Trajectory of maternal depression and parasomnias.

Maternal depressive symptoms are associated with poorer sleep quality in their children. Although parasomnias can occur at any age, this group of sleep disorders is more common in children. The aim of this study was to assess whether maternal depression trajectories predict parasomnias at the age of 11 years. Data were from a Birth Cohort of 4231 individuals followed in the city of Pelotas, Brazil. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 12, 24, and 48 months, and 6 and 11 years postpartum. Maternal depression trajectories were calculated using a group-based modelling approach. Information on any parasomnias (confused arousals, sleepwalking, night terrors, and nightmares) was provided by the mother. Five trajectories of maternal depressive symptoms were identified: chronic-low (34.9%), chronic-moderate (41.4%), increasing (10.3%), decreasing (8.9%), and chronic-high (4.4%). The prevalence of any parasomnia at the age of 11 years was 16.8% (95% confidence interval [CI] 15.6%-18.1%). Confusional arousal was the most prevalent type of parasomnia (14.5%) and varied from 8.7% to 14.7%, 22.9%, 20.3%, and 27.5% among children of mothers at chronic-low, moderate-low, increasing, decreasing, and chronic-high trajectories, respectively (p < 0.001). Compared to children from mothers in the chronic-low trajectory, the adjusted prevalence ratio for any parasomnia was 1.58 (95% CI 1.29-1.94), 2.34 (95% CI 1.83-2.98), 2.15 (95% CI 1.65-2.81), and 3.07 (95% CI 2.31-4.07) among those from mothers in the moderate-low, increasing, decreasing, and chronic-high trajectory groups, respectively (p < 0.001). In conclusion, parasomnias were more prevalent among children of mothers with chronic symptoms of depression.

Screen use and sleep duration and quality at 15 years old: Cohort study.

Objective/background: The evidence on the association between screen use and sleep of adolescents is mainly based on studies about time watching television, with a few examining time using computers, videogames, and mobile devices. Our aim was to investigate the association between screen time for entertainment (watching TV, using computer, or playing games on tablets, smartphones, or videogame consoles) and sleep duration and self-reported sleep quality, among adolescents aged 15 years. Methods: With data from the 2004 Pelotas Birth Cohort, sleep duration was assessed with questions extracted from the Munich Chronotype Questionnaire and quality was self-reported. Adjusted ß coefficients and prevalence ratios (PR) with (95% confidence intervals) were obtained, respectively, by linear and Poisson regressions. Results: 1,949 adolescents had information about screen time and sleep quality, and 1,851 about screen time and sleep duration. The median screen time was 4.5hs/24hs. The mean sleep duration was 7.6hs/24hs and the prevalence of bad sleep was 17.3% (15.7-19.0%). There was an inverse relationship between screen time and sleep duration. When compared with those with less than 2hs/24hs of screen time, adolescents with 6-8.8hs/24hs and ≥9hs experienced, respectively, 23.4 and 32.4 min reduction in sleep duration (ß = -0.39; -0.62;-0.16 and ß = -0.54; -0.77;-0.30). Adolescents with ≥9hs of screen time were 60% more likely to report bad sleep than those with less than 2hs/24hs (PR: 1.60; 1.10-2.32). Conclusions: The median time spent using screens was longer than recommended. Screen use for ≥6hs/24hs was associated with a shorter sleep duration, and ≥9hs/24hs with poor sleep quality.

Sleep characteristics and excessive daytime sleepiness in adolescents and adults: results from the birth cohorts of three Brazilian cities - RPS Consortium.

OBJECTIVE: To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. METHODS: Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. RESULTS: Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. CONCLUSION: Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants.

Breastfeeding Duration and Exclusivity Among Early-Term and Full-Term Infants: A Cohort Study.

Background: As compared to full-term infants (39-41 weeks of gestation), early-term infants (37-38 wk) are at increased risk of adverse outcomes, including shorter exclusive breastfeeding (EB) duration and continued breastfeeding. Objectives: To compare early-term with full- and late-term infants regarding the prevalence of EB at 3 mo and any breastfeeding at 12 mo. Methods: Data sets from two population-based birth cohorts conducted in the city of Pelotas, Brazil, were combined. Only term infants (37 0/7 through 41 6/7 weeks of gestation) were included in the analyses. Early-term infants (37 0/7 through 38 6/7 wk) were compared to the remaining term infants (39 0/7 through 41 6/7 wk). Information on breastfeeding was gathered through maternal interviews at the 3-mo and 12-mo follow-ups. The prevalence of EB at 3 mo and any breastfeeding at 12 mo with 95% CIs were calculated. Crude and adjusted prevalence ratios (PRs) were obtained through Poisson regression. Results: A total of 6395 infants with information on gestational age and EB at 3 mo and 6401 infants with information on gestational age and any breastfeeding at 12 mo were analyzed. There was no difference between early-term infants and the remaining term infants regarding the prevalence of EB at 3 mo (29.2% and 27.9%, respectively) (P = 0.248). Prevalence of any breastfeeding at 12 mo was lower in early-term infants than among those born between 39 0/7 and 41 6/7 weeks of gestation (38.2% compared with 42.4%) (P = 0.001). In the adjusted analysis, the PR for any breastfeeding at 12 mo was 15% lower in the early-term group than in the remaining term infants (PR = 0.85; 95% CI: 0.76-0.95) (P = 0.004). Conclusions: The prevalence of EB at 3 mo was similar among term infants. Nonetheless, in comparison with the remaining infants born at term, early-term infants were at increased risk of having been weaned before reaching 12 mo of age. Curr Dev Nutr 2023;xx:xx.

Impact of covid-19 pandemic over depressive symptoms among mothers from a population-based birth cohort in southern brazil.

PURPOSE: Our aim was to assess the impact of COVID-19 on depressive symptoms among mothers from a population-based birth cohort in Pelotas, Southern Brazil. METHODS: A subgroup of mothers from the Pelotas 2004 Birth Cohort was assessed pre-pandemic (November,2019 to March,2020) and mid-pandemic (August-December,2021). In both follow-ups, depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Pre-pandemic (T1) and pandemic-related predictors (T2) were analyzed. Prevalence of depression (EPDS score ≥ 13) at T1 and T2 were compared with chi-square test. Changes in EPDS from T1 to T2 were estimated by multivariate latent change score modelling. RESULTS: 1,550 women were assessed. Prevalence of depression increased 38.1% (from 18.9% at T1 to 26.1% at T2) (p < 0.001). At T1, higher schooling, higher family income and being employed or working were related to lower EPDS, whereas being beneficiary of a cash transfer program and a larger number of people living in the household predicted higher EPDS. The deterioration of ones' own perception of quality of overall health (ß = 0.191; SE = 0.028; p < 0.001) and worst family financial situation due to the pandemic (ß = 0.083; SE = 0.024; p = 0.001) predicted the increase in EPDS from T1 to T2. CONCLUSION: Almost two years after the beginning of the pandemic, the prevalence of depressive symptoms among the women was higher than before the pandemic. The deterioration of ones' own perception of quality of overall health and worst family financial situation due to the pandemic are proxies for the effect of COVID-19 pandemic (the true exposure of interest) in the women mental health.

Sleep characteristics and excessive daytime sleepiness in adolescents and adults: results from the birth cohorts of three Brazilian cities — RPS Consortium / Características do sono e sonolência diurna excessiva em adolescentes e adultos: resultados das coortes de nascimento de três cidades brasileiras - Consórcio RPS

ABSTRACT Objective: To describe the prevalence of insufficient sleep duration, long sleep latency, terminal or maintenance insomnia, subjective sleep quality, and excessive daytime sleepiness among participants of birth cohorts conducted in three Brazilian cities, and to evaluate differences in prevalence rates within cohorts according to sociodemographic characteristics. Methods: Cross-sectional analyses involving adolescents and adults participating in four birth cohorts conducted in Ribeirão Preto (RP78 and RP94), Pelotas (PEL93) and São Luís (SL97/98). Sleep duration, latency, terminal or maintenance insomnia, and subjective sleep quality were obtained through the Pittsburgh Sleep Quality Index; and excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale. Differences in the prevalence of the outcomes were analyzed in each cohort according to sociodemographic characteristics (skin color, marital status, socioeconomic status, study and working at the time of the interview) stratified by sex. Results: Insufficient sleep duration was the most common outcome at the four cohorts, with higher frequency among men. Long latency was more frequently reported by young adult women in RP94 and PEL93 cohorts, and insomnia by women of the four cohorts, when compared to men of the same age. Women generally suffered more from excessive daytime sleepiness and evaluated the quality of their sleep more negatively than men. In addition to sex, being a student and working were associated with the largest number of outcomes in both sexes. Conclusion: Sleep disorders are more prevalent in women, reinforcing the need for greater investment in sleep health in Brazil, without disregarding gender and socioeconomic determinants.

RESUMO Objetivo: Descrever a prevalência de duração do sono, latência, insônia terminal, qualidade subjetiva do sono e sonolência diurna excessiva entre participantes de coortes de nascimentos realizadas em três cidades brasileiras, bem como avaliar as diferenças nas taxas de prevalência das coortes de acordo com características sociodemográficas. Métodos: Análises transversais envolvendo participantes de quatro coortes de nascimento realizadas em Ribeirão Preto (RP78 e RP94), Pelotas (PEL93) e São Luís (SL97). A duração, a latência, a insônia terminal e a qualidade subjetiva do sono foram obtidas por meio do Índice de Qualidade do Sono de Pittsburgh; e a sonolência diurna excessiva foi avaliada pela Escala de Sonolência de Epworth. As diferenças na prevalência dos desfechos foram analisadas em cada coorte segundo características sociodemográficas estratificadas por sexo. Resultados: A duração insuficiente do sono foi o desfecho mais comum nas quatro coortes, com maior frequência entre os homens. Latência longa foi mais frequentemente relatada por mulheres adultas jovens nas coortes RP94 e PEL93, e insônia por mulheres das quatro coortes, quando comparadas a homens da mesma idade. As mulheres geralmente sofriam mais com sonolência diurna excessiva e avaliavam a qualidade do sono de forma mais negativa do que os homens. Além do sexo, ser estudante e trabalhar estiveram associados ao maior número de desfechos em ambos os sexos. Conclusão: Os distúrbios do sono são mais prevalentes em mulheres, reforçando a necessidade de maior investimento na saúde do sono no Brasil, sem desconsiderar gênero e determinantes socioeconômicos.

A WhatsApp-Based Intervention to Improve Maternal Social Support and Maternal-Child Health in Southern Brazil: The Text-Message Intervention to Enhance Social Support (TIES) Feasibility Study.

Participatory learning and action cycles with women's groups have been recommended by the WHO to promote maternal and newborn health, but few studies have tested its feasibility and acceptability in mobile health (mHealth) interventions among mothers of toddlers. This was a mixed-method feasibility assessment of an 8-week WhatsApp-based maternal support group for mothers of toddlers (12-18 months of age) enrolled in a birth cohort study in Southern Brazil. Daily messages and weekly activities were sent by moderators to promote maternal-child outcomes: child nutrition, child sleep, nurturing care, and maternal psychosocial well-being (assessed pre- and post-intervention via self-reported questionnaire). The implementation and engagement of the mothers in the program were assessed by message extraction. Acceptability was evaluated through in-depth interviews (n = 5) and open-ended surveys (n = 10). 1481 messages were exchanged in 3 WhatsApp groups (n = 30 mothers). Mothers were most active on weekdays (68.6% of messages sent on Tuesdays and 72.6% on Thursdays), afternoons (2:00-4:00pm), and evenings (9:00-11:00 pm). Engagement was higher at weeks 1-4. Mothers enjoyed and considered topics relevant. Group interaction was perceived as low, which influenced their participation. The prevalence of depression symptoms decreased from pre- to post-intervention (9% to 5%; P = .04). A moderated mobile-based support group for mothers of toddlers was feasible. mHealth services to promote maternal support are a promising strategy to improve maternal-child outcomes, but engagement and use of the service remains a challenge. Program managers should work with community members to identify ways to support engagement and participation throughout the intervention.

Maternal mental health before and during the COVID-19 pandemic in the 2019 Rio Grande birth cohort.

OBJECTIVE: To describe and compare measures of maternal depression, anxiety, and posttraumatic stress symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic in a Brazilian birth cohort. METHODS: All hospital births occurring in the municipality of Rio Grande (southern Brazil) during 2019 were identified. Mothers were invited to complete a standardized questionnaire on sociodemographic and health-related characteristics. Between May and July 2020, we tried to contact all cohort mothers of singletons, living in urban areas, to answer a standardized web-based questionnaire. They completed the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder 7-item (GAD-7) in both follow-ups, and the Impact of Event Scale (IES) in the online follow-up. RESULTS: We located 1,136 eligible mothers (n=2,051). Of those, 40.5% had moderate to severe stress due to the current pandemic, 29.3% had depression, and 25.9% had GAD. Mothers reporting loss of income during the pandemic (57.2%) had the highest proportions of mental health problems. Compared to baseline, the prevalence of depression increased 5.7 fold and that of anxiety increased 2.4-fold during the pandemic (both p < 0.001). CONCLUSION: We found a high prevalence of personal distress due to the ongoing COVID-19 pandemic, and a clear rise in both maternal depression and anxiety.

Maternal perinatal depression and infant sleep problems at 1 year of age: Subjective and actigraphy data from a population-based birth cohort study.

This study used data from 2,222 mothers and infants participating in a population-based birth cohort to verify whether maternal depression in the perinatal period was associated with poor infant sleep. Mothers who scored ≥13 points on the Edinburgh Postnatal Depression Scale at 16-24 weeks of gestation and/or 3 months after delivery were considered perinatally depressed. The main outcome variable was poor infant sleep at 12 months of age, defined as >3 night wakings, nocturnal wakefulness >1 hr or total sleep duration <9 hr. Infant sleep data were obtained with the Brief Infant Sleep Questionnaire (BISQ) and 24-hr actigraphy monitoring. Prevalence of perinatal depression in the sample was 22.3% (95% confidence interval [CI], 20.5-24.0). After Poisson regression, infants of depressed mothers showed an adjusted relative risk (RR) of 1.44 (95% CI, 1.00-2.08; p = .04) for >3 night wakings with questionnaire-derived data. When actigraphy data were analysed, no association was found between perinatal depression and poor infant sleep (adjusted RR, 1.20; 95% CI, 0.82-1.74; p = .35). In conclusion, although mothers in the depressed group were more likely to report more night wakings, objective data from actigraphy did not replicate this finding. Dysfunctional cognition, maternal behavioural factors and sleep impairment associated with perinatal depression may affect the mother's impression of her infant's sleep.

Maternal intention to breastfeed, duration of breastfeeding and reasons for weaning: a cohort study, Pelotas, RS, Brazil, 2014. / Intenção de amamentar, duração do aleitamento materno e motivos para o desmame: um estudo de coorte, Pelotas, RS, 2014.

OBJECTIVE: to evaluate maternal intention to breastfeed, duration of breastfeeding up to 24 months-of-age and reasons for weaning in the first year of life. METHODS: this was a cohort study conducted in Pelotas, RS, Brazil, with participants from the Multi-Center Body Composition Study; a life table was used to analyze duration of breastfeeding. RESULTS: of the 1377 mothers screened, 74.3% reported intending to exclusively breastfeed up until 6 months, while 91.1% intended to prolong breastfeeding until at least 12 months; 58.0% of children were breastfed up to at least 6 months; median breastfeeding duration was 10.8 months (IQR: 5.8 - 23.0); the main reasons reported for weaning were insufficient breast milk (57.3%), return to work/school (45.5%), and unexplained refusal by the baby (40.1%). CONCLUSION: the results show that despite the intention to breastfeed, there are still structural and social barriers that interfere with successful breastfeeding, especially those related to working mothers.

Validity of the Brief Infant Sleep Questionnaire (BISQ) in Brazilian children.

OBJECTIVE: To investigate the validity of the Brief Infant Sleep Questionnaire (BISQ), in assessing sleep quality in childhood. METHODS: This was a validation study with children from the Pelotas 2015 Birth Cohort. BISQ was applied to mothers when their children were 3, 6, 12, and 24 months of age. The poor sleep indicators analysed, as defined by BISQ, were >3 wakings per night, nocturnal wakefulness >1 h and total sleep duration <9/24 h, compared to number of wakings per night and nocturnal and total sleep duration defined by actigraphy taken as the gold standard. The Actiwatch wGT3X-BT device was used by the child consecutively during five days at three and six months and for three days at 12 and 24 months. At each age the prevalence, sensitivity, specificity, accuracy, and positive (PPV) and negative predictive values (NPV) of each sleep indicator was calculated. RESULTS: A total of 586 children were enrolled in the study. Nocturnal wakefulness >1 h was the most frequent indicator at all ages, with higher sensitivity (varying from 27.5% at six months to 54.8% at three) and lower specificity (53.4% at three months to 79.4% at six months), in comparison to the other sleep indicators. Specificity for >3 wakings and total sleep duration <9 h was greater than 85.0% at all the ages. Higher accuracies were observed for total sleep <9 h at 3 (85.6%), 6 (88.2%) and 12 months (73.6%) and for > 3 wakings at 24 months (84.5%). The sensitivity for the presence of at least one indicator decreased with age from 56.0% at three months to 35.8% at 24 months, whereas the specificity increased from 50.6% at three months to 63.8% at 24 months. CONCLUSION: The high specificity of the BISQ sleep parameters supports the validity of parents' reports on sleep-related problems in childhood for use in epidemiological studies.

Is social jetlag similar to travel-induced jetlag? Results of a validation study.

Social jetlag (SJL) is defined as the misalignment between the biological clocks and the social clock imposed by work and social constraints. In order to accomplish the workdays duties, people tend to not respect the internally sleep-wake cycle during the week, often using alarm clock to wake-up, which would lead to a chronic form of travel-induced jetlag. This circadian misalignment has been found to be associated with increased health risk and health-impairing behaviors. In this cross-sectional study, we aimed to explore whether the SJL is a valid concept for the travel-induced jetlag symptoms, as well as what is the cutoff point with best parameters for defining the presence of SJL, in a sample of undergraduate students of a university in Southern Brazil. We assessed SJL by the Munich ChronoType Questionnaire (MCTQ) and defined the concept as the difference between the midsleep point on free days and the midsleep point on classes days. The gold standard was defined as having at least one travel-induced jetlag symptom (fatigue, sleepiness or difficulty concentrating). Relative SJL, sensitivity and specificity were calculated for different cutoff points, plotted on ROC curves. A total of 452 students with complete sleep information were included in the analysis. The relative SJL mean was 2 h 23 min (SD = 1 h 24 min; range -3 h to 7 h 58 min) and 63.7% of the students had ≥2 h of relative SJL. All the tested cutoff points of the instrument had low sensitivity and specificity values, covering a small area under the ROC curve (0.487). The best parameters were for the cutoff point ≥2 h, with 63.4% sensitivity and 35.9% specificity. SJL did not revealed to be a valid concept for the studied sample comparing it to travel-induced jetlag symptomatology. One possible explanation for the lack of validity of our results regards the fact that SJL may not have the same apparent wide-term effects as the travel-induced jetlag. Then, the symptoms of SJL do not well represent the symptoms of travel-induced jetlag.

The Role of Sleep Duration and Sleep Problems During Childhood in the Development of ADHD in Adolescence: Findings From a Population-Based Birth Cohort.

Objective: We aimed to investigate the association between sleep in early life and ADHD in adolescence. As a secondary analysis, we tested whether the associations may be specific to ADHD. Method: Data from 3,467 participants of the 2004 Pelotas Birth Cohort were used. Information on their sleep duration and problems was collected at 12, 24, and 48 months of age. ADHD diagnosis and hyperactivity/inattention problems were assessed with the Development and Well-Being Assessment (DAWBA) and the Strengths and Difficulties Questionnaire (SDQ) among participants at 11 years of age. Results: Difficulty going to sleep at 24 months, nightmares at 24 months and at 48 months, and restless sleep at 48 months were consistently associated with ADHD as well as with other mental disorders. Conclusion: The results suggest that sleep disturbances may be more important ADHD predictors than sleep duration or sleep duration trajectories. However, it may also be considered early markers of other mental disorders.

Intenção de amamentar, duração do aleitamento materno e motivos para o desmame: um estudo de coorte, Pelotas, RS, 2014 / Intención de amamantar, duración de la lactancia materna y motivos para la ablactación: estudio de cohorte, Pelotas, RS, Brasil, 2014 / Maternal intention to breastfeed, duration of breastfeeding and reasons for weaning: a cohort study, Pelotas, RS, Brazil, 2014

Resumo Objetivo: avaliar a intenção materna de amamentar, duração do aleitamento materno até os 24 meses e os motivos para o desmame no primeiro ano de vida. Métodos: trata-se de estudo de coorte realizado em Pelotas, RS, Brasil, com participantes do Multi-Centre Body Composition Study; para a análise da duração da amamentação, utilizou-se tábua de vida. Resultados: das 1.377 mães rastreadas, 74,3% relataram intenção de amamentar exclusivamente até os 6 meses, enquanto 91,1% pretendiam prolongar o aleitamento materno até pelo menos os 12 meses; até pelo menos 6 meses, 58,0% das crianças foram amamentadas; a mediana da amamentação foi de 10,8 meses (IIQ: 5,8 a 23,0); os principais motivos relatados para desmame foram leite insuficiente (57,3%), retorno ao trabalho/escola (45,5%) e recusa inexplicável do bebê (40,1%). Conclusão: apesar da intenção de amamentar, persistem barreiras estruturais e sociais que interferem no sucesso da amamentação, especialmente as relacionadas ao trabalho materno.

Resumen Objetivo: evaluar la intención materna de amamantar, la duración de la lactancia materna hasta los 24 meses de edad y los motivos para la ablactación en el primer año de vida. Métodos: se trata de un estudio de cohorte realizado en Pelotas, RS, Brasil, con participantes del Multi-Centre Body Composition Study; para el análisis de la duración de la lactancia, se utilizó la tabla de vida. Resultados: de las 1.377 madres rastreadas, el 74,3% tenía intención de amamantar exclusivamente hasta los 6 meses, mientras que el 91,1% pretendía prolongarla hasta por lo menos los 12 meses; el 58,0% de los niños fueron amamantados hasta, al menos, los 6 meses; la mediana de la lactancia fue de 10,8 meses (IIQ: 5,8 a 23,0); los principales motivos para el destete fueron: leche insuficiente (57,3%), retorno al trabajo/escuela (45,5%) y la negativa inexplicable del bebé (40,1%). Conclusión: los resultados muestran que, a pesar de la intención de amamantar, todavía hay barreras estructurales y sociales que interfieren en el éxito de la lactancia, especialmente los relacionados con el trabajo materno.

Abstract Objective: to evaluate maternal intention to breastfeed, duration of breastfeeding up to 24 months-of-age and reasons for weaning in the first year of life. Methods: this was a cohort study conducted in Pelotas, RS, Brazil, with participants from the Multi-Center Body Composition Study; a life table was used to analyze duration of breastfeeding. Results: of the 1377 mothers screened, 74.3% reported intending to exclusively breastfeed up until 6 months, while 91.1% intended to prolong breastfeeding until at least 12 months; 58.0% of children were breastfed up to at least 6 months; median breastfeeding duration was 10.8 months (IQR: 5.8 - 23.0); the main reasons reported for weaning were insufficient breast milk (57.3%), return to work/school (45.5%), and unexplained refusal by the baby (40.1%). Conclusion: the results show that despite the intention to breastfeed, there are still structural and social barriers that interfere with successful breastfeeding, especially those related to working mothers.

Effect of Parental Counseling on Infants' Healthy Sleep Habits in Brazil: A Randomized Clinical Trial.

Importance: Poor sleep during early childhood is associated with adverse outcomes, including obesity, cognitive impairment, and mental and behavioral disorders. Objective: To assess the efficacy of an educational intervention in the promotion of nighttime sleep duration. Design, Setting, and Participants: This single-blind, intent-to-treat randomized clinical trial included participants in Pelotas, Brazil, aged 3 months who were followed up until age 24 months. Eligibility criteria included healthy infants aged approximately 3 months who slept less than 15 hours per 24 hours. Infants were randomized to the intervention group or control group. Interventions: Information on sleep characteristics, improvements in the environment, establishment of a nighttime sleep routine, and waiting before attending nocturnal awakenings was delivered to mothers in the intervention group by trained home-visitors at baseline. The intervention group received a telephone call on the first and second day after the intervention and a home visit on the third day after the intervention. The intervention's content was reinforced at health care visits for ages 6 months and 12 months. Mothers allocated to the control group were counseled on the benefits of breastfeeding for the mother's and child's health and given written material with content on breastfeeding. Main Outcomes and Measures: Nighttime sleep duration was measured by interview and actigraphy at baseline and ages 6, 12, and 24 months and diaries at baseline and age 6 months. At ages 3 and 6 months, nighttime sleep self-regulation was calculated by subtracting nighttime sleep duration recorded by actigraphy from nighttime sleep duration recorded in the diaries and at ages 12 and 24 months by subtracting nighttime sleep duration recorded by actigraphy from nighttime sleep duration obtained by interview. Results: Among 1812 mother-infant dyads invited to participate, 798 met the inclusion criteria and 586 agreed to participate. The intervention group included 298 infants (154 [52.9%] boys), and the control group included 288 infants (164 [58.2%] boys). At age 6 months, mean (SD) nighttime sleep duration recorded in diaries was 9.80 (1.85) hours in the intervention group and 9.49 (2.07) hours in the control group, a difference of 19 minutes longer for the intervention group. At age 12 months, mean (SD) nighttime sleep duration based on the Brief Infant Sleep Questionnaire was 8.43 (1.35) hours in the intervention group and 8.52 (1.35) hours in the control group, a difference of 5 minutes shorter for the intervention group. At age 24 months, compared with information from the interview, actigraphy records showed that children in the intervention group stayed awake at night without signalizing for a mean (SD) of 0.52 (2.52) hours, whereas children in the control group stayed awake at night without signalizing for a mean (SD) of 0.23 (2.43) hours. There were no statistically significant difference between groups in any of the sleep parameters investigated. Conclusions and Relevance: This randomized clinical trial found that the educational intervention did not achieve longer nighttime sleep duration among infants in the intervention group. Trial Registration: ClinicalTrials.gov identifier: NCT02788630.

Maternal depression symptoms and use of child health-care services at The Pelotas 2004 Birth Cohort.

OBJECTIVE: To investigate the influence of maternal depression on child health-care services utilization. METHODOLOGY: Data from The Pelotas 2004 Birth Cohort collected at birth and at 12- and 24-month follow-ups were used. Four outcomes occurring in the second year of life were investigated: number of well-baby visits, number of medical appointments, number of visits to emergency rooms, and number of hospitalizations. The main exposure was maternal depression symptoms at 12-month post-partum as assessed by the Edinburgh Postpartum Depression Scale (EPDS). Adjusted prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by Poisson regression. RESULTS: The prevalence of mothers with depressive symptoms was 27.6% (95% CI: 26.2-29.0%). These mothers showed a 10% lower probability of taking their children to well-baby visits (0.90; 0.85-0.95; p = 0.001); 16% higher probability to seek medical consultations (1.16; 1.09-1.25, p = 0.001); and they sought emergency services for their children more often (1.30; 1.17-1.45, p < 0.001) as compared to mothers who did not present depressive symptoms. Although the PR for hospitalizations was 26% higher for children from mothers with depressive symptoms, the association did not achieve statistical significance (1.26; 0.98-1.63; p = 0.072). CONCLUSION: Children from mothers with depressive symptoms attend fewer number of preventive consultations. In contrast, they are taken to medical and emergency care more often, suggesting that these children are given healthcare when they are at more advanced stages of their illnesses.

Dietary patterns and attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis.

BACKGROUND: The Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder characterized by persistent symptoms of inattention, impulsivity and hyperactivity. The diet during childhood has been investigated as a factor potentially involved in the ADHD etiology. OBJECTIVE: To review systematically the evidence of the association between dietary patterns and ADHD. METHODS: Two independent literature searches were carried out in PubMed, LILACS and PsycINFO databases. The studies included were only those that assessed dietary patterns and ADHD in children and adolescents. Due to heterogeneity between the studies random-effects models were used to pool the estimates. RESULTS: We included fourteen observational studies (four cohorts, five case-control and five cross-sectional studies). In the pooled analysis, healthy dietary patterns were protective against ADHD (OR: 0.65; 95% CI: 044 - 0.97), while unhealthy dietary patterns were found as risk to ADHD (OR: 1.41; 95% CI: 1.15-1.74). After stratifying the studies by design (cohort/case control or cross-sectional), continent (Europe or Asia/Oceania) and sample size (≥1000 or <1000) the effects remained. LIMITATIONS: Absence of randomized controlled trials at the literature on this subject and scarce evidence from more robust designs, such as cohort and case-control studies. CONCLUSION: This study suggests that a diet high in refined sugar and saturated fat can increase the risk, whereas a healthy diet, characterized by high consumption of fruits and vegetables, would protect against ADHD or hyperactivity. Nevertheless, giving the number and the design of most of the studies available in the literature, the current evidence is weak. More studies using longitudinal design need to be performed to reinforce this evidence.