Sabine Plancoulaine

Multidimensionality of the relationship between social status and dietary patterns in early childhood: longitudinal results from the French EDEN mother-child cohort.

BackgroundThe association between socioeconomic position and diet in early childhood has mainly been addressed based on maternal education and household income. We aimed to assess the influence of a variety of social factors from different socio-ecological levels (parents, household and child-care) on multi-time point dietary patterns identified from 2 to 5 y.MethodThis study included 974 children from the French EDEN mother-child cohort. Two multi-time point dietary patterns were derived in a previous study: they correspond to consistent exposures to either core- or non-core foods across 2, 3 and 5 y and were labelled “Guidelines” and “Processed, fast-foods”. The associations of various social factors collected during pregnancy (age, education level) or at 2-y follow-up (mother’s single status, occupation, work commitments, household financial disadvantage, presence of older siblings and child-care arrangements) with each of the two dietary patterns, were assessed by multivariable linear regression analysis.ResultsThe adherence to a diet close to “Guidelines” was positively and independently associated with both maternal and paternal education levels. The adherence to a diet consistently composed of processed and fast-foods was essentially linked with maternal variables (younger age and lower education level), household financial disadvantage, the presence of older sibling (s) and being cared for at home by someone other than the mother.ConclusionsMultiple social factors operating at different levels (parents, household, and child-care) were found to be associated with the diet of young children. Different independent predictors were found for each of the two longitudinal dietary patterns, suggesting distinct pathways of influence. Our findings further suggest that interventions promoting healthier dietary choices for young children should involve both parents and take into account not only household financial disadvantage but also maternal age, family size and options for child-care.

Gender‐specific factors associated with shorter sleep duration at age 3 years

Total sleep duration has been decreasing among children in the last decades. Short sleep duration (SSD) has been associated with deleterious health consequences, such as excess weight/obesity. Risk factors for SSD have already been studied among school‐aged children and adolescents, but inconsistent results have been reported regarding possible gender differences. Studies reporting such relationships are scarce in preschoolers, despite the importance of this period for adopting healthy behaviour. We aimed to investigate factors associated with SSD in 3‐year‐old boys (n = 546) and girls (n = 482) in a French Mother–Child Cohort (EDEN Study). Children were born between 2003 and 2006 in two French university hospitals. Clinical examinations and parent self‐reported questionnaires allowed us to collect sociodemographic (e.g. income, education, family situation, child‐minding system), maternal [e.g. body mass index (BMI), parity, depression, breastfeeding duration] and childs characteristics (e.g. gender, birth weight, term, physical activity and TV viewing duration, food consumption, usual sleep time). Sleep duration/24‐h period was calculated and SSD was defined as <12 h. Analyses were performed using logistic regression. The mean sleep duration was 12 h 35 ± 56 min, with 91% of the children napping. Patterns of risk factors associated with SSD differed according to gender. In addition to parental presence when falling asleep, short sleep duration was associated strongly positively with high BMI Z‐score and TV viewing duration among boys and with familial home child‐minding and lower scores on the ‘fruits and vegetables’ dietary pattern among girls. These results suggest either a patterning of parental behaviours that differs according to gender, or a gender‐specific sleep physiology, or both.

Sleep Trajectories Among Pregnant Women and the Impact on Outcomes: A Population-Based Cohort Study

Objectives Sleep problems and deprivation are common during pregnancy, particularly in the third trimester. Previous studies are mostly descriptive or focused on specific clinical groups and late pregnancy. We aimed to identify sleep duration trajectories during the pregnancy period, their associated factors, and impact on pregnancy and birth outcomes. Methods We studied 200 women from a mother–child cohort recruited in 2009–2011 from the French general population. We used semi-parametric models to analyze data collected through questionnaires. Results We detected three sleep duration trajectories during pregnancy: short-decreasing (<6.5h/night, 10.8% of the sample), medium-decreasing (6.5-8h/night, 57.6%), and long-increasing (>8h/night, 31.6%) trajectories. Factors associated with the short-decreasing trajectory relative to the medium-decreasing trajectory were older age (odds-ratio/yearu2009=u20091.13 [95%Confidence-Interval 1.00-1.29]) and workingu2009>u200928 weeks of gestational age (odds-ratiou2009=u20090.30 [0.10–0.90]). Sleep duration during pregnancy in this trajectory group was modified by insomniac symptoms (regression coefficient/trimesteru2009=u2009−0.74 [Standard-Error 0.12]) and naps (regression coefficient/trimesteru2009=u20090.58 [0.25]). Restless legs syndrome was the only factor associated with the long-increasing trajectory and decreased sleep duration (regression coefficient/trimesteru2009=u2009−0.88 [0.25]). Assisted delivery (i.e. cesarean section and/or instrumental delivery) and post-partum depression were more frequent among women with the short-decreasing and long-increasing trajectories whereas cesarean section alone was more prevalent among those with the short-decreasing trajectory. Proportion of premature births was higher in the short-decreasing trajectory group. Birth-weight-z-score was lower in the long-increasing trajectory group. Conclusion We identified sleep trajectories among pregnant women with specific risk factors that could affect both pregnancy and birth outcomes. Taking these into consideration could improve both maternal and child health.

Night-waking trajectories and associated factors in French preschoolers from the EDEN birth-cohort

Night waking in preschoolers has been associated with adverse health outcomes in cross-sectional studies, but has rarely been analyzed in a longitudinal setting. Therefore, little is known about the evolution of night waking in early childhood. The objectives of the present study were: to identify night-waking trajectories in preschoolers, and to examine the risk factors associated with those trajectories. Analyses were based on the French birth-cohort study EDEN, which recruited 2002 pregnant women between 2003 and 2006. Data on a childs night waking at the ages of two, three, and five, six years, and potential confounders, were collected through parental self-reported questionnaires. Night-waking trajectories were computerized using group-based trajectory modeling on 1346 children. Two distinct developmental patterns were identified: the 2-5 rare night-waking (77% of the children) and the 2-5 common night-waking pattern. Logistic regressions were performed to identify the factors associated with the trajectories. Risk factors for belonging to the 2-5 common night-waking trajectory were: exposure to passive smoking at home, daycare in a collective setting, watching television for extended periods, bottle feeding at night, high emotionality, and low shyness. This approach allowed identification of risk factors associated with night waking during a critical age window, and laid the groundwork for identifying children at higher risk of deleterious sleep patterns. Those risk factors were mainly living habits, which indicated that prevention and intervention programs could be highly beneficial in this population.

Sleep and its relation to cognition and behaviour in preschool‐aged children of the general population: a systematic review

This is the first systematic review of the literature on sleep and its relation to cognition and behaviour in preschool‐aged children. In comparison with the literature focused on school‐aged children, knowledge involving preschoolers is rather sparse. A total of 26 studies was included in this review, which revealed a high degree of heterogeneity regarding the type and means of measuring sleep variables and behavioural and cognitive variables, as well as the statistical methods employed. Amongst the 13 articles with the largest sample sizes (top 50% of the included studies, 12 different populations), 12 found that a higher quantity or quality of sleep was associated with better behavioural and/or cognitive outcomes. Results point to an association between sleep, behaviour and cognition as early as preschool years, but the strengths of associations reported in the articles were relatively small. Studies with a smaller sample size were less concordant. It is consistent with our findings that the strengths of association are small, and thus require large sample sizes to ensure statistical detection power. Different aspects of sleep were not associated with all cognitive or behavioural features in the same way, which underscores the need for specific measures rather than general ones such as ‘sleep problems’ or ‘behaviour problems’ to be able to decipher the relationships. There is also a need for large longitudinal studies using objective measures and accounting for confounding factors. The childs genotype has recently been shown to have a moderating role in the association between sleep and behaviour, and should be further explored.

Altered sleep architecture during the first months of life in infants born to depressed mothers

OBJECTIVEnThis study investigated sleep architecture in newborn and six-month-old infants who were born to depressed mothers.nnnMETHODnSixty-four healthy full-term infants (32 males and 32 females) participated in the study. Of these, 32 were high-risk infants who were born to mothers diagnosed with depression, and 32 were low-risk infants born to mothers without a personal history of depression. 24-hour polysomnography was recorded at zero and six months of age (M0 and M6). Sleep macro-structural parameters (total sleep time, TST; awake time; non-rapid eye movement, NREM sleep (%); rapid eye movement, REM sleep %; arousal index; and sleep efficiency) were analysed at M0 and M6. Micro-architectural sleep features (slow-wave activity, SWA; delta sleep ratio, DSR; spindle density; and rapid eye movement density) were calculated at M6. The data between high-risk and low-risk groups were compared using Students t-tests.nnnRESULTSnAt M0 and M6, the high-risk infants showed more awake time and fewer arousals than the low-risk infants. However, the high-risk group had less NREM% at M0 and a shorter TST as well as less REM% at M6 than the low-risk group. At M6, the high-risk group showed higher SWA, higher DSR and lower spindle density in comparison with the low-risk group.nnnCONCLUSIONSnAltered sleep structure was observed during their first months of life in infants born from depressed mothers, thereby suggesting that the prenatal environment could enhance the depression vulnerability of the child and potentially decrease their neuroplasticity.

Night-waking and behavior in preschoolers: a developmental trajectory approach

OBJECTIVEnThe aim was to study, with a developmental approach, the longitudinal association between night-waking from age 2 to 5-6 years and behavior at age 5-6 years.nnnMETHODSnWithin the French birth cohort study Etude sur les Déterminants pré et post natals du développement et de la santé de lENfant (EDEN), repeated measures of childrens night-waking were collected at age 2, 3 and 5-6 through parental questionnaires and were used to model night-waking trajectories. Behavior was assessed with the Strengths and Difficulties Questionnaire, which provides five subscales measuring a childs conduct problems, emotional symptoms, peer relation problems, antisocial behavior, and hyperactivity/attention problems. The behavioral subscales were dichotomized at the tenth percentile. Multivariable logistic regressions, adjusted for parents socio-economic factors, parental characteristics, and childrens characteristics and sleep habits allowed us to study, in 1143 children, the association between night-waking trajectories from 2 to 5-6 years and behavior at age 5-6 years.nnnRESULTSnThe 2 to 5-6 rare night-waking trajectory represented 78% of the included population (nxa0=xa0896), and the 2 to 5-6 common night-waking 22% (nxa0=xa0247%). Children belonging to the 2 to 5-6 common night-waking trajectory had, at age 5-6, increased risk of presenting emotional symptoms (odds ratio [OR]xa0=xa02.17, 95% CIxa0=xa01.27-3.70, pxa0=xa00.004), conduct problems (ORxa0=xa01.63, 95% CIxa0=xa01.00-2.65, pxa0=xa00.050), and hyperactivity/attention problems (ORxa0=xa01.61, 95% CIxa0=xa01.00-2.57, pxa0=xa00.049). After adjusting for baseline behavior at age two years, only the association with emotional symptoms remained significant (ORxa0=xa02.02, 95% CIxa0=xa01.15-3.55, pxa0=xa00.015). Results did not differ according to sex.nnnCONCLUSIONnResults suggest that the persistence of night-waking difficulties in early years is positively associated with emotional symptoms, hyperactivity/inattention, and conduct problems.

Early features associated with the neurocognitive development at 36 months of age: the AuBE study

BACKGROUNDnFew studies on the relations between sleep quantity and/or quality and cognition have been conducted among preschoolers from healthy general population. We aimed at identifying, among 36 months old children, early factors associated with intelligence quotient (IQ) estimated through the Weschler Preschool and Primary Scale Intelligence-III test and its indicators: Full-Scale-, Verbal- and Performance-IQs and their subscale scores.nnnMETHODSnWe included 194 children from the French birth cohort AuBE with both available Weschler Preschool and Primary Scale Intelligence-III scores at three years and sleep data. Information was collected through self-questionnaires at birth, 6, 12, 18 and 24 months. A day/night sleep ratio was calculated.nnnRESULTSnMean scores were in normal ranges for Verbal, Performance, and Full-Scale IQs ?. In multivariate models, being a third-born or more child and watching television ≥1xa0h/day at 24 months were negatively associated with all IQ scores, whereas collective care arrangement was positively associated. Night waking at six months and frequent snoring at 18 months were negatively associated with Performance IQ, some subscales, and Full Scale IQ contrary to day/night sleep ratio at 12 months. No association was observed between early sleep characteristics and Verbal IQ.nnnCONCLUSIONnWe showed that early features including infant sleep characteristics influence IQ scores at 36 months old. Some of these may be accessible to prevention.

Night sleep duration trajectories and associated factors among preschool children from the EDEN cohort

OBJECTIVEnSleep duration may vary both interindividually and intraindividually over time. We aimed to identify night-sleep duration (NSD) trajectories among preschoolers and to study associated factors.nnnMETHODSnNSD was collected within the French birth-cohort study EDEN at ages 2, 3, and 5-6 years through parental questionnaires, and were used to model NSD trajectories among 1205 children. Familial socioeconomic factors, maternal sociodemographic, health and lifestyle characteristics, as well as child health, lifestyle, and sleep characteristics at birth and/or at age two years were investigated in association with NSD using multinomial logistic regressions.nnnRESULTSnFive distinct NSD trajectories were identified: short (SS, <10xa0h, 4.9%), medium-low (MLS, <11xa0h, 47.8%), medium-high (MHS, ≈11.5xa0h, 37.2%), long (LS, ≥11.5xa0h, 4.5%) and changing (CS, ie, ≥11.5xa0h then <11xa0h, 5.6%) NSD trajectories. Multivariable analyses showed in particular that compared to the MHS trajectory factors associated with increased risk for the SS trajectory were male gender, first child,xa0maternal age and working status, night-waking, parental presence when falling asleep, television-viewing duration, as well as both Processed and fast foods and the Baby food dietary patterns at age two years. Factors positively associated with the CS trajectory were maternal smoking, feeding at night, and the Processed and fast foods dietary pattern at age two years, whereas childs activity and emotionality scores at age one year were negatively associated.nnnCONCLUSIONnWe identified distinct NSD trajectories among preschoolers and associated early life factors. Some of them may reflect less healthy lifestyles, providing cues for early multi-behavioral prevention interventions.

Association of night-waking and inattention/hyperactivity symptoms trajectories in preschool-aged children

The objective was to study the longitudinal associations between inattention/hyperactivity symptoms and night-waking in preschool-years, in light of their joint evolution. Within the French birth-cohort study EDEN, repeated measures of 1342 children’s night-waking and inattention/hyperactivity symptoms were collected at age 2, 3 and 5–6 through questionnaires. Trajectories were computed using group-based modeling. Logistic regressions, adjusted for confounding factors, were used to measure the association between trajectories and to determine risk factors for belonging to the identified joint trajectories. Two night-waking trajectories were observed, 20% of the children had a trajectory of “common night-waking”, and 80% a trajectory of “rare night-waking”. The children were distributed in three inattention/hyperactivity trajectories, a low (47%), medium (40%) and high one (13%). Both night-waking and inattention/hyperactivity trajectories showed persistence of difficulties in preschool years. The risk of presenting a high inattention/hyperactivity trajectory compared to a low one was of 4.19[2.68–6.53] for common night-wakers, compared to rare night-wakers. Factors associated with joint trajectories were parent’s education level and history of childhood behavioral problems, and the child’s gender, night-sleep duration and collective care at 2 years of age. Results suggest that children presenting behavioral difficulties would benefit from a systematic investigation of their sleep quality and conversely.