Social Determinants of Sleep Health Disparities Among Postpartum Mothers

Background and Purpose: Adverse childhood experiences (ACEs) may be transmitted across generations and are known social determinants of health disparities across the lifespan. An emerging literature shows that poor sleep health, including short sleep duration and poor sleep quality, is common among adults with childhood adversity. Indeed, the prevalence of poor sleep health is higher during the perinatal period, or the months before and after pregnancy. Despite knowledge that specific clusters of ACEs, namely child maltreatment and household stressors, are independently associated with health disparities, less is known about how childhood adversities may carry over into the postpartum period to affect maternal sleep health. Because the perinatal period is an especially vulnerable time when social and environmental influences may have lasting effects across generations, mothers with young infants who experience childhood adversity and current household stressors may be at particularly high risk of poor sleep health. Therefore, the aim of this study was to determine the extent to which ACEs (i.e., childhood maltreatment and household stressors) may lead to household stressors during postpartum and, in turn, impact sleep health among mothers with low-income.

Methods: Families involved with departments of human services were recruited to participate in a larger longitudinal study involving families experiencing adversity. Participants included 70 mothers (M_age=29.88 years, SD_age=6.49) and their infants (M_age=8.47 months, SD_age=2.39) with low-income. Data on mother’s sleep health (Pittsburgh Sleep Quality Index, actigraphy, and sleep diaries), adverse childhood experiences (ACEs Scale), and current household stressors (Confusion, Hubbub, and Order Scale) were used for the present study. Independent samples t-tests and regression analyses were conducted to determine the associations among childhood maltreatment and household stressors, current household stressors, and indices of sleep health.

Results: Results revealed that mother’s with experiences of household stressors in childhood were more likely to experience household stressors during the postpartum period (t=-3.02, p<.01). Although experiencing current household stressors was associated with poor sleep quality (B=.03, p<.05), household stressors in childhood were more strongly associated with poor sleep health postpartum, as indicated by higher sleep disturbance (B=1.03, p<.05) and poorer sleep quality (B=.13, p<.05). In sum, childhood household stressors were a significant correlate of poor sleep health over and above current household stressors and childhood maltreatment.

Conclusions and Implications: Findings indicate that experiences of adversity in childhood carry over into the postpartum period and may be key social determinants of poor maternal sleep health. Our findings were even more pronounced among mothers who experienced household stressors during childhood, indicating that they may be particularly sensitive to characteristics in their early home environments in the context of later health outcomes. Given that problems with sleep are also likely to be passed down intergenerationally and help to explain observed health disparities among marginalized groups, it is essential to understand how specific and co-occurring adversities in childhood and early postpartum influence sleep health. This greater understanding can assist in developing specific targets for future intervention with the goal of closing the health gap for mother-infant dyads.