Effects Of Maternal Sleep And Nutrition In Pregnancy On Newborn Birth Weight And Early Childhood Neurodevelopment

Background: The first 1000 days of life is a unique window of opportunity to build healthier and more prosperous futures.Pregnancy is the first stage in this window.Ideal sleep and nutrition in pregnancy can promote fetal growth and early childhood neurodevelopment.Objectives: To explore the associations of maternal sleep,nutrition in pregnancy,and their interactions with newborn birth weight and early childhood neurodevelopment.Methods: The analysis was performed in two populations.1.The China National Birth Cohort(CNBC).We enrolled 1466 women who had singleton deliveries in the International Peace Maternity and Child Health Hospital,Shanghai,from March 2017 to June 2019.The Pittsburgh sleep quality index(PSQI)was used to evaluate the sleep quality in each trimester of pregnancy.A short food frequency questionnaire was used to assess the food intake in mid-pregnancy.Neonatal birth weight Z-score was calculated based on the NTERGROWTH-21 st standards.A generalized estimating equation model was applied to explore the association between maternal sleep quality and birth weight Z-score.Generalized linear or logistic models were used to analyze the associations between food frequency and sleep quality or birth weight status.2.The Canada 3D(Design,Develop,Discover)cohort study.A number of 1580 motherinfant pairs who participated in the follow-up at 24 months postnatally were included in this study.PSQI was used to assess maternal sleep quality during pregancy.A 3-day food record was used to estimate dietary intakes at mid-pregnancy(20-24 gestational weeks).Bayley Scales of Infant Development,3rd edition(Bayley-III),Mac Arthur-Bates Communicative Development Inventories(CDI)were used to evaluate the cognitive,motor and language development in children age 2 years.Modified Checklist for Autism in Toddlers(M-CHAT)was used to evaluate the risk for autism spectrum disorder.The relationships of maternal sleep,nutrient intakes,nutrient intake patterns,and the interactions between sleep and nutrient intakes with early child neurodevelopment were analyzed.Results:1.We found that maternal PSQI scores in the first and third trimesters were negatively associated with birth weight Z-scores among female newborns(?=-0.032,95% CI:-0.063,-0.001,P=0.043 for the first trimester;?=-0.031,95% CI:-0.060,-0.003,P=0.033 for the third trimester).Poor sleep quality in late pregnancy was a risk factor for low birth weight(OR=1.501,95% CI: 1.082,2.083,P=0.015).2.Eating puffed food during the second trimester was positively associated with poor sleep quality in primiparas(OR=1.49,95% CI: 1.10,2.00,P = 0.01)and the prevalence of lagre for gestational age(OR=1.43,95% CI: 1.03,1.98,P = 0.035).3.Maternal sleep duration above 9 hours per day in early pregnancy might increase the risk of early childhood cognitive delay,compared with those sleep duration between6 and 9 hours(OR=1.96,95% CI: 1.01,3.80,P=0.046).Long sleep duration in the first or second trimester was associated with early language developmental delay(OR=1.86,95% CI: 1.05,3.30,P=0.035 for the first trimester;OR=2.75,95% CI:1.48,5.12,P=0.001 for the second trimester).4.Maternal antioxidant vitamin intakes,including beta-carotene,vitamins A,C,and E,were beneficial for early language development.High vitamin C intake was associated with a decreased risk for cognitive delay(OR=0.61,95% CI: 0.42,0.88,P=0.008).Three nutrient intake patterns were obtained using the treelet transform method.Two of them were associated with child neurodevelopment.A higher dietary quality was in relation to better child language development.5.There was an interaction between maternal sleep quality in early pregnancy and iron intake on early language development.When iron intake?the median,CDI score was lower by 7 in infants whose mother had poor sleep quality in early pregnancy compared with those with good sleep quality.When iron intake>the median,there was no difference in CDI scores between good and poor sleep quality groups.6.Thiamine and iron intakes during pregnancy were correlated with the risk of early childhood autism spectrum disorder.(OR=0.103,95% CI: 0.011,0.963,P=0.046 for thiamine;OR=0.596,95% CI: 0.414,0.859,P=0.006 for iron).Conclusions: Sleep quality and sleep duration during pregnancy may affect fetal growth and early neurodevelopment.Antioxidant vitamin intakes during pregnancy,specific nutrient intake patterns,and high dietary quality may be beneficial for early childhood neurodevelopment.There may be interactions between maternal sleep and nutrition on early childhood development.Further prospective studies are needed to verify our findings.