorts. Prenatal PSS score was associated with both CBCL (Beta=0.09, 95% confidence interval [CI]: 0.06, 0.11; p<0.01) and PSD4a (Beta=0.07, 95% CI: 0.03, 0.12; p<0.01) scores. Postnatal perceived stress mediated a proportion of the total effect of prenatal stress in both CBCL (66.3%) and PSD4a (95.9%) samples. Both pre- and postnatal maternal perceived stress appear to influence sleep quality during early life.