Racial/ethnic disparities in sleep duration and sleep disturbances among pregnant and non‐pregnant women in the United States

Abstract

Sleep disturbances among pregnant women are increasingly linked to suboptimal maternal/birth outcomes. Few studies in the USA investigating sleep by pregnancy status have included racially/ethnically diverse populations, despite worsening disparities in adverse birth outcomes. Using a nationally representative sample of 71,644 (2,349 pregnant) women from the National Health Interview Survey (2004–2017), we investigated relationships between self‐reported pregnancy and six sleep characteristics stratified by race/ethnicity. We also examined associations between race/ethnicity and sleep stratified by pregnancy status. We used average marginal predictions from fitted logistic regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for each sleep dimension, adjusting for sociodemographic and health characteristics. Pregnant women were less likely than non‐pregnant women to report short sleep (PROverall = 0.75; 95% CI, 0.68–0.82) and more likely to report long sleep (PROverall = 2.06; 95% CI, 1.74–2.43) and trouble staying asleep (PROverall = 1.34; 95% CI, 1.25–1.44). The association between pregnancy and sleep duration was less pronounced among women aged 35–49 years compared to those <35 years. Among white women, sleep medication use was less prevalent among pregnant compared to non‐pregnant women (PRWhite = 0.45; 95% CI, 0.31–0.64), but this association was not observed among black women (PRBlack = 0.98; 95% CI, 0.46–2.09) and was less pronounced among Hispanic/Latina women (PRHispanic/Latina = 0.82; 95% CI, 0.38–1.77). Compared to pregnant white women, pregnant black women had a higher short sleep prevalence (PRBlack = 1.35; 95% CI, 1.08–1.67). Given disparities in maternal/birth outcomes and sleep, expectant mothers (particularly racial/ethnic minorities) may need screening followed by treatment for sleep disturbances. Our findings should be interpreted in the historical and sociocultural context of the USA.

Gestational sleep deprivation is associated with higher offspring body mass index and blood pressure

“…Healthy gestational sleep has several perinatal benefits, whereas based on our findings, it probably also has positive long-term effects on childhood cardiometabolic health. Primary prevention may be limited to few socioeconomic factors previously related to sleep deprivation, for example, ethnicity and occupation [ 53 ]. But also secondary prevention could have a great impact for mothers with sleep disturbances already in early pregnancy.…”

Racial/ethnic disparities in sleep in mothers and infants during the Covid-19 pandemic

“…Individuals from racial/ethnic minority backgrounds have been shown to experience worse sleep health, 18–20 but less is known about racial/ethnic disparities in sleep in the post-partum period. 21,22 Similar racial/ethnic disparities in sleep have also been reported for children, such that racial/ethnic minority children compared to their White counterparts are reporting to have the highest rates of insufficient sleep. 23 A few studies have focused on the infant period and results suggest emergence of sleep disparities early on in life.…”

Environmental Factors Involved in Maternal Morbidity and Mortality

“…48 Such conditions may subsequently contribute to the disproportionately increased risk of adverse maternal health behaviors (e.g., disrupted sleep) and outcomes (e.g., preeclampsia), along with a cascade of suboptimal health consequences (e.g., cardiovascular disease). 2,[49][50][51] Chemical exposures are higher, or their reported associations tend to be stronger, among racial/ethnic minorities compared to white populations for cardiometabolic health outcomes, such as obesity, hypertension, type 2 diabetes mellitus, chronic kidney disease, and cardiovascular disease. 2,20,[52][53][54][55][56][57][58] For example, a recent review of the effects of synthetic chemicals on cardiometabolic health among vulnerable populations (defined broadly as pregnant women and children, the economically disadvantaged, and racial/ethnic minorities) found associations of some POPs (e.g., perfluoroalkyl/polyfluoroalkyl substances) and non-POPs (i.e., phenols, phthalates, and parabens) with gestational diabetes and dysregulated glucose metabolism.…”