Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Steven Browning and Ketrell McWhorter

Committee Member

Ketrell McWhorter

Committee Member

Hartley Feld

Committee Member

Steven Browning


Objectives: To determine the relationship between maternal depressive symptoms and unsafe infant sleep intention and practices during and after pregnancy.

Methods: This study recruited 100 women from a small clinic in a low-resource community of Santo Domingo, Ecuador from 2018 to 2020. Information on intention to practice safe sleep was collected during the third trimester of pregnancy and safe sleep practices were assessed at 1 month and 6 months postpartum via survey. Depressive symptoms were measured using the Patient Health Questionnaire 2 (PHQ-2). Using log-binomial regression, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) cross-sectionally at each time point.

Results: Pregnant women with depressive symptoms were more likely to report an unsafe position as the position the infant should sleep in (PR=1.12; 95% CI: 0.84 – 1.50) and to intend to put unsafe items in the infant sleeping environment (PR=1.56; 95% CI: 0.67 – 3.63). Mothers with depression were more likely put their infant to bed in an unsafe position at both 1 and 6 months postpartum (PR=1.15; 95% CI: 0.39 – 3.41; PR=1.26, 95% CI: 0.46 – 3.43), respectively. At 1- month postpartum, these mothers also had a higher prevalence of letting their child sleep with unsafe items (PR= 1.61, 95% CI: 0.95 – 2.73), though this relationship attenuated at 6 months (PR 0.87 95% CI: 0.45 – 1.74).

Conclusions: Findings suggest the need for early and comprehensive screening for postpartum depression and early interventions to reinforce safe sleeping practices among mothers who exhibit depressive symptoms to improve the safety of the sleep environment for infants.

Available for download on Wednesday, April 30, 2025

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