ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Authors: Claudia Lugo-Candelas, Tse Hwei, Seonjoo Lee, Cristiane Duarte, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

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.

What were the study results?

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.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

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 in the U.S., including Puerto Rico.

Who was involved?

The research team used data from 794 mother-child pairs across five ECHO research sites. All enrolled pairs with available prenatal sleep and offspring ADHD assessments before age seven were included. The pregnant participants were between 27 and 37 years old.

What happened during the study?

Pregnant people 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.

What happens next?

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.

Where can I learn more?

Access the full journal article, 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,” in The Lancet Regional Health - Americas.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 9, 2023

Access the associated article.

Download this summary

ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

New ECHO Research Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Problems in Children

Posted on October 27, 2023October 27, 2023 by Jodi Snare

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 person 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.

Read the research summary.

NIH Study Suggests Association Between Mothers’ Experiences of Maltreatment in Their Own Childhood to Their Children’s Health Outcomes

Posted on February 24, 2023May 19, 2023 by Jodi Snare

FOR IMMEDIATE RELEASE

Children of mothers who experienced childhood abuse or neglect may have a higher risk for developing asthma, ADHD, autism spectrum disorder, and certain mental health issues, according to a study funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

This research suggests that a mother’s history of being abused or neglected as a child may increase their child’s risk for developing one or more of these health outcomes at once. Daughters of these mothers may also be more likely to develop obesity, the study found, as compared to sons.

“Asking parents about their childhood experiences during prenatal and pediatric care, identifying parents with a history of childhood abuse or neglect, and offering counseling and support to those parents could help improve health outcomes for their children,” said Claudia Buss, PhD, an ECHO Program investigator at the University of California, Irvine and Charité - Universitätsmedizin Berlin.

The researchers surveyed 4,337 mothers from 21 ECHO cohorts across the U.S. on their childhood experiences. About 44 percent of these mothers reported childhood abuse or neglect. The researchers also collected data on the rates of diagnosis for a number of physical and mental conditions among the children of mothers participating in the study.

Dr. Buss and Nora K. Moog, PhD of Charité - Universitätsmedizin Berlin led this collaborative research published in The Lancet Public Health.

Buss, C. et al. Intergenerational transmission of the consequences of maternal exposure to childhood maltreatment – a United States nationwide observational study of multiple cohorts in the ECHO program. The Lancet Public Health. DOI: 10.1016/S2468-2667(23)00025-7

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

Authors: Claudia Buss, Nora K. Moog

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

Results from this study suggest that mothers’ maltreatment experience as children may influence their own children’s future health. Children of mothers who were neglected or abused during childhood were more likely to have diagnoses of asthma, ADHD, and ASD. These children were also more likely to demonstrate symptoms and behaviors linked to depression (i.e., internalizing behaviors). Additionally, girls whose mothers experienced maltreatment during childhood were more likely to have obesity. Children with mothers who experienced childhood maltreatment were also more likely to develop several of these health outcomes at once. Furthermore, exposure to several different forms of maternal childhood maltreatment was associated with highest risk increases for most offspring health outcomes suggesting the more severe the maternal childhood experiences were, the higher the risk for adverse health outcomes in her child.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study highlights the impact of maternal childhood maltreatment experiences as a major determinant of health across generations. While not all children of mothers who experienced abuse or neglect during childhood develop health problems, those who do are at higher risk for developing more than one condition. Results from this study suggest that screening and identifying these children early on, can allow the opportunity to direct targeted interventions to interrupt the intergenerational impact of adversity.

Why was the study needed?

Childhood maltreatment increases the risk for adverse health outcomes, and this risk can be transmitted from one generation to the next. Previous studies have investigated single health outcomes in children of mothers that were exposed to childhood abuse or neglect. However, health outcomes can often be connected to one another and affected by the same factors. This study investigated six health outcomes simultaneously and investigated whether a mother’s own exposure to maltreatment affects a child’s risk for experiencing more than one of these health outcomes.

Who was involved?

This study included over 4,000 mothers and their children from 21 ECHO cohorts. About 44% of mothers who participated in the study reported experiencing some form of abuse or neglect during their own childhood.

What happened during the study?

Mothers self-reported on their childhood experiences, and researchers used this information to assign mothers to one of two groups: 1) exposed to childhood maltreatment and 2) not exposed to childhood maltreatment. The researchers compared the risk for physical and mental conditions, including asthma, internalizing behaviors (e.g., social withdrawal, trouble sleeping, symptoms of anxiety or depression), autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and obesity, between the children in the two groups. They also examined whether multiple health outcomes co-occur in the same child.

What happens next?

Follow-up studies will investigate the pathways between maternal childhood maltreatment experiences and child health outcomes. Other studies may also investigate if other forms of negative childhood experiences are linked to different consequences of childhood maltreatment in the next generation.

Where can I learn more?

Access the full journal article, titled “Intergenerational transmission of the consequences of maternal exposure to childhood maltreatment – a United States nationwide study of multiple cohorts in the ECHO program” in The Lancet Public Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 23, 2023

Access the associated article.

Download this summary

ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

New ECHO Research Investigates the Consequences of Maternal Exposure to Childhood Maltreatment on Their Children’s Health Outcomes

Posted on February 23, 2023December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Claudia Buss, PhD of the University of California, Irvine and Charité – Universitätsmedizin Berlin and Nora K. Moog, PhD of Charité – Universitätsmedizin Berlin, suggests that maternal history of childhood maltreatment may increase the risk for multiple child health outcomes, including asthma, depressive symptoms, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). The results of this study also indicate that children of mothers who experienced neglect or abuse as children were more likely to develop several of these health outcomes simultaneously. This research, titled “Intergenerational transmission of the consequences of maternal exposure to childhood maltreatment – a United States nationwide observational study of multiple cohorts in the ECHO program,” is published in The Lancet Public Health.

Childhood maltreatment increases the risk for adverse health outcomes, and this risk can be transmitted from one generation to the next. Previous research has investigated single health outcomes in children of mothers exposed to childhood maltreatment. However, health problems are often interconnected and affected by the same factors, so this study investigated the association between maternal exposure to childhood abuse or neglect and children’s risk of experiencing more than one of six evaluated health outcomes simultaneously: ASD, ADHD, asthma, allergies, obesity, and internalizing behaviors (e.g., social withdrawal, trouble sleeping, symptoms of anxiety or depression).

The researchers evaluated data from 4,337 mothers and their children from 21 ECHO cohorts in the United States. Mothers self-reported on their childhood experiences, and researchers used this information to categorize them based on whether or not they were exposed to childhood neglect or abuse. About 44% of participating mothers reported experiencing some level of childhood maltreatment. The researchers then compared the rates of diagnosis for a number of physical and mental conditions between the children in the two groups.

Children of mothers exposed to childhood maltreatment had higher rates of asthma, ADHD, ASD, and internalizing problems compared with children of mothers without CM. Additionally, girls whose mothers experienced childhood neglect or abuse were more likely to develop obesity. Children of mothers who experienced childhood maltreatment were at higher risk of developing more than one of the evaluated health outcomes. Exposure to several different forms of maternal childhood maltreatment was associated with highest risk increases for most offspring health outcomes suggesting the more severe the maternal childhood experiences were, the higher the risk for adverse health outcomes in her child.

“Not all children of mothers with experiences of childhood maltreatment will develop health problems, but those who do are at risk of developing more than one condition,” said Dr. Buss. “Asking parents about their childhood experiences during prenatal and pediatric care, identifying parents with a history of childhood abuse or neglect, and offering counseling and support to those parents could help improve health outcomes for their children.”

Follow-up studies will further investigate the different pathways between maternal childhood maltreatment and child health outcomes. Future studies may also track the effects of other forms of negative childhood experiences in combination with childhood maltreatment on child health outcomes.

Read the research summary.

For more background, view this ECHO Discovery webinar about how a mother’s own adverse childhood experiences may affect her child’s health and well-being.