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

Sarah Dee Geiger; Aruna Chandran; Marie L Churchill; Maxwell Mansolf; Cai Zhang; Salma Musaad; Courtney K Blackwell; Stephanie M Eick; Dana E Goin; Susan Korrick; Akram Alshawabkeh; Patricia A Brennan; Carrie V Breton; Jose F Cordero; Sean Deoni; Viren D'Sa; Anne L Dunlop; Amy J Elliott; Assiamira Ferrara; Arlene Keddie; Monique LeBourgeois; Kaja Z LeWinn; Daphne Koinis-Mitchell; Maristella Lucchini; Sara S Nozadi; Thomas O'Connor; Yeyi Zhu; Emily Zimmerman; Susan L Schantz; program collaborators for Environmental influences on Child Health Outcomes

doi:10.1038/s41390-024-03542-4

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

Pediatr Res. 2024 Oct 11. doi: 10.1038/s41390-024-03542-4. Online ahead of print.

Authors

Sarah Dee Geiger^{1

2}, Aruna Chandran³, Marie L Churchill³, Maxwell Mansolf⁴, Cai Zhang^{5

6}, Salma Musaad⁷, Courtney K Blackwell⁴, Stephanie M Eick⁸, Dana E Goin⁹, Susan Korrick¹⁰, Akram Alshawabkeh¹¹, Patricia A Brennan¹², Carrie V Breton¹³, Jose F Cordero¹⁴, Sean Deoni¹⁵, Viren D'Sa¹⁵, Anne L Dunlop¹⁶, Amy J Elliott¹⁷, Assiamira Ferrara¹⁸, Arlene Keddie¹⁹, Monique LeBourgeois²⁰, Kaja Z LeWinn²¹, Daphne Koinis-Mitchell¹⁵, Maristella Lucchini²², Sara S Nozadi²³, Thomas O'Connor²⁴, Yeyi Zhu²⁵, Emily Zimmerman²⁶, Susan L Schantz⁵; program collaborators for Environmental influences on Child Health Outcomes

Collaborators

program collaborators for Environmental influences on Child Health Outcomes:
P B Smith, L K Newby, L P Jacobson, D J Catellier, R Gershon, D Cella, J Meeker, D Dabelea, C S Duarte, C Monk, J Posner, K Lyall, H Volk, R Schmidt, L Croen, R J Wright, M Bosquet-Enlow, C Breton, T O'Connor, H Simhan

Affiliations

¹ Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. smurphy7@illinois.edu.
² Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA. smurphy7@illinois.edu.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁵ Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
⁶ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
⁷ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
⁸ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
⁹ Department of Obstetrics, Gynecology, and Reproductive Sciences, Program on Reproductive Health and the Environment, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
¹⁰ Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹¹ Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA.
¹² Department of Psychology, Emory University, Atlanta, Georgia.
¹³ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁴ Department of Epidemiology, University of Georgia College of Public Health, Athens, Georgia.
¹⁵ Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA.
¹⁶ Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
¹⁷ Avera Research Institute, Sioux Falls, SD, USA.
¹⁸ Division of Research, Kaiser Permanente North California, Oakland, CA, USA.
¹⁹ School of Health Studies, Northern Illinois University, DeKalb, IL, USA.
²⁰ Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA.
²¹ Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA.
²² Department of Psychiatry, Columbia University, New York, NY, USA.
²³ Community Environmental Health Program, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
²⁴ Departments of Psychiatry, Neuroscience, Obstetrics and Gynecology, University of Rochester, Rochester, NY, USA.
²⁵ Kaiser Permanente North California Division of Research, Oakland, CA, USA.
²⁶ Department of Communication Sciences and Disorders, Northeastern University, Boston, MA, USA.

PMID: 39394425
DOI: 10.1038/s41390-024-03542-4

Abstract

Background: Childhood sleep quality is associated with physical, cognitive, and behavioral health and predicts later sleep quality; it has many determinants, including developmental exposures.

Objectives: To examine associations between maternal stress during pregnancy and childhood sleep quality and determine whether postnatal stress mediates the association.

Method: 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.

Results: Prenatal PSS score was associated with both CBCL (B = 0.09, 95% confidence interval [CI]: 0.06, 0.11; p < 0.01) and PSD4a (B = 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.

Conclusions: Both pre- and postnatal maternal perceived stress appear to influence sleep quality during early life.

Impact: Prenatal stress significantly associates with child sleep problems and disturbances at ages 4-8 years; postnatal maternal stress is a significant mediator of these associations. Research suggests a range of prenatal affective/distress exposures associated with child sleep problems, but the conclusions remain in doubt due to the mixture of exposures and outcomes employed. Ours is the first US-based effort to explore associations between perceived maternal stress during pregnancy and child sleep problems and disturbance in early and middle childhood. Even a small effect of a prevalent issue like psychosocial stress may have important public health implications at the population level.