Proper Sleep During Pregnancy for Mental Health of Newborn: An Evidence Based Appeal to Policy Makers
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In this letter to the editor/correspondence, the aim was to draw attention towards prevailing sleep loss during peri-partum in the present society that has serious consequences on the cognitive development of children. Recent research has provided several evidences for it and this issue is a big challenge of wider consideration and interest.
In the present society, where people are in the rat race for survival, adequate sleep and rest during the gestational period is a far cry for the large numbers of women who are working in offices, factories and at home. Sleep is compromised even in healthy women during normal pregnancy, especially during the last trimester, due to a variety of physiological and anatomical reasons . Severe sleep loss during pregnancy is a potential risk factor for gestational diabetes, preeclampsia, intrauterine growth restriction, preterm birth, depression and anxiety disorders [2, 3].
Pregnancy itself confers long-lasting changes in a woman’s brain . There will be more serious consequences, not only for the mother but also for the newborn, if there is severe reduction and fragmentation of sleep, especially during the last trimester of pregnancy [5, 6]. The maternal stress during the prenatal window results in various anxiety disorders and cognitive deficits in the offspring .
In spite of mounting evidences about serious consequences for the neural development of the newborn, health-care programmes all over the world do not give sufficient emphasis on sleep and avoidance of stress during pregnancy. One of the reasons for the neglect of this important aspect is the lack of experimental studies on the association of sleep loss during pregnancy and its consequences for the offspring. Such studies on human subjects are difficult to be undertaken due to practical problems and ethical issues. Epidemiological studies have indicated that poor outcomes in pregnancy, despite proper nutrition and health care, are related to sleep deprivation [2, 5, 6].
Apart from epidemiological human studies, there are enough animal experiments that show that sleep deprivation during pregnancy impairs the cognitive development of the offspring [8, 9, 10, 11]. Pregnancy-associated changes in sleep–wakefulness have been demonstrated in rats, which is the most common animal model for investigational research . Persistent high delta power during sleep, which is a marker for a homeostatic drive, during the last trimester and all through the lactation period strongly points to an unhidden need of good rest, which may not be reflected in traditional sleep quantity scores. Rapid eye movement (REM) sleep deprivation of the mother during pregnancy gave rise to depression-like symptoms in the offspring, whereas deprivation of non-REM and REM sleep together elicited hyperactivity and increased risk-taking behaviour in the offspring during its adolescence [8, 9, 10]. It may be noted that hyperactivity is one of the key symptoms in attention deficit hyperactivity disorder, which has a high prevalence in children (about 6–9%). Sleep deprivation during the third trimester of pregnancy delays the development of neural network for sleep–wakefulness in newborns . The brain development is fast during the last trimester and continues during the postnatal window. In human and altricial species, though the brain development during the postnatal period is crucial in determining cognitive functions, the impaired neural development during foetal life does influence emotional development in newborns.
With all these evidences, should we wait any longer to take measures to protect our future generation? The time has come to give a thrust to maternal health-care programmes that ensure proper sleep during pregnancy. Most countries have laws to provide maternity benefits to working women, and they are getting modified to provide better care to pregnant women. Indian Parliament, representing the largest democracy, took a leading role in March 2017 by raising the paid maternity leave from 12 to 26 weeks. There are a few small countries like Papua New Guinea, Suriname and Lesotho that do not guarantee paid maternity leave. Unfortunately, the USA also does not have a countrywide policy for paid maternity leave, even now.
The responsibility of the governments does not end with ensuring maternity leave to working women. It should ensure that every woman gets proper rest and sleep during pregnancy. There are millions of lady workers in unorganized sectors, in addition to unemployed women. It is the government’s responsibility to protect their physical and mental health. Anything that disturbs a pregnant woman physically or mentally will affect her sleep, which in turn will harm her unborn child. Prescribing medications to cope with sleep problems is counterproductive and harmful, especially for pregnant women. Sleep disruptions, not only during pregnancy, but also during postpartum lactation period should be viewed as an emerging health concern. We cannot afford to have a world population with poor physical and mental health. Strict laws and rational governmental policies should ensure that pregnant women are not subjected to manmade stress, and they should guarantee a worry-free period and proper sleep for expecting mothers.
The research grants from the Cognitive Science Research Initiation program of the Department of Science and Technology, India (SR/CSI/110/2012 and SR/CSRI/102/2014), to KKG and VMK is acknowledged.
Compliance with ethical standards
Conflict of interest
The authors declare no competing financial interests.
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