"Multidimensional sleep health during pregnancy - The influences of prenatal depression and experiences of racial discrimination" 

Public Health/Epidemiology

Committee:
Dara D. Mendez, Department of Epidemiology  (advisor)
Marquis Hawkins, Department of Epidemiology
Michele D. Levine, Department of Psychiatry
Meredith L. Wallace, Department of Psychiatry

Abstract: 

Sleep is fundamental to one’s health and well-being. Poor sleep health in pregnancy is associated with higher risks of pregnancy complications including gestational diabetes and hypertension. It is important to characterize pregnancy sleep health and identify associated risk factors to improve sleep health in pregnancy and further reduce adverse maternal health outcomes.

Studies have predominantly assessed sleep health by its quality and duration. More recent studies have defined sleep health to be multidimensional which includes sleep quality, duration, sleepiness, continuity, timing, and regularity. Some less observed sleep dimensions such as late sleep timing, is also a risk factor for pregnancy complications. There is a need to better understand multidimensional sleep health in pregnancy. Therefore, the first goal of this dissertation was to characterize sleep in pregnancy by each sleep dimension and create a composite sleep health score to describe overall sleep health in pregnancy.

Prenatal depression is a depressive episode that occurs specifically during pregnancy. Depression and sleep are highly associated with shared biological pathways. Therefore, prenatal depression may also be an important factor that negatively impacts pregnancy sleep health. The second goal of this dissertation was to identify the cross-sectional and longitudinal associations between prenatal depression and sleep health in pregnancy.  

Racism is a system that places individuals into the hierarchy of supremacy and inferiority based on one’s race. Racism further develops prejudice and discrimination towards specific racial groups. While prior studies have identified racial disparities in sleep health, the association no longer exists after adjusted for racism factors. The findings suggested that racial disparities in sleep health is not biological, but more likely a social factor. Our third goal was to identify the association between racial discrimination experiences and sleep health during pregnancy.

The completion of the dissertation provides us the sleep health characteristics in pregnancy under specific dimensions and overall sleep health. The findings also support the consideration of maternal mental health and racial discrimination as potential factors to improve sleep health during pregnancy under specific sleep dimensions and overall sleep health, which may further reduce adverse maternal health outcomes attributed to poor sleep health during pregnancy.