Elsevier

Journal of Affective Disorders

Volume 238, 1 October 2018, Pages 218-225
Journal of Affective Disorders

Research paper
Perinatal maternal depression, antidepressant use and infant sleep outcomes: Exploring cross-lagged associations in a pregnancy cohort study

https://doi.org/10.1016/j.jad.2018.05.025Get rights and content

Highlights

  • No reciprocal associations between maternal depression and infant sleep problems.

  • Antidepressant exposure not associated with increased infant sleep problems.

  • Maternal depression not associated with increased infant sleep problems.

  • Reciprocal longitudinal effects between maternal cognitions and infant waking.

  • Early maternal cognitions and infant waking predicted later night settling behaviors.

Abstract

Background

Both perinatal depression and infant sleep problems are common concerns in many communities, with these problems often coinciding. Findings in this area conflict and much of the research relies on poor measures of sleep and/or depression. Adding to this complexity is the rise in antidepressant treatment for perinatal maternal depression and no previous study has examined the relationship between such exposure and infant sleep.

Methods

This study draws on four waves of data (early pregnancy and third trimester, and six and 12 months postpartum) from 264 women in the Mercy Pregnancy and Emotional Wellbeing Study, a prospective pregnancy cohort study of women recruited in early pregnancy in Melbourne, Australia. Cross-lagged regression models were used to examine reciprocity of longitudinal effects between depressive symptoms and infant sleep.

Results

Maternal antepartum depression and antidepressant use were not significant predictors of infant sleep problems. Likewise, infant sleep problems were not significant predictors of postpartum maternal depression. However, maternal cognitions about infant sleep, characterised by maternal expectations to immediately attend to their crying child, did demonstrate positive reciprocal effects with infant nocturnal waking between six and 12 months postpartum.

Limitations

Infant sleep outcomes were reported by the mother and the sample were predominantly Anglophone, restricting generalizability of the models to other cultures.

Conclusions

Maternal depression and antidepressant use were not found to be significant factors in infant sleep problems and, likewise, infant sleep problems were not associated with maternal depression. However, postpartum maternal cognitions around six months postpartum regarding limit-setting at night may predict increases in later nocturnal infant signaling.

Section snippets

Method

This is a prospective cohort study of 282 pregnant women recruited before the 20th week of pregnancy (Wave 1), and followed up during third trimester (Wave 2), birth of their child (Wave 3), and six months (Wave 4), 12 months (Wave 5) and 36 months postpartum (Wave 6). For this study, 264 women (Mage = 31.21, SDage = 4.69, range: 18–48 years old) were included using data from Waves 1, 2, 4 and 5. Women are missing if they had withdrawn prior to or after Wave 3 or if they were missing both

Results

As predicted in our first hypothesis, we expected antidepressant exposure to influence sleep outcomes (Table 1). Infants differed only at six months postpartum in the average number of hours they were sleeping at night, such that infants with AD exposure slept for a significantly shorter period between 7pm and 7am. All other comparisons between the groups were not significant (p > .01).

None of the correlations for infant nocturnal sleep duration with sertraline-equivalent dose, and maternal and

Discussion

Our findings do not support a relationship between either earlier maternal depression predicting later infant sleep outcomes, or earlier increased infant nocturnal signaling predicting later depression. Maternal cognitions regarding setting limits for infant sleep, such as concern their baby will feel abandoned if not immediately responded to at night, did predict depressive symptoms at 12 months of age and these maternal cognitions also predicted increased nocturnal signaling at 12 months and

Contributors

MG and AL proposed the original study. MG, AL and DT designed the overall study. SW, MG and AL contributed to the planning and undertaking the statistical analysis and all authors contributed to the interpretation of findings. MG and SW prepared the draft of the paper and all authors critically reviewed and revised for content and gave approval to the final to be published version of the manuscript.

Role of the funding source

The organizations that funded the study did not contribute to any of the following elements of the paper: study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the paper for publication.

Conflict of interest

MG has previously received honorarium for speaking from Lundbeck. The other authors declare that they have no competing interests.

Funding

This study is supported through the 2012 National Priority Funding Round of beyondblue in a three-year research grant (ID 519240) and a 2015 National Health and Medical Research Council (NHMRC) project grant for 5 years (APP1106823). Financial support has also been obtained from the Academic Research Development Grants from Mercy Health and from the Centre for Mental Health and Well-Being, Deakin University.

Declaration of interest

MG has previously received honorarium for speaking from Lundbeck. The other authors declare that they have no competing interests.

Acknowledgements

The authors would like to thank those who have both supported and given advice in the development of MPEWS including: Marinus van IJzendoorn, Michael Permezel, Anne Buist, Philip Boyce, Marie-Paule Austin, Peter Fonagy, Robert Emde, Marian Bakermans-Kranenburg and Michelle Leech. The authors also thank the staff and students on the study and research coordinators: Tina Vaiano and Nicole Brooks and volunteer Susan Pitchford for their contribution to MPEWS. Thank you also to Carole Branch at

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