Sleep during pregnancy: A Systematic Review of Racial and Ethnic Disparities and Associations to Experiences of Discrimination.

Abstract

Objective: Sleep is critical to perinatal health, with poor quality and short sleep duration in pregnancy being associated to adverse maternal outcomes (e.g., preterm birth, preeclampsia, depression), as well as increased risk for poor offspring outcomes (e.g., lower birthweight, risk for neurodevelopmental disorders). However, a growing body of work documents the existence of ethnic and racial sleep health disparities, but no reviews have examined disparities during pregnancy, a period where sleep is critical for health of the pregnant person and offspring and where stark disparities in pregnancy and delivery outcomes are also observed. We reviewed the available evidence regarding racial/ethnic disparities in prenatal sleep health and the association between exposure to racial/ethnic discrimination and prenatal sleep, a potential mechanism underlying disparities.

Data sources: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, and ClinicalTrials.gov were searched from inception until November 3, 2023.

Study eligibility criteria: Peer-reviewed quantitative studies that examined 1) racial/ethnic disparities in sleep and/or 2) associations between exposure to racial/ethnic discrimination in the prenatal period.

Study appraisal and synthesis methods: The present systematic review conducted a narrative synthesis and used the National Heart, Lung, and Blood Institute Quality Assessment tool for Observational Cohort and Cross-sectional Studies.

Results: Eighteen studies were included: 12 found disparities, three did not, and three documented associations between experiences of discrimination and sleep. Overall, African American/Black pregnant persons were found to experience shorter sleep duration and poorer quality, compared to White persons. Studies yielded mixed findings when examining sleep disturbances, latency, and insomnia symptoms. Findings were mixed for Hispanic/Latine persons, with some studies finding increased risk for short and long sleep duration and both increased and decreased sleep disruptions. Studies of other racial/ethnic groups were too few to draw conclusions. Associations between experiencing racial/ethnic discrimination and poorer prenatal sleep were documented across the three studies that examined the topic, but two studies had overlapping samples, precluding from conclusions.

Conclusions: Studies suggest ethnic/racial disparities in prenatal sleep, emphasizing the need for targeted interventions and support. However, important gaps remain, including poor consideration of covariates like socioeconomic status and maternal age, health conditions, and depression. Yet, studies that controlled for socioeconomic status documented disparities, suggesting disparities persist when factors like educational attainment and income are considered. There was considerable variety in how sleep was measured, contributing to the heterogeneity of findings. Our review strongly underscores the need for more research and highlights the importance of addressing social determinants of health and to achieve sleep health equity, which is critical to sustaining healthy pregnancies.