Sleep during pregnancy: a systematic review of racial and ethnic disparities and associations to experiences of discrimination

OBJECTIVE

Sleep is critical for perinatal health with poor quality and short sleep duration in pregnancy being associated with adverse maternal outcomes (eg, preterm birth, preeclampsia, depression) and an increased risk for poor offspring outcomes (eg, lower birth weight, 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 these disparities during pregnancy, a period when sleep is critical for the health of the pregnant person and offspring and when 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 that underlie the disparities.

DATA SOURCES

PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and ClinicalTrials.gov were searched from inception to November 3, 2023.

STUDY ELIGIBILITY CRITERIA

Peer-reviewed quantitative studies that examined (1) racial/ethnic disparities in sleep and/or (2) associations with exposure to racial/ethnic discrimination in the prenatal period.

STUDY APPRAISAL AND SYNTHESIS METHODS

In this systematic review, a narrative synthesis was conducted using the National Heart, Lung, and Blood Institute Quality Assessment tool for Observational Cohort and Cross-sectional Studies.

RESULTS

A total of 18 studies were included; 12 found disparities, 3 did not, and 3 documented associations between experiences of discrimination and sleep. Overall, African American/Black pregnant persons were found to experience shorter sleep durations and poorer sleep quality than White persons. Studies yielded mixed findings when sleep disturbances, latency, and insomnia symptoms were examined. 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 3 studies that examined the topic, but 2 studies had overlapping samples, precluding any conclusions.

CONCLUSION

Studies suggest the presence of 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. However, studies that controlled for socioeconomic status documented disparities, suggesting that disparities persist when factors like educational attainment and income are considered. There was considerable variety in how sleep was measured, contributing to the heterogeneity in the findings. Our review strongly underscores the need for more research and highlights the importance of addressing social determinants of health and achieving sleep health equity, which is critical to sustaining healthy pregnancies.