Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida
Autor(a) principal: | |
---|---|
Data de Publicação: | 2018 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da PUC_RS |
Texto Completo: | http://tede2.pucrs.br/tede2/handle/tede/8369 |
Resumo: | The period extending from pregnancy to the months following delivery, although usually associated to positive feelings, represents a moment of great vulnerability to the development of major depressive disorders. Perinatal depression is a frequent pathology, and its consequences extend beyond the mother, potentially affecting the relationship with her partner and family functioning. Early exposure to maternal depression is associated to lower breastfeeding rates, impairment of mother-infant bonding, and consequences over child growth and development. Perinatal depression has been linked to infant sleep disturbances as early as in the neonatal period, with description of more night wakings, shorter sleep duration and more fragmented sleep. Sleep plays a fundamental role in child cognitive, social, and emotional development, and its disturbances, in a crucial moment of brain development, may facilitate significant and persistent dysfunctions. Studies associating maternal depression to child sleep disturbances show important heterogeneity in terms of design as in moment of sleep assessment. Sleep patterns go through important changes throughout the first twelve months of life, rendering impaired the association’s precise evaluation, as well as that of its potential long-term consequences. This study aimed to investigate the association between perinatal depression and altered infant sleep macrostructure at one year of life among participants in a birth cohort. In this population-based study, recruitment was carried out from pregnancy to soon after delivery, aiming to include all livebirths in the municipality of Pelotas throughout the year of 2015. Participants to one or both cohort-nested trials and those lacking information on maternal depression were excluded from these analyses. For the diagnosis of perinatal depression, the Edinburgh Postnatal Depression Scale (EPDS) was completed during pregnancy and 3 months after delivery, having been considered perinatally depressed mothers who scored ≥13 points in one or both follow-ups. Infant sleep was assessed at 3 months through the Brief Infant Sleep Questionnaire (BISQ) and, at 12 months, through the same subjective questionnaire added to objective data derived from continuous 24-hour actigraphy. Main sleep outcomes were number of night time wakings, night vigil time and total sleep duration in 24 hours. The sample consisted of 2222 mothers/infants, in which prevalence of perinatal depression was of 22.3% (CI 95% 20.5-24). Adjusted analyses using Poisson’s regression from BISQ-derived data showed greater risk of >3 night time wakings at 12 months among infants of depressed mothers (RR 1.52; CI 95% 1.06-2.18; p=0.02). Actigraphic data did not, however, confirm those findings (adjusted RR=1.24; CI 95% 0.85-1.81; p=0.26). No association was found between perinatal depression and the other investigated sleep variables. This study suggests a potential defining role of dysfunctional cognition among mothers with a history of perinatal depression on infant sleep characteristics at the end of the first year of life. |
id |
P_RS_9ac5372bc9ae241f50f5c151ef5f4004 |
---|---|
oai_identifier_str |
oai:tede2.pucrs.br:tede/8369 |
network_acronym_str |
P_RS |
network_name_str |
Biblioteca Digital de Teses e Dissertações da PUC_RS |
repository_id_str |
|
spelling |
Nunes, Magda Lahorguehttp://lattes.cnpq.br/2543067198319684Hallal, Pedro Rodrigues Curihttp://lattes.cnpq.br/6116355397890812El Halal, Camila dos Santos2018-12-06T10:35:35Z2018-08-17http://tede2.pucrs.br/tede2/handle/tede/8369The period extending from pregnancy to the months following delivery, although usually associated to positive feelings, represents a moment of great vulnerability to the development of major depressive disorders. Perinatal depression is a frequent pathology, and its consequences extend beyond the mother, potentially affecting the relationship with her partner and family functioning. Early exposure to maternal depression is associated to lower breastfeeding rates, impairment of mother-infant bonding, and consequences over child growth and development. Perinatal depression has been linked to infant sleep disturbances as early as in the neonatal period, with description of more night wakings, shorter sleep duration and more fragmented sleep. Sleep plays a fundamental role in child cognitive, social, and emotional development, and its disturbances, in a crucial moment of brain development, may facilitate significant and persistent dysfunctions. Studies associating maternal depression to child sleep disturbances show important heterogeneity in terms of design as in moment of sleep assessment. Sleep patterns go through important changes throughout the first twelve months of life, rendering impaired the association’s precise evaluation, as well as that of its potential long-term consequences. This study aimed to investigate the association between perinatal depression and altered infant sleep macrostructure at one year of life among participants in a birth cohort. In this population-based study, recruitment was carried out from pregnancy to soon after delivery, aiming to include all livebirths in the municipality of Pelotas throughout the year of 2015. Participants to one or both cohort-nested trials and those lacking information on maternal depression were excluded from these analyses. For the diagnosis of perinatal depression, the Edinburgh Postnatal Depression Scale (EPDS) was completed during pregnancy and 3 months after delivery, having been considered perinatally depressed mothers who scored ≥13 points in one or both follow-ups. Infant sleep was assessed at 3 months through the Brief Infant Sleep Questionnaire (BISQ) and, at 12 months, through the same subjective questionnaire added to objective data derived from continuous 24-hour actigraphy. Main sleep outcomes were number of night time wakings, night vigil time and total sleep duration in 24 hours. The sample consisted of 2222 mothers/infants, in which prevalence of perinatal depression was of 22.3% (CI 95% 20.5-24). Adjusted analyses using Poisson’s regression from BISQ-derived data showed greater risk of >3 night time wakings at 12 months among infants of depressed mothers (RR 1.52; CI 95% 1.06-2.18; p=0.02). Actigraphic data did not, however, confirm those findings (adjusted RR=1.24; CI 95% 0.85-1.81; p=0.26). No association was found between perinatal depression and the other investigated sleep variables. This study suggests a potential defining role of dysfunctional cognition among mothers with a history of perinatal depression on infant sleep characteristics at the end of the first year of life.O período que se estende da gestação até os meses seguintes ao parto, apesar de normalmente associado a sentimentos positivos, representa um momento de grande vulnerabilidade ao desenvolvimento de quadros depressivos maiores. A depressão perinatal é um distúrbio frequente, cujas consequências se estendem para além da mulher acometida, potencialmente exercendo efeito sobre a relação com o parceiro e o funcionamento familiar. Exposição precoce a depressão materna associa-se a menores taxas de amamentação, prejuízo do vínculo com o bebê, e consequentes efeitos sobre o crescimento e desenvolvimento infantis. Evidências associam a depressão perinatal a distúrbios do sono da criança desde o período neonatal, sob a forma de maior número de despertares noturnos, menor duração de sono e maior fragmentação. O sono, por sua vez, exerce papel primordial no desenvolvimento cognitivo, social e emocional da criança, e seus distúrbios, em um período crucial do desenvolvimento cerebral, podem favorecer disfunções significativas e permanentes. Existe uma importante heterogeneidade em relação tanto ao delineamento dos estudos que associam depressão materna a distúrbios do sono na criança, quanto ao momento de avaliação do sono, que sofre mudanças significativas no decorrer dos primeiros doze meses de vida. Com isso, a avaliação dessa possível associação fica prejudicada, assim como a mensuração de suas consequências a longo prazo. Este estudo objetivou investigar a presença de associação entre depressão perinatal e alterações da macroarquitetura do sono de lactentes com um ano de vida, participantes de uma coorte de nascimentos. Neste estudo de base populacional, o recrutamento ocorreu desde a gestação até logo após o parto, visando incluir todos os nascidos vivos na cidade de Pelotas no transcorrer de 2015. Participantes de uma das intervenções aninhadas à coorte e aqueles sem informações referentes à depressão materna foram excluídos desta análise. Para diagnóstico de depressão perinatal, foi aplicada a Escala de Depressão Pós-natal de Edimburgo (EPDS) na gestação e 3 meses após o parto, tendo sido consideradas deprimidas as mães com pontuação ≥13 em um ou ambos os acompanhamentos. O sono dos lactentes foi avaliado aos 3 meses através do Brief Infant Sleep Questionnaire (BISQ) e, aos 12 meses, a partir dos mesmos dados subjetivos somados a informações objetivas obtidas a partir de 24 horas contínuas de actigrafia. Os principais desfechos de sono analisados foram o número de despertares noturnos, duração da vigília noturna, e tempo total de sono em 24 horas. A amostra constituiu-se de 2.222 mães e lactentes, na qual a prevalência de depressão perinatal foi de 22,3% (IC95% 20,5-24). Pelo BISQ, as análises ajustadas através de regressão de Poisson mostraram maior risco para >3 despertares noturnos aos 12 meses entre filhos de mães deprimidas (RR 1,52; IC95% 1,06-2,18; p=0,02). No entanto, a avaliação dos dados actigráficos não confirmou este achado (RR ajustado=1,24; IC95% 0,85-1,81; p=0,26). Não houve associação entre depressão perinatal e as demais variáveis do sono. Este estudo sugere um potencial papel definidor da impressão disfuncional entre mães com história de depressão perinatal sobre as características do sono dos lactentes ao final do primeiro ano de vida.Submitted by PPG Medicina e Ciências da Saúde (medicina-pg@pucrs.br) on 2018-12-04T18:22:09Z No. of bitstreams: 1 CAMILA_DOS_SANTOS_EL_HALAL.pdf: 6036562 bytes, checksum: 43db97c52dcd3d105fd3916ba1d0f0cd (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-12-06T10:22:40Z (GMT) No. of bitstreams: 1 CAMILA_DOS_SANTOS_EL_HALAL.pdf: 6036562 bytes, checksum: 43db97c52dcd3d105fd3916ba1d0f0cd (MD5)Made available in DSpace on 2018-12-06T10:35:35Z (GMT). No. of bitstreams: 1 CAMILA_DOS_SANTOS_EL_HALAL.pdf: 6036562 bytes, checksum: 43db97c52dcd3d105fd3916ba1d0f0cd (MD5) Previous issue date: 2018-08-17Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESapplication/pdfhttp://tede2.pucrs.br:80/tede2/retrieve/173663/TES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.jpghttps://tede2.pucrs.br/tede2/retrieve/189497/TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.jpgporPontifícia Universidade Católica do Rio Grande do SulPrograma de Pós-Graduação em Medicina e Ciências da SaúdePUCRSBrasilEscola de MedicinaDepressão PerinatalLactenteDistúrbios do SonoPerinatal DepressionInfantSleep DisordersCIENCIAS DA SAUDE::MEDICINADepressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vidainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisTrabalho será publicado como artigo ou livro60 meses06/12/2023-721401722658532398500500500600-224747486637135387-9693694523087866273590462550136975366info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSORIGINALTES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdfTES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdfapplication/pdf6036562https://tede2.pucrs.br/tede2/bitstream/tede/8369/5/TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf43db97c52dcd3d105fd3916ba1d0f0cdMD55THUMBNAILTES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.jpgTES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.jpgimage/jpeg4086https://tede2.pucrs.br/tede2/bitstream/tede/8369/4/TES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.jpgda91f89e2ddfbe0d386e012c8f88ba69MD54TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.jpgTES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.jpgimage/jpeg5955https://tede2.pucrs.br/tede2/bitstream/tede/8369/7/TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.jpg95ff9097bb1e9ca7157a968bf11b44dcMD57TEXTTES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.txtTES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.txttext/plain1137https://tede2.pucrs.br/tede2/bitstream/tede/8369/3/TES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.txt1b2edd55d1624bfa14b2c82a2006e450MD53TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.txtTES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.txttext/plain246180https://tede2.pucrs.br/tede2/bitstream/tede/8369/6/TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.txt6baa2164b15c7211cbfcbff785d3ebc4MD56LICENSElicense.txtlicense.txttext/plain; charset=utf-8590https://tede2.pucrs.br/tede2/bitstream/tede/8369/1/license.txt220e11f2d3ba5354f917c7035aadef24MD51tede/83692023-12-11 12:00:13.266oai:tede2.pucrs.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2023-12-11T14:00:13Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.por.fl_str_mv |
Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida |
title |
Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida |
spellingShingle |
Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida El Halal, Camila dos Santos Depressão Perinatal Lactente Distúrbios do Sono Perinatal Depression Infant Sleep Disorders CIENCIAS DA SAUDE::MEDICINA |
title_short |
Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida |
title_full |
Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida |
title_fullStr |
Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida |
title_full_unstemmed |
Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida |
title_sort |
Depressão materna no período perinatal e macroarquitetura do sono ao final do primeiro ano de vida |
author |
El Halal, Camila dos Santos |
author_facet |
El Halal, Camila dos Santos |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Nunes, Magda Lahorgue |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/2543067198319684 |
dc.contributor.advisor-co1.fl_str_mv |
Hallal, Pedro Rodrigues Curi |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/6116355397890812 |
dc.contributor.author.fl_str_mv |
El Halal, Camila dos Santos |
contributor_str_mv |
Nunes, Magda Lahorgue Hallal, Pedro Rodrigues Curi |
dc.subject.por.fl_str_mv |
Depressão Perinatal Lactente Distúrbios do Sono |
topic |
Depressão Perinatal Lactente Distúrbios do Sono Perinatal Depression Infant Sleep Disorders CIENCIAS DA SAUDE::MEDICINA |
dc.subject.eng.fl_str_mv |
Perinatal Depression Infant Sleep Disorders |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA |
description |
The period extending from pregnancy to the months following delivery, although usually associated to positive feelings, represents a moment of great vulnerability to the development of major depressive disorders. Perinatal depression is a frequent pathology, and its consequences extend beyond the mother, potentially affecting the relationship with her partner and family functioning. Early exposure to maternal depression is associated to lower breastfeeding rates, impairment of mother-infant bonding, and consequences over child growth and development. Perinatal depression has been linked to infant sleep disturbances as early as in the neonatal period, with description of more night wakings, shorter sleep duration and more fragmented sleep. Sleep plays a fundamental role in child cognitive, social, and emotional development, and its disturbances, in a crucial moment of brain development, may facilitate significant and persistent dysfunctions. Studies associating maternal depression to child sleep disturbances show important heterogeneity in terms of design as in moment of sleep assessment. Sleep patterns go through important changes throughout the first twelve months of life, rendering impaired the association’s precise evaluation, as well as that of its potential long-term consequences. This study aimed to investigate the association between perinatal depression and altered infant sleep macrostructure at one year of life among participants in a birth cohort. In this population-based study, recruitment was carried out from pregnancy to soon after delivery, aiming to include all livebirths in the municipality of Pelotas throughout the year of 2015. Participants to one or both cohort-nested trials and those lacking information on maternal depression were excluded from these analyses. For the diagnosis of perinatal depression, the Edinburgh Postnatal Depression Scale (EPDS) was completed during pregnancy and 3 months after delivery, having been considered perinatally depressed mothers who scored ≥13 points in one or both follow-ups. Infant sleep was assessed at 3 months through the Brief Infant Sleep Questionnaire (BISQ) and, at 12 months, through the same subjective questionnaire added to objective data derived from continuous 24-hour actigraphy. Main sleep outcomes were number of night time wakings, night vigil time and total sleep duration in 24 hours. The sample consisted of 2222 mothers/infants, in which prevalence of perinatal depression was of 22.3% (CI 95% 20.5-24). Adjusted analyses using Poisson’s regression from BISQ-derived data showed greater risk of >3 night time wakings at 12 months among infants of depressed mothers (RR 1.52; CI 95% 1.06-2.18; p=0.02). Actigraphic data did not, however, confirm those findings (adjusted RR=1.24; CI 95% 0.85-1.81; p=0.26). No association was found between perinatal depression and the other investigated sleep variables. This study suggests a potential defining role of dysfunctional cognition among mothers with a history of perinatal depression on infant sleep characteristics at the end of the first year of life. |
publishDate |
2018 |
dc.date.accessioned.fl_str_mv |
2018-12-06T10:35:35Z |
dc.date.issued.fl_str_mv |
2018-08-17 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://tede2.pucrs.br/tede2/handle/tede/8369 |
url |
http://tede2.pucrs.br/tede2/handle/tede/8369 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.program.fl_str_mv |
-721401722658532398 |
dc.relation.confidence.fl_str_mv |
500 500 500 600 |
dc.relation.department.fl_str_mv |
-224747486637135387 |
dc.relation.cnpq.fl_str_mv |
-969369452308786627 |
dc.relation.sponsorship.fl_str_mv |
3590462550136975366 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Pontifícia Universidade Católica do Rio Grande do Sul |
dc.publisher.program.fl_str_mv |
Programa de Pós-Graduação em Medicina e Ciências da Saúde |
dc.publisher.initials.fl_str_mv |
PUCRS |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Escola de Medicina |
publisher.none.fl_str_mv |
Pontifícia Universidade Católica do Rio Grande do Sul |
dc.source.none.fl_str_mv |
reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS instname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) instacron:PUC_RS |
instname_str |
Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) |
instacron_str |
PUC_RS |
institution |
PUC_RS |
reponame_str |
Biblioteca Digital de Teses e Dissertações da PUC_RS |
collection |
Biblioteca Digital de Teses e Dissertações da PUC_RS |
bitstream.url.fl_str_mv |
https://tede2.pucrs.br/tede2/bitstream/tede/8369/5/TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf https://tede2.pucrs.br/tede2/bitstream/tede/8369/4/TES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.jpg https://tede2.pucrs.br/tede2/bitstream/tede/8369/7/TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.jpg https://tede2.pucrs.br/tede2/bitstream/tede/8369/3/TES_CAMILA_DOS_SANTOS_EL_HALAL_CONFIDENCIAL.pdf.txt https://tede2.pucrs.br/tede2/bitstream/tede/8369/6/TES_CAMILA_DOS_SANTOS_EL_HALAL_COMPLETO.pdf.txt https://tede2.pucrs.br/tede2/bitstream/tede/8369/1/license.txt |
bitstream.checksum.fl_str_mv |
43db97c52dcd3d105fd3916ba1d0f0cd da91f89e2ddfbe0d386e012c8f88ba69 95ff9097bb1e9ca7157a968bf11b44dc 1b2edd55d1624bfa14b2c82a2006e450 6baa2164b15c7211cbfcbff785d3ebc4 220e11f2d3ba5354f917c7035aadef24 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 MD5 MD5 MD5 |
repository.name.fl_str_mv |
Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) |
repository.mail.fl_str_mv |
biblioteca.central@pucrs.br|| |
_version_ |
1799765336968396800 |