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Abstract Introduction Maternal stress levels, sleep, and mother-infant interactions are associated with infant sleep. However, the potential impact of these factors experienced during the early postpartum period on future infant sleep development is understudied. This study examined whether maternal stress and sleep at 3 weeks postpartum predicted infant wakefulness at 6 months of age through mother-infant bonding and the home environment quality at 8 weeks postpartum. Methods This secondary analysis of the longitudinal Snuggle Bug/Acurrucadito cohort included a subsample of mothers (n=171, 31.4±5.4y, 74.9% married, 38% Hispanic/Latina, 64.3% ≥ bachelor’s degree) and their full-term infants who were visited in their homes at 3 and 8 weeks, and 6 months postpartum. Infant wakefulness after sleep onset (WASO) was assessed using ankle-actigraphy and sleep diaries over 5 days at the 3-week and 6-month visits. At the 3-week visit, mothers completed the Pittsburgh Sleep Quality Index (PSQI, range:0-21) and the Stress subscale of the Depression Anxiety Stress Scales-21 (range:0-42). At 8 weeks, mothers completed the Postpartum Bonding Questionnaire infant-focused anxiety subscale (PBQ-anxiety, range:0-20, higher scores indicate greater anxiety-related bonding difficulties), and staff assessed the home environment quality with the Home Observation for Measurement of the Environment Inventory (HOME, range:0-45, higher scores indicate a more enriched and interactive environment). Based on the Transactional Model of Infant Sleep, path analyses were conducted to identify the direct effect of 3-week PSQI and Stress scores, and indirect effects via 8-week PBQ-anxiety and HOME scores, on 6-month WASO, adjusting for 3-week WASO, maternal age, education, and marital status. Results Average 3-week PSQI and Stress, and 8-week PBQ-anxiety and HOME scores were 6.8±3.1, 7.4±6.5, 2.1±1.9, and 36±4.5, respectively. WASO at 3 weeks and 6 months were 146.9±64.9 and 63.4±33.2min. The 3-week Stress score was not directly related to 6-month WASO (β=-0.28, 95%CI: -0.79-0.17), but positively related to 6-month WASO indirectly through 8-week PBQ-anxiety (β=0.14, 95%CI:0.02-0.31]). The 3-week PSQI was not directly or indirectly associated with 6-month WASO, and the HOME score was not a significant mediator. Conclusion Early, heightened maternal stress, independent of maternal sleep quality may indirectly lead to greater infant nighttime wakefulness later in infancy by disrupting early mother-infant bonding. Support (if any) NIH/NHLBIR01HL147931
Jiao et al. (Sat,) studied this question.