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Santos, Alicia Matijasevich and Marlos R. Domingues Pediatrics 2012;129;860; originally published online April 2, 2012; DOI: 10.1542/peds.2011-1773
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2012 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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E-mail: coriolis@vetorial. MD.a MD.c aPostgraduate Program in Epidemiology and bPostgraduate Program in Physical Education. and behavioral characteristics. Nearly 20% were heavy consumers ($300 mg/day) during pregnancy and 14. PhD. Escola Superior de Educação Física. infant.aappublications. 2004” conducted by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas.pediatrics. National Support Program for Centers of Excellence. 95% conﬁdence interval: 0. 1098-4275). RESULTS: The subsample included 885 of the 4231 infants born in 2004. Online. The highest prevalence ratio was observed among breastfed infants from mothers consuming $300 mg/day during the whole pregnancy and in the postpartum period (1. Federal University of Pelotas.2011-1773 doi:10. coffee ABBREVIATION CI—95% conﬁdence interval Dr Santos conceived and planned the study and drafted the article. FUNDING: This article is based on data from the study “Pelotas birth cohort. Santos. Multivariable analysis was performed by using Poisson regression. Brazil. Drs Matijasevich and Domingues contributed in the analyses.Maternal Caffeine Consumption and Infant Nighttime Waking: Prospective Cohort Study WHAT ’S KNOWN ON THIS SUBJECT: Fetus and infants until 3 months of age are unable to metabolize caffeine.129:860–868 860 SANTOS et al Downloaded from pediatrics.65. Pediatrics 2012. infant sleeping. All but 1 mother consumed caffeine in pregnancy.3 episodes per night) was 13. sleep duration. PhDb. PhD.a and Marlos R.2011-1773 Accepted for publication Dec 22. all authors contributed to interpretation of data and approved the submitted version of the article. Rua Luiz de Camões. Pelotas. Little is known about the effect of caffeine consumption by pregnant or nursing mothers over infant sleeping. Domingues.8% (95% conﬁdence interval: 11. caffeine may interfere with sleep onset and have a dose-response effect similar to those seen during insomnia. sociodemographic. we aimed to investigate if maternal caffeine consumption during pregnancy and lactation leads to frequent nocturnal awakening among infants at 3 months of age.org/cgi/doi/10. Brazil.86–3.1542/peds. during 2004 were enrolled on a cohort study. Domingues. CONCLUSIONS: Caffeine consumption during pregnancy and by nursing mothers seems not to have consequences on sleep of infants at the age of 3 months.org at Indonesia:AAP Sponsored on May 2.net PEDIATRICS (ISSN Numbers: Print. 2011 Address correspondence to Marlos R. Prevalence of frequent nighttime awakeners (. night waking. The 2004 birth cohort study is currently supported by the Wellcome Trust Initiative entitled Major Awards for Latin America on Health Consequences of Population Change. www. METHODS: All children born in the city of Pelotas. heavy consumption ($300 mg/day) did not increase the number of nighttime awakenings by their 3-month-old infants. 625 Pelotas/RS CEP 96055-630. Brazil KEY WORDS sleep. reproductive.0%). WHAT THIS STUDY ADDS: In this setting where caffeine is largely consumed in pregnancy and by nursing mothers. 0031-4005. PhD. Pelotas.a Alicia Matijasevich. In adults. abstract OBJECTIVE: Coffee and other caffeinated beverages are commonly consumed in pregnancy. Mothers were interviewed at delivery and after 3 months to obtain information on caffeine drinking consumption. caffeine. AUTHORS: Iná S. 2012 . which crosses the placenta and in adults has a somnolytic effect. the Brazilian National Research Council.3% at 3 months postpartum. Federal University of Pelotas. nighttime waking is a common event. Night waking was deﬁned as an episode of infant arousal that woke the parents during nighttime.17) but at a nonsigniﬁcant level.1542/peds.5%– 16. and cPhysical Activity Epidemiology Research Group. With this study. In infancy. and the Children’s Mission. Previous phases of the study were supported by the World Health Organization. Infant sleeping pattern in the previous 15 days was obtained from a subsample. Copyright © 2012 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no ﬁnancial relationships relevant to this article to disclose. the Brazilian Ministry of Health.
and her subjective assessment of quality of the child’s sleeping pattern. mothers were asked about the size of the spoon used to serve and the number of spoons per serving.12 However.18–21 Maternal caffeine intake may affect the fetus for several reasons11: caffeine readily crosses the placenta.25 mg/mL (45 mg per cup of 180 mL). and amount consumed per serving to establish the average daily amount of caffeine per trimester. as used previously in another study21: samples of ﬁltered coffee (without adding sugar or milk) and the used leaves of mate drink were collected at households and assessed for caffeine content by liquid chromatography. the analyses revealed an average concentration of 17 mg of caffeine per 100 mL of liquid (∼10 mg per gourd).4–7 Higher prevalence of night waking in infancy has been associated with male gender.8 mg per cup). rapid response to infant frets and cries.1–3 and poor sleep may affect the functioning of both children and their parents. cause for nighttime waking (sickness or other reasons). Mothers were asked to report for the 15 days before the interview the number of hours the infant had slept during the day and during the night. Caffeine variables in milligrams were generated considering the source. For mate drink.11 mg/mL (19.5. nighttime waking is a common event.15 Habitual coffee drinkers show little sensitivity to its effects on sleep.17 Coffee and other caffeinated beverages are commonly consumed in pregnancy.13. and to investigate whether maternal caffeine consumption during pregnancy and lactation would lead to more frequent nocturnal awakening episodes among infants at 3 months of age. lower socioeconomic groups. alcohol consumption during pregnancy. May 2012 This study was planned to assess prevalence of heavy caffeine consumption by pregnant and nursing women. Caffeine intake was assessed considering all 3 trimesters of pregnancy and the ﬁrst 3 months postpartum (to explore if it could inﬂuence child’s sleep behavior through breastfeeding). infants until 3 months of age are unable to metabolize caffeine.28 who attended to nighttime waking. to describe nocturnal sleep pattern at 3 months of age. Number 5. it was possible to infer the following average milligram of caffeine per milliliter: strong coffee. 0.org at Indonesia:AAP Sponsored on May 2. Mothers were interviewed at the hospital soon after birth. interindividual differences in sensitivity to the effects of caffeine on sleep have been described. schooling. skin color.aappublications. frequency. Furthermore. living with or without a partner. Other exposures investigated were maternal age in complete years.30 Caffeine sources analyzed were coffee (instant and ground) and mate (a hot tealike beverage highly consumed in this region of Brazil). Infants from mothers consuming $300 mg/day of caffeine (heavy consumers) were considered exposed. its halflife is increased in late gestation both in the mother and her fetus. 0.26. being nursed to sleep. The manufacturer’s information of an average 3 mg of caffeine per gram of instant coffee powder was used. and there is a reuptake of caffeine from the amniotic ﬂuid through fetal swallowing. METHODS A birth cohort was started in 2004 in the city of Pelotas (Southern Brazil) and all live births were included between January 1 and December 31. number of waking up episodes during the night. parity. bed-sharing. From these analyses. paid work. For instant coffee. and children were examined (perinatal study). and 861 Downloaded from pediatrics. More details of the study can be found elsewhere.20 mg/mL (36 mg per cup). Spoon sizes were obtained from household measurements. These results were used to estimate caffeine intake of the whole cohort. frequent breastfeeding. 0. A caffeine consumer was deﬁned as the consumption of caffeine from any of those 2 sources at least once a week in at least 1 trimester of pregnancy.8–10 Caffeine is a central stimulant and somnolytic agent. amount smoked per day.25 PEDIATRICS Volume 129. the fetus has poor ability to metabolize caffeine. Night waking was deﬁned as an episode of infant arousal that woke the parents during nighttime. bedsharing during the night (mother and child sharing the same surface to sleep). The main exposure in study was the maternal heavy caffeine consumption ($300 mg/day).14. and weak coffee.11 Studies have revealed that caffeine interferes with sleep onset in adults and has a doseresponse effect similar to those seen during insomnia. medium strength coffee.29.24 turning the newborn exposed to caffeine through breastfeeding.ARTICLE In infancy. and infant-demanding parenting method of care (prolonged holding.22 Caffeine is rapidly absorbed from the gastrointestinal tract23 and is distributed to saliva and milk of lactating women. smoking (at least 1 cigarette per day everyday in at least 1 trimester of pregnancy). and cosleeping with infants at night). preparing method. exclusive breastfeeding. family monthly income. 2012 . higher number of naps per day.3. which is excreted in nature through the urine. The child’s usual sleeping pattern was investigated for a subsample (all those born from October to December 2004).16 and sleep disturbances are unrelated to plasma caffeine concentrations. and it is not clearly established whether these differences could be attributable to the development of tolerance13 or depends on genetic modulation of its effect. Photographs of spoons were used during the interview to avoid misclassiﬁcation.27 The ﬁrst follow-up of the cohort took place when children were 3 months old.
2) 223 (29.20 20–35 .7) 194 (21.org at Indonesia:AAP Sponsored on May 2.9) 587 (19. a higher proportion of infants in the subsample belonged to wealthier families and was from mothers with higher education 862 and lower parity.1) 2535 (83.2) 446 (14.019 2495 (82.0) P . therefore.1) 479 (15.1) 423 (47. average SANTOS et al Downloaded from pediatrics.6) 196 (22.aappublications.1) 247 (27. To establish a cutoff point.6) 309 (10.9) .6) 556 (18.064 2533 (84.9) 516 (17.9) . The infants were categorized according to the number of night waking episodes in the previous 15 days. a hierarchical model was used to control for potential confounders.4) 182 (20.737 171 (19.8) 526 (70.8) 570 (18.218 850 (96.9) 1209 (40.1) .014 2457 (81. Proportion of heavy consumers of caffeine in the ﬁrst and second trimesters was higher in the subsample.0) 335 (38.8) 770 (87.3) 577 (19.10 Alcohol consumption No Yes Heavy caffeine consumption in the ﬁrst trimester of pregnancy No Yes Heavy caffeine consumption in the second trimester of pregnancy No Yes Heavy caffeine consumption in the third trimester of pregnancy No Yes Heavy caffeine consumption at 3 mo postpartum No Yes Infants Not Included in the 3-Mo Subsample (n = 3020) 630 (20.1) 480 (16. .8 6 0.318 514 (58.9) .8) .004 390 (44.11 analyses were repeated by using the latter.3) 1151 (38.4) 324 (10. and information on child sleeping was gathered for 885 infants in the subsample (Table 1).284 155 (66.7) 976 (32.522 638 (72.009 RESULTS The entire cohort had 4231 newborns.6) .5) 78 (33.6) . To explore possible dose-response relationship.5) 95 (10.2) 219 (7.3) 612 (20.8) 2926 (96. Values above the mean + 1SD were positive for this variable and.5) .9) 147 (16. infants usually waking up more than 3 times a night were considered as presenting frequent night waking.0) 115 (13.186 2574 (85.739 747 (84. y .2) 191 (21.1) 371 (41. Caffeine Intake Only 1 of the 885 women reported no caffeine consumption during pregnancy.1) 192 (21. The study protocol was approved by the Medical Research Ethics Committee of the Federal University of Pelotas. Because the locally measured levels of caffeine in ﬁltered coffee were substantially lower than the international reference levels of 80 mg of caffeine per 150 mL of ﬁltered coffee. For the analyses.4) 614 (20.4) 138 (15.9) 94 (3.9) 2125 (70.35 Maternal skin color White Black Other Parity 0 1–3 $4 Paid work during pregnancy No Yes Smoking during pregnancy No Yes Daily cigarettes during pregnancy 1–10 .5) .009 113 (13. Prevalence ratios and 95% conﬁdence intervals (95% CIs) were obtained through Poisson regression with robust variance.7) 55 (6. TABLE 1 Comparison Between the Subsample and the Remaining Cohort With Regard to Maternal Characteristics Variables Family income (quintiles) 1 (poorest) 2 3 4 5 (wealthiest) Living with partner Yes No Schooling.2) 810 (26.2) . the rationale was that among infants presenting night waking. and mothers were requested to ﬁll a written consent.5) 164 (18.31 Only infants from singleton pregnancies were included in the analyses.4) 689 (77.6) .6) 326 (37.3) 626 (70.1) 2210 (73. 2012 . In comparison with the rest of the cohort.7) 2220 (73. the mean number and SD of night waking episodes were calculated (1.190 638 (72.2) 1810 (59.8) 72 (8.9) 485 (16.1) 35 (3.maternal depression according to the Edinburgh Postnatal Depression Scale.1) Infants Included in the 3-Mo Subsample (n = 885) 157 (17.9) .0) 1252 (41.8) 87 (9.1) 1559 (51.9) 721 (81. y Up to 4 5–8 9–11 $12 Maternal age.5) 581 (19. and only variables associated to the outcome (P .1) .2) were kept in the regression.5) 293 (9. Among the consumers.9). caffeine intake was also analyzed as a continuous variable.9) 196 (22.1) 703 (79. Frequent night waking infants were deﬁned as those who woke up more than average in the previous 15 days.
1% of the infants was considered as regular or poor by their mothers.21 reinforcing the notion that coffee and mate consumption are deeply rooted cultural behaviors. At 3 months postpartum. heavy consumption was associated to higher maternal age and to maternal depression. and 14. Prevalence of frequent night waking was higher among these infants in comparison with those who were not exposed to maternal heavy caffeine consumption. More than three-quarters (75.86–3. this association was nonsigniﬁcant (22. Forty infants were exposed to caffeine in uterus and through breastfeeding. 7.114).4% (95% CI: 19. Heavy consumption was reported by ∼20% of mothers. and 14.4%).7 per night and 4.3% (95% CI: 12. as previously mentioned. 22.1% (95% CI: 21.17) but at a nonsigniﬁcant level.3%).4 6 3.6%–23. and third trimester. An experimental study34 revealed that in comparison with caffeine-naive fetuses. Some mothers presented heavy caffeine consumption throughout pregnancy and during the 3 months postpartum ( n = 62. The characteristics of mothers reporting heavy consumption are presented in Table 2.7 in daytime). none of the heavy consumption variables were associated to frequent night waking. the amount reported by consumerswas on average 144 mg/day.ARTICLE intake decreased with the progress of gestation: 178. and 54. It is possible. Generally.7% of them had woken every night (generally twice or more at the same night).6%– 25.14 We assessed the effect of caffeine on child’s crying (a symptom of infant activity) and colic at 3 months of age for the entire cohort (n = 3985).65.32. 175.1% of them are frequent nighttime awakeners. Table 3 presents the distribution of frequent night waking according to maternal and child characteristics. In adjusted analyses through Poisson regression (Table 4). however.3% (95% CI: 17. and 166 mg/day in the ﬁrst.1%).0 6 2. even in large amounts during gestation and lactation. The reason for no association is not clear. Prevalence of frequent PEDIATRICS Volume 129. and interindividual differences in the subjective response to caffeine may be modulated by distinct polymorphisms in genes identiﬁed as contributing factors to sleep architecture. with depressed mothers presenting a prevalence of heavy consumption almost twice as high as the observed among nondepressed mothers.org at Indonesia:AAP Sponsored on May 2. Infant Nighttime Waking in the Previous 15 Days During the previous 15 days.5%–16. Frequent night waking was more prevalent among boys than girls and among infants of nonwhite mothers. Number 5. respectively. and the prevalence decreased from ﬁrst to third trimester and to the third month postpartum: 24.2% of the mothers. tolerance to caffeine is not clearly deﬁned. second. that infant from heavy consumers develop tolerance to caffeine.4 6 1. DISCUSSION This study revealed that prevalence of caffeine consumption is almost universal during pregnancy. However. as well as among those born from mothers who smoked and consumed alcoholic beverages during pregnancy.6%). respectively. The quality of sleep of 11.3% in postpartum. however. Most of the 3-month-old infants wake up during the night. had no consequences on sleep of the infant at 3 months of age. the mother was in charge of attending the child (69. those regularly exposed to caffeine presented a differential performance in active wakefulness. May 2012 nighttime wakers was 13.0%). After birth (3 months).0%–16. Smokers and alcoholic beverage drinkers were more likely to be heavy caffeine consumers throughout gestation and during postpartum. P = . Looking at caffeine consumption as a continuous variable in milligrams per day or employing international parameters to estimate caffeine consumption from ﬁltered coffee did not change these results. the infants had slept a mean of 13.1%). the lower the proportion of heavy consumers. general movements. as already highlighted by others. during nighttime waking. and heart rate variation before and after maternal coffee loading suggesting fetal tolerance in response to maternal habitual coffee ingestion.2%–27.5% against 13. An inverse linear trend was veriﬁed for heavy consumption and schooling and family income. However. The higher the schooling/ income. infants of mothers reporting heavy consumption at the third trimester of pregnancy and at the 3 months postpartum presented increased (nonsigniﬁcant) prevalence ratios.5%. 20. vulnerability to sleep loss.8% (95% CI: 11. respectively. Bed-sharing was reported by 46.1 hours in 24 hours (9. 2012 .33 Maternal caffeine consumption. as well as for frequent night waking at 12 months (n = 3907) and found no association in 863 Downloaded from pediatrics. Prevalence of heavy consumption ($300 mg/day) was 20% in pregnancy and 14. The highest prevalence ratio was observed among breastfed infants from mothers consuming $300 mg/ day during the whole pregnancy and during the postpartum period (1. and subjective and objective effects of caffeine on sleep.5%) had woken during the night in at least 1 night. it is similar to that observed almost a decade ago in this same city. 95% CI: 0.aappublications.6%). The prevalence of heavy consumption increased with parity and was higher among mothers who did not work during pregnancy and who bed-shared with their infants. With regard to the prevalence of caffeine consumption and of heavy caffeine consumption during pregnancy.
0 20.5 ..628 16.2 9.001 crude or adjusted analyses (data available upon request).001 12.001 13.012 13. and 55% of the infants at 6.3 28.5 .001 29.114 17.8 24.TABLE 2 Prevalence of Heavy Caffeine Consumption ($300 mg/day) During Pregnancy and at 3 Mo Postpartum According to Maternal and Infant Characteristics Variables First Trimester % Maternal characteristics Family income (quintiles) 1 (poorest) 2 3 4 5 (wealthiest) Living with partner Yes No Schooling.1 8.010 7.007 6.2 16.0 .267 19.7 20.5 35.2 21.0 30.9 . Previous studies have revealed that regular night waking is common 864 throughout the ﬁrst year after birth and that the number of awakenings per night is a function of the age.5 .7 41.001 17.2 .174 16..001 22.001 23.229 12.0 14.1 21.9 20.001 20.8 .938 14.2 .5 39.9 16.0 10.2 2.1 .5 8...6 18.1 22. but the SANTOS et al Downloaded from pediatrics.3 .4 9.5 .org at Indonesia:AAP Sponsored on May 2.5 .001 21.001 9.8 .3 .6 .9 . and 12 months. 58%.35 Maternal skin color White Black Other Parity 0 1–3 $4 Paid work during pregnancy No Yes Smoking during pregnancy No Yes Daily cigarettes during pregnancy 1–10 .9 15.095 11.001 15.3 7.001 32.6 19.537 7.8 18.1 ..5 19.1 21.001 10.2 .4 20.5 ..9 .5 8. of h slept at daytime (tertiles) 1 2 3 P .9 .5 21.5 12.9 .7 15.5 .6 .8 10.001 7.3 20.5 33.001 14.0 24.aappublications...4 .2 18.001 12.0 8.4 13.3 .0 14...2 .2 19.001 8.3 22...5 17.1 31.7 .2 23.5 21.3.9 15.2 14.8 .2 9.380 8.5 16.8 35.10 Alcohol consumption No Yes Maternal depression 3 mo postpartum No Yes Infant characteristics Gender Boy Girl Maternal bed-sharing No Yes No.9 8.1 20.9 7.5 .993 17.001 18.9 23.4 15.2 15.0 ..6 20.7 24.946 22.018 15.5 16..1 . y .6 ..5 2.7 44.2 7.5 16.2 .3 .8 17.8 21..35 A study in Israel revealed that 46% at 3 months.6 .9 20. respectively.3 17.778 Second Trimester % P .5 .5 31.6 .5 11.190 6.9 13.001 31.7 19.4 8.0 .1 ..001 3 Mo Postpartum % P ..2 6.8 .001 26.4 19..8 12.2 48.0 15.2 .1 .3 .8 21..940 13.5 18.0 30. woke during the night.0 .20 20–35 .429 16.0 6.2 .3 .111 Third Trimester % P .4 13.9 19.2 4.001 12.913 19.009 17.. 39%.9 18.1 17..9 16.8 ..4 18.9 21.7 ..001 16.2 7.001 6.001 16.2 .001 5. y Up to 4 5–8 9–11 $12 Maternal age.6 15.7 .4 .2 21.3 9..2 ..3 5.7 37.8 .001 32.102 21.006 6.5 .1 .001 2.9 .6 .001 28.6 14.554 20..8 7.35 Most infants wake at night in the ﬁrst months.001 3.8 20.0 .009 18.2 11...001 18.6 9.5 8.2 9.5 ..001 15..3 28.001 11.244 15..001 15.8 6..0 21.4 27.3 19..001 4.7 26. 2012 .001 12.4 2.001 24.311 30.8 .7 5.2 .0 25.3 8.6 15.3 17.001 11.1 .1 5.315 6.7 23..8 .7 . 9..3 33.214 Whole Pregnancy + Postpartum % P .7 19.001 13..252 15.
2 .274 10.139 21.6 .6 25.ARTICLE TABLE 3 Prevalence of Frequent Night Waking (.75 episodes of night wakening.8 .029 12. whereas from previous analyses with the whole cohort at age of 12 months this prevalence was 46.417 13. From 6 to until 9 months.4 18.2 16.aappublications.36 Burnham et al36 in the United States monitoring night sleep with use of a VHS videotape reported 2.35 Maternal skin color White Black Other Parity 0 1–3 $4 Paid work during pregnancy No Yes Smoking during pregnancy No Yes Daily cigarettes during pregnancy 1–10 .1 17. y . as observed by Goodlin-Jones et al. the prevalence at age of 3 months (46%) is lower than the observed in Thailand.3 Times Per Night in the Previous 15 Days) According to Maternal and Infant Characteristics Variables Maternal characteristics Family income (quintiles) 1 (poorest) 2 3 4 5 (wealthiest) Living with partner Yes No Schooling.9 .408 13.6%–47.7 .3 proportion decreases until about 6 months. there is an increase and from then until 12 months decreases again.031 12.6 17. Number 5. this study revealed that 41.3 13.241 13.0 15.151 19.6 .2 .044 13.108 13.0% of the sample woke up every night by the age of 3 months.5 13. Although bed-sharing is a common sleep practice in Pelotas.717 19. May 2012 Downloaded from pediatrics. including proximity.2 The mean frequency of awakening episodes per night reported by mothers of night awakener infants in Pelotas (1.702 14. Maternal perception of the child wakefulness is a function of several factors.337 13.2 9.5 12.6 18.217 13.3 In fact.8 14. several awakenings may be observed and infants may vocalize or not when awaken.5 .3 .8.8 .20 20–35 .6 21.org at Indonesia:AAP Sponsored on May 2.37 during the course of a typical night for any single infant.10 Alcohol consumption No Yes Maternal depression 3 mo postpartum No Yes Heavy consumption ﬁrst trimester No Yes Heavy consumption second trimester No Yes Heavy consumption third trimester No Yes Heavy consumption 3 mo postpartum (all infants) No Yes Heavy consumption whole pregnancy and postpartum (all infants) No Yes Heavy consumption 3 mo postpartum (breastfed only) No Frequent Night Waking. 2012 .077 13.4 .7%). So it is possible that some noncrying awakenings may have passed unnoticed to 865 PEDIATRICS Volume 129. Anuntaseree et al8 studying Thai infants of the same age and employing the same deﬁnition of night waking as used in the current study found a mean of 2.9) was lower than the observed in other studies.4 .8 20.6 15. Moreover.0 .78 6 1.0 14.1 18.6 10. Physical proximity during sleep promotes prompt response from the mother to small signals of child’s arousal what may in part explain the difference between the results.7 .1 .7 6 1.1 episodes of nighttime awakenings.8 6 0. % P . y Up to 4 5–8 9–11 $12 Maternal age.9 11. In the current study. More than two-thirds of the Thai infants shared a bed with their parents.6 16.0 .146 13.1 14.733 13.1% (95% CI: 44.3 13.6 16.2 19. noncrying awakenings in which the infant returns to sleep without help as self-soothing awakenings were not distinguished from awakenings in which the infant cries and needs assistance to return to sleep.
231 13. schooling. alcohol consumption.3 Times Per Night in the Previous 15 Days) Among Infants of Mothers With Heavy Consumption of Caffeine ($300 mg/day) According to the Trimester of Pregnancy and Postpartum Period na Frequent Night Waking Crude Analysis PR (95% CI) P . parity. child’s gender. excitability.39 In Pelotas. and family income.5 hours.82–1. Although large amounts of caffeine intake by school-aged children. parity. alcohol consumption.5 12.86) 1. parity.03) 1.31 (0.114 13.80) 1.32 None of these studies revealed any differences in sleep difﬁculty or number of times waking at night.98 (0.aappublications.00 . parity.487d 0.55 (0. .41) 1.90–3. Only 1 study explored the effect of discontinuation of coffee intake among iron-deﬁcient toddlers employing a randomized design. skin color.379 16.0 6 1.8 and 10. Furthermore.00 1.405 1.17) 1.74) 1.00 .18 (0.80–1. child’s gender.15 (0.00 .80–1.65 (0. another possible reason for difference in mean number of wakening episodes is the overrepresentation of wealthier families in the subsample because prevalence of frequent awaking among infants from the wealthiest families was 50% lower than the observed among infants from the poorest families. studies in which caffeine was used to treat apnea of prematurity revealed that caffeine did not modify either the duration of active sleep41 or the total sleep time or the sleep stage durations of preterm infants.102 40 585 1.89–2.94–2. b Controlled for maternal age.138 77 548 1. nighttime sleep duration was on average half an hour shorter than the observed in a birth cohort in Zurich (9.334 1.17 (0. alcohol consumption.67 (0.098 62 759 1. e Controlled for maternal age. Furthermore.46 (0.42 Furthermore.30 (0. d Controlled for maternal age.00 .00 .5 22. the parents’ sleep behavior may affect the chance of being Downloaded from pediatrics. c Controlled for maternal age.01 (0. non-bed-sharing mothers in Pelotas. prevalence ratio.128d 1.00 1.71) 1. and family income. usually from sources other than coffee.907b Caffeine Consumption Heavy consumption ﬁrst trimester Yes No Heavy consumption second trimester Yes No Heavy consumption third trimester Yes No Heavy consumption 3 mo postpartum (all infants) Yes No Heavy consumption whole pregnancy and postpartum (all infants) Yes No Heavy consumption 3 mo postpartum (breastfed only) Yes No Heavy consumption whole pregnancy and postpartum (breastfed only) Yes No PR. and family income.71) 1. Nocturnal sleep consolidation occurs during the ﬁrst 12 months after birth with a decreasing trend of daytime sleep duration. P . can result in increased restlessness.64 (0.66–1. and family income. smoking.07) 1.59) 1.51) 1. nighttime sleep duration and number of awakenings may be a function of the infants’ daytime sleep duration. of h slept at daytime (tertiles) 1 2 3 Frequent Night Waking.org at Indonesia:AAP Sponsored on May 2.22 (0. 2012 .4 6 1.5 .5 .TABLE 3 Continued Variables Yes Heavy consumption whole pregnancy and postpartum (breastfed only) No Yes Infant characteristics Gender Boy Girl Maternal bed-sharing No Yes No. there is no consensus between the authors with regard to the TABLE 4 Prevalence Ratios and 95% CIs for Frequent Night Waking (. % 19.38 Also.271d 1.05) 1.234 113 708 1. In clinical settings. skin color. a Data available for caffeine consumption and night waking.51) 1.49 (0.7 13.135e 1. child’s gender. smoking.92–2. child’s gender. A study conducted in São Paulo (Brazil) comparing sleep habits revealed that adults went to bed later in 1995 than in 1987 and that there was a decrease in total hours slept by day in 1995 in comparison with 1987.5 .3 P awakened by the child.82–2.40 there are few studies investigating the effect of caffeine and other methylxanthine derivates by the mother on sleep of infants.86–3.414 195 626 181 640 164 654 1. alcohol consumption.970c Adjusted Analysis PR (95% CI) P . because night waking in this study was deﬁned as an episode of 866 SANTOS et al infant arousal that woke the parents during the nighttime. and inattention.45) 1.1 .00 .00 .00 . skin color.00 .0 16.033 16.84–2.88–2.001) at the same age.77–1.00 . respectively.00 .00 .080e 1. skin color.7 11.67–1.
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