Prioritizing maternal sleep: a public health strategy for preventing childhood allergic diseases
Article information
Key message
Sleep disorders affect more than half of pregnancies worldwide and can harm maternal health and offspring outcomes. Prioritizing maternal sleep as a public health strategy may help prevent prenatal and pediatric allergic diseases and reduce their burden. Other maternal health strategies may also reduce the burden of offspring allergic diseases, while adequate maternal sleep is associated with other offspring outcomes, underscoring its importance as a key public health strategy.
Introduction
Allergic diseases are a major global public health concern, with prevalence steadily increasing, particularly among children [1,2]. Maternal health conditions during pregnancy, including alterations in the gut microbiome and dietary patterns, are associated with the subsequent risk of allergic diseases in offspring [3]. Maternal psychological stress has been linked to an elevated risk of asthma and wheezing in children [4].
Among these maternal factors, sleep quality during pregnancy has emerged as a critical element [5]. Sleep disorders are highly prevalent among expectant mothers and have been associated with various adverse offspring outcomes [6], but their specific association with offspring allergic diseases remains unclear. In this context, the study “Maternal sleep disorders during pregnancy and subsequent risk of allergic diseases in Japanese children: the TMM BirThree Cohort Study,” by Uematsu et al. [7] published in the current issue of Clinical and Experimental Pediatrics, provides important evidence.
Maternal sleep disorders and allergic diseases in the offspring
This study found that maternal sleep disorders during pregnancy were associated with an increased risk of allergic diseases in children, even after adjusting for potential confounders. In models adjusted for psychological distress, the risk remained elevated for atopic dermatitis (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.04–1.30) and allergic conjunctivitis/rhinitis/hay fever (aHR, 1.26; 95% CI, 1.14–1.40). These findings position sleep quality during pregnancy as a modifiable factor for potentially reducing allergic outcomes. Mediation analysis clarified the contribution of maternal psychological distress, showing minimal mediation for most outcomes (atopic dermatitis, 5.6%; food allergy, 5.0%; allergic conjunctivitis/rhinitis/hay fever, -2.3%). The exception was bronchial asthma, for which maternal psychological distress mediated 34.0% of the association.
However, these findings relied on maternal self-reports of the offsprings' diagnoses and were derived from a single nation's population, which may limit generalizability. Furthermore, allergic outcomes were assessed up to 5 years of age, as such, environmental exposures and dietary patterns may contribute to the onset of allergic diseases [8]. Despite these limitations, the findings underscore the importance of addressing maternal sleep quality as a potential strategy for preventing pediatric allergic diseases.
Maternal sleep disorders in the broader context
Growing evidence underscores the broad impact maternal sleep disturbance on various adverse perinatal and childhood outcomes. Meta-analyses and systematic reviews report associations between sleep-related problems during pregnancy and higher risks of preterm birth, fetal growth abnormalities, and low birth weight (Table 1). Objective measures of sleep-disordered breathing were associated with preterm birth (adjusted odds ratio, 1.6; 95% CI, 1.2–2.2) [5]. Maternal psychological distress during pregnancy, which is often related to sleep disorders, was reportedly associated with an increased risk of asthma or wheeze in the offspring [4].
Meta-analyses of the association between prenatal exposure and adverse health outcomes in offspring
Future research roadmaps
This study provides valuable evidence from a large Japanese cohort on the association between maternal sleep disorders and allergic diseases in the offspring, however, several recommendations can guide future research. First, future studies should include diverse ethnic populations to extend these findings beyond a single national cohort. Second, diagnostic accuracy could be enhanced by employing standardized clinical criteria to classify offspring outcomes. This standardization would improve comparability across different healthcare systems, thereby enabling integrated analyses and robust meta-analyses. Finally, where data are available, sibling-comparison analyses could help control for shared familial or genetic predispositions.
Policy recommendations
Taken together, the findings emphasize the need for public health policies that raise awareness of the association between maternal sleep disorders and adverse offspring health outcomes. When sleep disorders cannot be fully prevented, early life monitoring of children for associated adverse outcomes should be considered. Considering allergic disease onset variability, regular screening throughout early childhood may facilitate timely detection. Caregivers should be supported in implementing evidence-based preventive strategies, including the early introduction of allergenic foods and probiotics [8].
Given the broad implications of maternal sleep disorders, formal guidance on sleep health during pregnancy is required. Global initiatives, such as the World Health Organization’s Maternal Health Unit, should integrate evidence-based recommendations into existing health frameworks. Nonpharmacological interventions—including sleep hygiene, relaxation techniques, and cognitive behavioral therapy—should be prioritized [9]. Our analysis of the Global Burden of Disease Study 2021 revealed increasing incidence trends of asthma and atopic dermatitis among children under 5 years of age in Sub-Saharan Africa (Fig. 1) [2]. This underscores the importance of addressing maternal sleep health globally, particularly in low-resource settings.
Global and regional trends from the Global Burden of Disease Study 2021: Incidence of asthma (A) and atopic dermatitis (B) and prevalence of asthma (C) and atopic dermatitis (D).
Concerning outlook and conclusion
Sleep disorders occur in more than half of all pregnancies globally [10], adversely affecting maternal health and offspring outcomes, including allergic diseases. Allergic diseases, such as atopic dermatitis, often manifest in early childhood and are associated with diminished quality of life and various complications [1]. Consequently, global initiatives to improve maternal sleep during pregnancy, coupled with targeted follow-up of at-risk children, are needed. These strategies could contribute to the primary prevention of allergic diseases and reduce their overall burden.
Notes
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Funding
This work was supported by the Institute of Information & Communications Technology Planning & Evaluation (IITP) grant funded by the Korea government (MSIT) (RS-2024-00509257, Global AI Frontier Lab). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Author contribution
Conceptualization: EL, SH, DKY; Data curation: EL, SH, DKY; Formal analysis: EL, SH, DKY; Funding acquisition: DKY; Methodology: DKY; Project administration: DKY; Visualization: EL, DKY; Writing - original draft: EL, SH, DKY; Writing - review & editing: SH, DKY.