Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: a prospective analysis of timing and sex differences in the ECHO cohort

Claudia Lugo-Candelas; Tse Hwei; Seonjoo Lee; Maristella Lucchini; Alice Smaniotto Aizza; Linda G Kahn; Claudia Buss; Thomas G O'Connor; Akhgar Ghassabian; Amy M Padula; Judy Aschner; Sean Deoni; Amy E Margolis; Glorisa Canino; Catherine Monk; Jonathan Posner; Cristiane S Duarte

doi:10.1016/j.lana.2023.100609

Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: a prospective analysis of timing and sex differences in the ECHO cohort

Lancet Reg Health Am. 2023 Oct 9:27:100609. doi: 10.1016/j.lana.2023.100609. eCollection 2023 Nov.

Authors

Claudia Lugo-Candelas¹, Tse Hwei¹, Seonjoo Lee¹, Maristella Lucchini², Alice Smaniotto Aizza¹, Linda G Kahn³, Claudia Buss⁴, Thomas G O'Connor⁵, Akhgar Ghassabian³, Amy M Padula⁶, Judy Aschner⁷, Sean Deoni⁸, Amy E Margolis¹, Glorisa Canino⁹, Catherine Monk¹, Jonathan Posner¹⁰, Cristiane S Duarte¹

Affiliations

¹ New York State Psychiatric Institute/Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA.
² Research Department, Nanit, 122 Grand St, New York, NY, 10013, USA.
³ NYU Grossman School of Medicine, 227 East 34th Street, Room 811, New York, NY, 10016, USA.
⁴ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstrasse 57, 10117, Berlin, Germany.
⁵ University of Rochester, 300 Crittenden Blvd, Rochester, NY, 14642, USA.
⁶ University of California, San Francisco, 490 Illinois Street, Box 0132, San Francisco, CA, 94158, USA.
⁷ Hackensack Meridian School of Medicine, Nutley NJ and Albert Einstein College of Medicine, Bronx, NY, USA.
⁸ Bill & Melinda Gates Foundation, 500 Mercer Str, Seattle, WA, 98275, USA.
⁹ University of Puerto Rico Medical Sciences Campus, Behavioral Sciences Research Institute, 9th Floor, Rio Piedras, PR, 00935, Puerto Rico.
¹⁰ Duke University, North Pavilion Building, 2400 Pratt Street, Durham, NC, 27705, USA.

Abstract

Background: Sleep difficulties are common in pregnancy, yet poor prenatal sleep may be related to negative long-term outcomes for the offspring, including risk for attention-deficit/hyperactivity disorder (ADHD). Existing studies are few and have not examined timing of exposure effects or offspring sex moderation. We thus aimed to test the hypotheses that poor sleep health in pregnancy is associated with increased risk for ADHD symptoms and offspring sleep problems at approximately 4 years of age.

Methods: Participants were 794 mother-child dyads enrolled in the NIH Environmental Influences on Child Health Outcomes Study (ECHO). Participants self-reported on sleep duration, quality, and disturbances during pregnancy and on children's ADHD symptoms and sleep problems on the Child Behaviour Checklist.

Findings: Pregnant participants were 32.30 ± 5.50 years and children were 46% female. 44 percent of pregnant participants identified as Hispanic or Latine; 49% identified as White. Second-trimester sleep duration was associated with offspring ADHD symptoms (b = -0.35 [95% CI = -0.57, -0.13], p = 0.026), such that shorter duration was associated with greater symptomatology. Poorer sleep quality in the second trimester was also associated with increased ADHD symptomatology (b = 0.66 [95% CI = 0.18, 1.14], p = 0.037). Greater sleep disturbances in the first trimester were associated with offspring ADHD (b = 1.03 [95% CI = 0.32, 1.03], p = 0.037) and in the second trimester with sleep problems (b = 1.53 [95% CI = 0.42, 2.92], p = 0.026). We did not document substantial offspring sex moderation.

Interpretation: Poor prenatal sleep health, particularly quality and duration in the second trimester, may be associated with offspring risk of neurodevelopmental disorders and sleep problems in early childhood. Further research is needed to understand mechanisms, yet our study suggests that prenatal maternal sleep may be a modifiable target for interventions aimed at optimizing early neurodevelopment.

Funding: NIH grants U2COD023375, U24OD023382, U24OD023319, UH3OD023320, UH3OD023305, UH3OD023349, UH3OD023313, UH3OD023272, UH3OD023328, UH3OD023290, K08MH117452 and NARSAD Young Investigator Award 28545.

Keywords: Intergenerational transmission; Offspring ADHD; Prenatal sleep health.

Abstract

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