Collaborative ECHO research led by Claudia Lugo-Candelas, PhD, Tse Hwei, MPH, Seonjoo Lee, PhD, and Cristiane Duarte, MPH, PhD of the Columbia University Irving Medical Center and New York State Psychiatric Institutes investigates the effect of prenatal sleep on children’s health outcomes, including neurodevelopment disorders and sleep quality. This research, titled “Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: A prospective analysis of timing and sex differences in the ECHO Cohort,” is published in The Lancet Regional Health – Americas.
Sleep difficulties are common in pregnancy. Poor prenatal sleep may relate to negative outcomes for both parent and child, including pregnancy complications and certain birth outcomes. The impact of poor prenatal sleep may also extend beyond pregnancy and birth and may increase the risk for neurodevelopment disorders in offspring, particularly attention-deficit/hyperactivity disorder (ADHD).
In this study, ECHO researchers aimed to study potential associations between poor prenatal sleep and an increased risk of ADHD symptoms and sleep problems in offspring. The research team used data from 794 mother-child pairs across five ECHO research sites and all enrolled pairs with available prenatal sleep and offspring ADHD assessments before age 7 were included. The pregnant participants reported on their sleep during pregnancy using self-report questionnaires and reported on children’s symptoms and behaviors when children were between 3 and 5 years old. The study assessed the children’s ADHD symptoms and associated characteristics using the Child Behavior Checklist Preschool Version, a widely used parent report that measures behavior problems in children.
The study found that prenatal sleep quality and duration, particularly in the second trimester, appeared related to children’s risk for ADHD, emotional reactivity, and sleep problems at age 4. Longer sleep duration in the second trimester was associated with fewer ADHD symptoms in children. Poorer sleep quality scores in the second trimester were associated with greater offspring ADHD symptomatology. Shorter duration and poorer quality of sleep during the second trimester were also associated with more sleep difficulties in children.
“This study extends prior work by examining the associations between self-reported prenatal maternal sleep health and offspring ADHD symptoms in early childhood in a large, socio-demographically diverse sample,” Dr. Lugo-Candelas said. “This study was also the first looking to understand if sleep at a particular time in pregnancy is specifically related to offspring outcomes. Our research suggests we need to better study the role of sleep in pregnancy on both the health of the pregnant woman and their offspring to understand these potential associations.”
Future studies are needed to replicate these findings, as well as investigate the possible mechanisms. Poor sleep may impact inflammation in pregnancy and offspring development, but studies have not examined that association.