4. Discussion
sleepiness, excessive sleepiness, daytime sleepiness
LATE PREGNANCY, SECONDARY, EXCESSIVE SLEEPINESS
The goal of this exploratory analysis was to examine relationships between subjectively reported excessive sleepiness during early and late pregnancy and at 6 months postpartum with breastfeeding intentions and behavior, as well as attitudes and beliefs about other aspects of infant feeding. We found that excessive sleepiness in late pregnancy was associated with less favorable attitudes towards breastfeeding. Specifically, participants with Epworth Sleepiness Scale (ESS) scores ≥ 10 had lower scores on the Mitra Index after adjusting for age, racial/ethnic identity, parity, marital status, and maternal education. Unadjusted models showed that those with excessive sleepiness were more likely to report obstacles related to time and social constraints (e.g., It would take too much time for me to breastfeed my baby) and embarrassment factors (e.g., I would feel shy breastfeeding outside my home). We did not find an association between sleepiness and breastfeeding intentions or behavior.Between 18 and 20% of our sample reported excessive daytime sleepiness in pregnancy, which is similar to rates in other studies [At 6 months postpartum, our unadjusted model showed that participants with excessive sleepiness had a lower tendency to use feeding to soothe their fussy infants. More granular data should be collected to confirm and explain this intriguing finding. In the meantime, given evidence of emotional congruity in the mother–infant dyad [We did not find an association between excessive sleepiness during early or late pregnancy and intention to breastfeed or initiation of breastfeeding in our sample. Moreover, excessive sleepiness in pregnancy did not predict continued breastfeeding at 3 or 6 months postpartum. Rates of continued breastfeeding were lower in our sample than have been reported in other studies in community samples [This analysis has both strengths and limitations. Our findings add to a very small body of literature examining associations between sleep during pregnancy and breastfeeding behavior, and to our knowledge, this is the first study to examine associations with breastfeeding attitudes and intent, and infant feeding practices and beliefs beyond those related to breastfeeding. Both sleep and breastfeeding variables (i.e., attitudes, intentions, and behaviors) were assessed at multiple timepoints, allowing us to examine longitudinal associations in addition to cross-sectional associations. However, the only postpartum measure of sleepiness we had was at 6 months postpartum. Future studies should aim to assess sleepiness at hospital discharge and earlier in the postpartum period (e.g., 3 months) because sleepiness during these important timepoints (i.e., before the feeding method is solidified and while infant night wakings are frequent) might have a stronger impact on breastfeeding behaviors. Another limitation of this secondary analysis is that subjective sleepiness was the only sleep-related variable that was measured. The multiple sleep latency test is an objective measure of the rapidity of latency to sleep onset using polysomnography and is considered the gold standard measure of daytime sleepiness [