The Effects of Early-life Environmental and Behavioral Factors on Child Growth and Development

Primary outcomes

1. Maternal sleep measured by Pittsburgh Sleep Quality Index(PSQI)

   Time frame: changes from baseline,3 month, 6month, 9month, 12month, 18month, 24 month,36month,48month follow-up

   The PSQI total score represents the sum of component scores for subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medicine, and daytime dysfunction. A PSQI score >5 defined poor sleep quality. Higher scores implied lower sleep quality or more severe sleep disturbance.

2. Maternal sleep measured by Actiwatch

   Time frame: baseline

   Sleep assessment was a major part of the study. A 7-day assessment of mothers' sleep quality was conducted during the third trimester by using Actiwatch (Respironics, Inc.1001, Actiwatch 2) and sleep diary. Actiwatch is a sleep assessment system based on monitoring individual activity whose evaluation point is based on the sleep diary.

3. Children sleep measured by Actiwatch

   Time frame: changes from 3 month, 6month, 9month, 12month, 18month, 24 month,36month,48month,72month follow-up

   Sleep assessment was a major part of the study. A 7-day assessment of mothers' sleep quality was conducted during the third trimester by using Actiwatch (Respironics, Inc.1001, Actiwatch 2) and sleep diary. Actiwatch is a sleep assessment system based on monitoring individual activity whose evaluation point is based on the sleep diary.

4. Children sleep measured by Brief Infant Sleep Questionnaire(BISQ)

   Time frame: changes from birth, 42days,3 month, 6month, 9month, 12month, 18month, 24 month,36month follow-up

   Infant sleep problems reported by the mother and according to Brief Infant Sleep Questionnaire (BISQ). It is not a scale. The variables of the questionnaire included 1) nocturnal sleep duration (between the hours of 7 pm and 7 am); 2) daytime sleep duration (between the hours of 7 am and 7 pm); 3) number of night wakenings; 4) duration of wakefulness during the night hours (10 pm to 6 am); 5) nocturnal sleep-onset time (the time when the child falls asleep for the night); 6) settling time (latency to falling asleep for the night); 7) method of falling asleep; 8) location of sleep; 9) preferred body position; 10) age of child; 11) gender of child; 12) birth order; and 13) role of the responder who completed the BISQ. If the child woke up more than 3 times per night, spent more than 1 hour in wakefulness during the night, or spent less than 9 hours in sleep (day and night), then they were considered as poor sleepers.

5. Children sleep measured by Children's Sleep Habits Questionnaire (CHSQ)

   Time frame: changes from 48month, 72month follow-up

   Children's Sleep Habits Questionnaire (CHSQ) Sleep onset and wake up time in the past weekdays and weekends were collected from a parent reported Children Sleep Habits Questionnaire23 and sleep duration in weekdays and weekends was calculated separately. Daily average sleep duration was calculated using the formula: ([weekday sleep duration×5] + [weekend sleep duration×2])/7.

6. Children weight

   Time frame: changes from birth,42days,3 month, 6month, 9month, 12month, 18month, 24 month,36month,48month,72month follow-up

   Child weight were obtained at each visit. Weight was measured using calibrated scales (birth to 24 months, Seca 335, Hamburg, Germany) and electronic personal scale (3-4 years, Seca 877, Hamburg, Germany).

7. Children length/height

   Time frame: changes from birth,42days,3 month, 6month, 9month, 12month, 18month, 24 month,36month,48month,72month follow-up

   Child length/height were obtained at each visit.Recumbent length (birth to 24 months) was measured from the top of the head to the soles of feet using the same calibrated scale as weight. Standing height (2-4 years) was measured using a stadiometer (Seca 206, Hamburg, Germany) from the top of children's head to his or her heels.

8. Social-emotion

   Time frame: changes from 36month,48month,72month follow-up

   The Strengths and Difficulties Questionnaire (SDQ) we use in this survey is a short screening questionnaire covering the current difficulties in social psychology (i.e. emotional symptoms, conduct problems, hyperactivity-inattention, peer problems), and personal strengths (i.e. prosocial behavior). High SDQ score is associated with an increase in psychiatric risk, on the opposite, prosocial behavior score is positive with prosocial behavior.