Date of Award

Fall 2023

Document Type

Open Access Thesis

Department

Epidemiology and Biostatistics

First Advisor

Michael D. Wirth

Abstract

STUDY OBJECTIVES: Sleep and mental health are two important factors for a new mother, as adequate sleep and a healthy mind help her prioritize self-care, seek support when needed, and create a nurturing environment for both her and her baby. Among various plausible theories exploring the etiology of sleep disturbances and depression, the concept of inflammation is gaining attention. This study examined the hypothesis that more pro-inflammatory diets during pregnancy are associated with a decrease in sleep quality and duration, abnormal sleep timing and higher Edinburg Postnatal depression score (EPDS) scores 6 months and 12 months post-partum.

METHODS: A secondary data analysis was conducted among 219 women from the Health in Pregnancy and Postpartum study, a randomized controlled trial promoting a healthy lifestyle in pregnant women with pre-pregnancy overweight or obesity. Data from baseline (i.e., 16 week gestation), 32 week gestation, 6 months post-partum and 12 months post-partum were utilized. Sleep was measured using BodyMedia’s SenseWear® armband. Diet was assessed using two 24-hr dietary recalls. Energy-density Dietary Inflammatory Index (E-DII) scores were calculated from micro and macronutrients. The E-DII was analyzed continuously and categorically (anti-inflammatory, neutral, and pro-inflammatory). The EPDS score was generated using a 10-item questionnaire that measured post-partum women’s behavior on a 4-point scale ranging from 0 to 3. Linear mixed-effects models estimated the impact of the prenatal E-DII score on sleep metrics (bedtime/sleep onset, final wake time, TIB, nighttime sleep duration, sleep efficiency, WASO, and sleep latency) post-partum. Multivariable linear regression analysis estimated the impact of pregnancy E-DII score on EPDS score.

RESULTS: Those consuming a pro-inflammatory diet, compared to anti-inflammatory diet were more likely to be younger (28.7 vs 31.6 years respectively, p=0.05). No significant associations were found between E-DII and EPDS score.

CONCLUSION: This study found significant positive association between diet-associated inflammation and post-partum sleep latency. Aside from this, longitudinal changes in diet-related inflammation was associated with specific post-partum sleep outcomes: earlier bedtime, more time in bed, and longer sleep duration. However, this association was evident only among the women in the intervention group (who received extensive counselling on diet/lifestyle modification and exercise throughout the study period). The lack of an association between inflammatory potential of diet and certain other sleep outcomes (i.e., sleep efficiency, WASO) as well as depressive symptoms, may be due to pregnancy-related factors other than diet that are stronger drivers of sleep and mental health. If diet truly impacts sleep during post-partum, then clinical interventions aimed at improving dietary choices and reducing inflammation both during pregnancy and early post-partum may positively impact post-partum sleep quality and quantity.

Rights

© 2024, Nowrin Tamanna

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