Complementary Feeding Frequency and Maternal Health: Reducing Anxiety and Improving Sleep Through Biobehavioral...

Maternal caregivers of infants frequently experience anxiety and sleep disturbances. Complementary feeding may influence maternal mental health through biobehavioral pathways, yet these mechanisms remain insufficiently explored. This study examined these associations and the moderating role of infant age.

We recruited 543 mother-child pairs with children aged 6-23 months from a maternal-child health center in southwestern China. Five WHO-recommended IYCF-CF indicators were assessed: Minimum Dietary Diversity, Minimum Meal Frequency, Minimum Acceptable Diet, Egg and/or Flesh Food Consumption, and Zero Fruit/Vegetable Consumption. Maternal sleep quality and anxiety were measured using the Pittsburgh Sleep Quality Index and Generalized Anxiety Disorder Scale, respectively. Binary and ordinal logistic regression models were used to examine associations and interaction effects with infant age.

Maternal sleep disturbances and anxiety were reported in 27.1% and 18.6% of participants, respectively. The prevalence of complementary feeding indicators ranged from 30-60%, while Minimum Acceptable Diet remained lowest at 12.5%. In adjusted regression models, mothers of children achieving Minimum Meal Frequency had significantly lower odds of poor sleep quality (OR = 0.67; 95% CI: 0.45-0.99) and reduced anxiety risk (OR = 0.53; 95% CI: 0.31-0.91). In minimally adjusted models, Minimum Meal Frequency, Minimum Dietary Diversity, and Zero Fruit/Vegetable intake were inversely associated with several PSQI components, including daytime dysfunction, sleep latency, and subjective sleep quality; however, these associations were attenuated and lost statistical significance after adjustment for infant age. Interaction analyses indicated that infant age moderated the associations of Minimum Meal Frequency and Zero Fruit/Vegetable with maternal sleep outcomes (p < 0.05).

Meeting Minimum Meal Frequency was linked to lower maternal anxiety and fewer sleep disturbances, potentially through reduced caregiving stress, improved infant sleep continuity, and stress- and circadian-related physiological regulation. Integrating sleep-focused guidance into IYCF counseling may support both infant feeding goals and maternal sleep health.