Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses.

Introduction
Sleep disturbances are common during pregnancy, yet underdiagnosed and under-investigated. We evaluated sleep quality during pregnancy and assessed associated factors, especially depressive and anxiety symptoms.

Material and methods
A total of 78 healthy pregnant women from the FinnBrain Birth Cohort Study were studied twice prospectively during pregnancy (in mid-pregnancy and late pregnancy). Sleep quality was evaluated by the Basic Nordic Sleep Questionnaire, depressive symptoms by the Edinburgh Postnatal Depression Scale, and anxiety symptoms by the State-Trait Anxiety Inventory.

Results
Poor general sleep quality, difficulty falling asleep, the number of nocturnal awakenings per night, and too-early morning awakenings increased in late pregnancy compared with mid-pregnancy (all p-values < 0.020). The total insomnia score (p < 0.001) and sleep latency increased (p = 0.005), but sleep duration and preferred sleep duration did not change. Women tended to snore more often in late pregnancy, but apneas remained rare. Almost one-fourth of the women reported both morning and daytime sleepiness, but the frequencies did not increase during the follow up. In late pregnancy, depressive and anxiety symptoms were cross-sectionally related to sleep disturbances, but depressive or anxiety symptoms in mid-pregnancy were not associated with sleep disturbances in late pregnancy.

Conclusions
We found deterioration in sleep quality across pregnancy. However, no increase in negative daytime consequences was found, presumably indicating a compensatory capacity against sleep impairment. Additionally, depressive and anxiety symptoms and sleep disturbances were only cross-sectionally associated. Our study calls for further research on the factors that influence sleep disturbances during pregnancy.

Sleep quality during pregnancy: associations with depressive and anxiety symptoms

Evidence suggests that excessive screen time in early childhood is related to children’s physical and mental health. This study aimed to review the relationships between screen media use and several health indicators in infants, toddlers, and preschoolers. A systematic search was conducted by two independent reviewers on PubMed, Web of Science, Embase, and Cochrane Library to identify the eligible studies, with an end date of 13 August 2019. Included studies (published in English) were peer-reviewed and met the determinate population (children aged 0–7 years with screen media exposure and related health outcomes). The AHRQ, NOS, and the Cochrane Handbook were used to evaluate the cross-sectional study, cohort study, and RCT, respectively. A meta-analysis and narrative syntheses were employed separately. Eighty studies (23 studies for meta-analysis) met the inclusion criteria for the systematic review. Strong evidence of the meta-analysis suggested that excessive screen time was associated with overweight/obesity and shorter sleep duration among toddlers and preschoolers. Excessive screen use was associated with various health indicators in physical, behavioral, and psychosocial aspects. Better-quality research on newer media devices, on various kinds of contents in young children, and on dose–response relationships between excessive screen use and health indicators are needed to update recommendations of screen use.

https://www.mdpi.com/1660-4601/17/19/7324/pdf

The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review.

The impact of screen‐based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0–6 years. The search identified 35,868 records, 1035 full‐text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties—reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.13260

Measurement of screen time among young children aged 0-6 years: A systematic review.

Background: The negative effects of sedentary behavior (SB) on public health have been extensively documented. A large number of studies have demonstrated that high prevalence of SB is a critical factor of all-cause mortality. Globally, the frequency of SB research has continued to rise, but little is known about SB in the Chinese population. Therefore, this review was conducted to scope the research situation and to fill the gaps related to the effects of SB in the Chinese population. Methods: Using a scoping review based on York methodology, a comprehensive search of published journal articles and grey literature was carried out through 12 databases. The literature research was conducted by two authors in July 2019, and included journal articles that targeted on the Chinese population were published between 1999 and 2019. The two authors screened the records independently and included those research topics related to SB in the Chinese population. Results: The number of included studies increased from 1 to 29 per year during the analyzed period, during which, a remarkable climb happened from 8 in 2013 to 19 in July 2019. Out of the 1303 screened studies, a total of 162 studies (81 English and 81 Chinese journal articles) met the inclusion criteria in this review. Most of the included studies (66.0%) reported the overall estimated prevalence of SB, in which, 43.2% of studies reported the average time of SB, and 40.0% of studies reported the cutoff point of SB. Besides this, 54.9% and 23.5% of studies focused on the outcomes and correlates/determinants of SB, and the proportions of studies based on testing the validation of measurement tools and on interventions were 3.7% and 4.9%, respectively. Nearly all of the reviewed articles used data from cross-sectional studies (75.9%) and longitudinal studies (13.6%), while intervention trials are less developed. The majority of the studies (64.8%) used self-reported surveys, and only 3.7% studies used device-based measurement tools. Furthermore, 35.8% of the included studies were focused on children and adolescents, while only a few studies investigated infants/toddlers and older adults. Both female and male were examined in most studies, and non-clinical populations were investigated in the context of SB in a relatively large number of studies. Conclusions: The number of research articles on SB in the Chinese population published per year has increased year by year, indicating a growing interest in this research area. More studies using population subgroup samples are needed, particularly among infants/toddlers, older adults, and clinical populations. To provide stronger evidence of the determinants and outcomes of SB, longitudinal studies using device-based measures of SB are required.

https://www.mdpi.com/1660-4601/17/10/3576/pdf

Sedentary Behavior Research in the Chinese Population: A Systematic Scoping Review.

The sleep quality of pregnant women in the third trimester is related to mental health. However, there is still a lack of large-scale cohort research exploring this relationship in the second trimester. Thus, we assessed the associations of sleep quality during the second trimester with antenatal stress and antenatal and postnatal depression. We examined 1152 pregnant women from a prospective cohort study in China to assess the associations of sleep quality in the second trimester with antenatal stress, antenatal depression, and postnatal depression. We used linear regression models and logistic regression models to examine the associations of sleep quality (Pittsburgh Sleep Quality Index [PSQI]) during pregnancy with perinatal stress (Pregnancy Pressure Scale [PPS]) and depression (Edinburgh Postnatal Depression Scale [EPDS]) status. We further assessed the relationship in groups divided according to maternal age. PSQI scores were positively associated with antenatal PPS scores (β: 1.52, 95% confidence interval [CI]: 1.28, 1.76), antenatal EPDS scores (β: 0.68, 95% CI: 0.58, 0.78), and postpartum EPDS scores (β: 0.51, 95% CI: 0.38, 0.64). Poor sleep quality (PSQI scores ≥5) was associated with antenatal stress status (odds ratio [OR]: 2.60, 95% CI: 1.79, 3.77), antenatal depression status (OR: 3.42, 95% CI: 2.48, 4.72), and postpartum depression status (OR: 2.40, 95% CI: 1.58, 3.64) after adjusting maternal age, BMI, gestational age, smoking, educational level, annual household income and social support. The association of poor sleep quality (PSQI scores ≥5) in the second trimester with postnatal depression status was significant among women more than or equal to 30 years old (OR: 4.12, 95% CI: 2.18, 7.78) but not among women less than 30 years old after adjusting covariates above. Poor sleep quality in the second trimester among Chinese pregnant women is associated with stress and depression symptoms. Strategies to boost sleep quality should be considered during prenatal health care to improve women’s mental health status.

/pdf/association-of-sleep-quality-during-pregnancy-with-stress-3n59ghq90l.pdf

Association of sleep quality during pregnancy with stress and depression: a prospective birth cohort study in China

Background Obese women with gestational diabetes mellitus (GDM) have a higher risk of adverse outcomes than women with obesity or GDM alone. Our study is aimed at investigating the discriminatory power of circulatory Wnt1-inducible signaling pathway protein-1 (WISP1), a novel adipocytokine, on the copresence of prepregnancy overweight/obesity and GDM and at clarifying the relationship between the WISP1 level and clinical cardiometabolic parameters. Methods A total of 313 participants were screened from a multicenter prospective prebirth cohort: Born in Shenyang Cohort Study (BISCS). Subjects were examined with a 2 × 2 factorial design for body mass index (BMI) ≥ 24 and GDM. Between 24 and 28 weeks of pregnancy, follow-up individuals underwent an OGTT and blood sampling for cardiometabolic characterization. Results We observed that the WISP1 levels were elevated in prepregnancy overweight/obesity patients with GDM, compared with nonoverweight subjects with normal blood glucose (3.45 ± 0.89 vs. 2.91 ± 0.75 ng/mL). Multilogistic regression analyses after adjustments for potential confounding factors revealed that WISP1 was a strong and independent risk factor for prepregnancy overweight/obesity with GDM (all ORs > 1). In addition, the results of the ROC analysis indicated that WISP1 exhibited the capability to identify individuals with prepregnancy overweight/obesity and GDM (all AUC > 0.5). Finally, univariate and multivariate linear regression showed that WISP1 level was positively and independently correlated with fasting blood glucose, systolic blood pressure, and aspartate aminotransferase and was negatively correlated with HDL-C and complement C1q. Conclusions WISP1 may be critical for the prediction, diagnosis, and therapeutic strategies against obesity and GDM in pregnant women.

/pdf/association-of-wisp1-ccn4-with-risk-of-overweight-and-1wcy1wtmd5.pdf

Association of WISP1/CCN4 with Risk of Overweight and Gestational Diabetes Mellitus in Chinese Pregnant Women

Television (TV) viewing may affect children’s obesity status. In the present study the association between TV viewing and early childhood overweight/obese status was investigated as well as the association based on age difference. The present study included 933 children 1–5 years of age that were individually matched on a 1:2 (cases: controls) ratio based on age and community. Cochran-Mantel-Haenszel test was used to evaluate the association between TV viewing time and the related unhealthy behaviors. Conditional logistic regression models were used to quantify the association between TV viewing and children overweight/obese status in two age groups. The effects of TV viewing-related behaviors on the associations were further investigated. TV viewing time > 1 h was positively associated with the prevalence of TV viewing-related unhealthy behaviors (P < 0.05). After controlling for these behaviors, the association between TV viewing and childhood overweight/obese status was significant among 4- to 5-year-old children (odds ratio, OR = 1.72, 95% confidence interval, CI: 1.16––2.54), but not significant among 1- to 3-year-old children. Childhood overweight/obese status was positively associated with longer TV viewing time only among 4- to 5-year-old children. The results from the present study may help in identifying the population susceptible for overweight and obesity caused by TV viewing.

/pdf/association-between-television-viewing-and-early-childhood-4eot2sqqt3.pdf

Association between television viewing and early childhood overweight and obesity: a pair-matched case-control study in China

The study aims to use the cross-lagged model and utilize data from the Born in Shenyang Cohort Study to characterize the bidirectional associations of the term-born infants’ neurodevelopment in five domains and physical growth in early life. This study consists of 688 mother-child dyads from the Born in Shenyang Cohort Study. Infants’ anthropometric (weight and length) and development in neurological outcomes (Gesell Development Scale) were measured at the age of 6 and 12 months. Cross-lagged analyses and multiple linear regression analyses were used to explore the longitudinal relationships in both directions. In terms of longitudinal studies, the inverse associations between infants’ two skills (gross motor and social behavior) at the age of 6 months with BMI Z -scores at the age of 12 months (gross motor: aβ = − 0.20, 95% CI: − 0.31 to- 0.09; social behavior: aβ = − 0.23, 95% CI: − 0.33 to- 0.13) were found. Conversely, a higher infant Z -scored BMI at the age of 6 months predicted a lower gross motor at the age of 12 months (aβ = − 0.08, 95% CI: − 0.12 to- 0.04). In cross-lagged analyses, an adverse association in both directions between gross motor and Z -scored BMI was observed. We found bidirectional relationships between infants’ neurodevelopment of gross motor with physical growth and suggested the term-born infants, who are on the edge of the developmental danger, should not be overlooked.

/pdf/bidirectional-association-of-neurodevelopment-with-growth-a-2ytydopd3m.pdf

Liu Yang

Papers

Association of sleep quality during pregnancy with stress and depression: a prospective birth cohort study in China

Association of WISP1/CCN4 with Risk of Overweight and Gestational Diabetes Mellitus in Chinese Pregnant Women

Association between television viewing and early childhood overweight and obesity: a pair-matched case-control study in China

Bidirectional association of neurodevelopment with growth: a prospective cohort study.