Gabriela Ksinanova receives prestigious award at an international conference

Congratulations on the Ferenc Bojan Award at the EPHC 2021 - it's an excellent achievement! What do you think the jury appreciated the most about your work?

I think the jury was interested in the topic because sleep is relevant to all of us - lots of people have children who don't sleep well. Parents wonder whether they could have done anything differently or what could have influenced this behavior. Sleep in babies is also associated with stress during pregnancy. Pregnancy is a challenging time, sometimes accompanied by relationship problems, housing, or financial difficulties. Again, many people have experience of such a situation, so this topic applies to them personally.

In addition, our research methodology is interesting – it included longitudinal data from the ELSPAC (European Longitudinal Study of Pregnancy and Childhood) study from over 4,000 people. Sleep was measured in children 1.5 to 11 years of age, which allowed tracking the impact of stress on sleep throughout childhood.

The judges were also impressed that I elected to present the research myself during the live session instead of providing a pre-recorded six-minute video. Plus, I tried not to show the study in an overly scientific manner. The expert committee would have surely understood; however, scientists are also just people. When they sit in front of monitors all day and see many scientific papers, it certainly helps if everything is explained in a digestible way.

What impact does this award have on your future work?

Mainly it has motivated me. I believe that awards are essential for everyone. The fact that someone noticed my work and appreciated it made me very happy. I also hope that this award will draw attention to this topic.

As a psychologist, I am relatively new to epidemiology and public health. Nevertheless, I have always worked with epidemiological data. However, since this study is thematically psychological, I was unsure whether it would be attractive to anyone at the conference. Thanks to the prize, I discovered that this topic is also relevant to public health, which is significant.

As you say, this is a psychology-based topic. However, in these crazy times, people tend to associate 'epidemiology' with the spread of viruses.

I agree with that. When you say epidemiology, most people think of the spread of disease, but it is certainly not just about that. Almost anything related to health, morbidity, and risk factors for developing various disorders or diseases is relevant to epidemiology and public health. Pregnancy stress certainly fits into that because it can contribute to the development of other health problems.

How did you find your way to science, and why did you choose sleep?

I graduated in psychology and wanted to go into practice after graduation. Initially, I worked as a school psychologist in a high school. I loved my job, but mainly for personal reasons, I decided to change fields. I felt that science fit my nature better, and I was just better at it. I also had the opportunity to go to the University of Kentucky in the US for Ph.D. studies. It was a great opportunity, so I went for it. I had already dealt with sleep in my dissertation in three studies. One focused on sleep in children as a risk factor for developing later psychological difficulties; another targeted sleep and problem behavior. The third one was a bit different - I looked at chronotype, whether someone is a morning or evening type, and their association with problem behaviors and psychological problems.

Why did you decide to return to Brno after your studies?

My husband and I were in the USA together. For personal and professional reasons, we wanted to return to Europe. After a month of searching, we decided to return to Brno, where we found a job opportunity at RECETOX. We especially liked that the job positions offered interdisciplinary collaboration, and it was, of course, also nice to be back home.

Could you summarize your research for us - although I am sure it is difficult to explain it in short?

As part of this work, we looked at the effect of stress experienced by mothers during pregnancy on later sleep problems in their children. Pregnancy stress measured the number and types of various stressful events, ranging from issues at work to severe stress, such as the death of a partner or child. In ESLPAC, 42 stressful situations were predefined. Mothers selected those that they had experienced during their pregnancy.

Following birth, the mothers were asked to report several types of sleep problems experienced by their babies. These were the typical problems - not wanting to go to sleep, waking up frequently, having nightmares, waking up too early, and so on. The mothers were interviewed five times, at 1.5, three, five, seven, and eleven years of age. I think this was an essential strength of the study. With this measurement, we were able to test whether stress in pregnancy is a risk factor for the rate of sleep problems and their persistence over time.

I want to clarify what 'we' means in the case of this study. I am not solely behind the study. I collaborated with Professor Stepanik, at RECETOX and the University of Alabama, and with my supervisors, Professors Bobak and Pikhart, ERA Chairs of Environmental Epidemiology.

What results did you get?

We found that sleep problems in children improved with age but that stressful events during pregnancy affected this improvement. Children of mothers experiencing more stressful events during pregnancy had more sleep problems than those experiencing fewer stressful events. At the same time, children whose mothers reported more stressful events had more sleep problems at all observed time points.

 To sum up - stress in pregnancy may contribute to chronic sleep problems in children.

What was the most challenging part of the study?

The study presented two main challenges, which can also be perceived as its limitations. The first challenge was understanding the relationship between stress during pregnancy and sleep. A  profound understanding of how they relate is necessary to know why this is the case and potentially prevent it. It is plausible that the stress experienced by a mother affects the fetus through some biological mechanisms, thereby modifying their response to stress after birth. This study did not answer this question.

Another challenge was using existing data, which meant that we could not influence the form and wording of the questions. Although it is not ideal, it is a common problem when using existing datasets.

Does your study provide you with other new themes that are worth exploring?

It would be helpful to look more closely at the biological mechanisms by which stress in pregnancy can affect sleep in children, for example, the role of the stress hormone cortisol. Also, it would be worthwhile to examine data from another large cohort study (e.g.,  in a population from another European country) to retest the relationship between maternal stress and infant sleep. If the relationship is confirmed, it will give more credibility to our results.

Is there a question you would like to answer that no one has asked you yet?

I want to conclude by saying that I very much appreciate this award. I am delighted that there has been so much interest in our study. I am pleased that the study has been relevant to public health and to many people who will hopefully find it helpful in understanding their situation.

Gabriela, thank you very much for your time and thoughtful conversation. We wish you similar success in the future.