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 (PR_Overall = 0.75; 95% CI, 0.68-0.82) and more likely to report long sleep (PR_Overall = 2.06; 95% CI, 1.74-2.43) and trouble staying asleep (PR_Overall = 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 (PR_White = 0.45; 95% CI, 0.31-0.64), but this association was not observed among black women (PR_Black = 0.98; 95% CI, 0.46-2.09) and was less pronounced among Hispanic/Latina women (PR_{Hispanic/Latina} = 0.82; 95% CI, 0.38-1.77). Compared to pregnant white women, pregnant black women had a higher short sleep prevalence (PR_Black = 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.

Keywords: ethnic groups; pregnancy; race factors; sleep; sleep deprivation; sleep initiation and maintenance disorders.

Figure 1.

Age-standardized prevalence of sleep disturbances by race/ethnicity and pregnancy status.

Figure 2.. Prevalence ratios and 95% confidence intervals of sleep characteristics for pregnant compared to non-pregnant women, overall and by race/ethnicity, National Health Interview Survey, 2004–2017.

Models are adjusted for age, marital status, educational attainment, occupational class, household income, smoking status, alcohol consumption, physical activity, self-rated health status, hypertension, diabetes, heart disease, cancer, and depressive symptoms. Overall models are additionally adjusted for race/ethnicity. Analyses of short sleep duration excluded those who reported >9 hours of sleep. Analyses of long sleep duration excluded those who reported <7 hours of sleep. Analyses of sleep medication use included fewer than 50 participants in a cell of the crosstab between pregnancy status and the sleep outcome.

Figure 3.. Prevalence ratios and 95% confidence intervals of sleep characteristics for pregnant compared to non-pregnant women, stratified by age (<35 vs. 35–49 years of age), overall and by race/ethnicity, National Health Interview Survey, 2004–2017.

Models are adjusted for marital status, educational attainment, occupational class, household income, smoking status, alcohol consumption, physical activity, self-rated health status, hypertension, diabetes, heart disease, cancer, and depressive symptoms. Overall models are additionally adjusted for race/ethnicity. Analyses of short sleep duration excluded those who reported >9 hours of sleep. Analyses of long sleep duration excluded those who reported <7 hours of sleep. Some analyses included fewer than 50 participants in a cell of the crosstab between pregnancy status and the sleep outcome.

Figure 4.. Prevalence ratios and 95% confidence intervals of sleep characteristics comparing non-Hispanic black and Hispanic/Latina to non-Hispanic white participants by pregnancy status, National Health Interview Survey, 2004–2017.

Models are adjusted for age, marital status, educational attainment, occupational class, household income, smoking status, alcohol consumption, physical activity, self-rated health status, hypertension, diabetes, heart disease, cancer, and depressive symptoms. Overall models are additionally adjusted for race/ethnicity. Analyses of short sleep duration excluded those who reported >9 hours of sleep. Analyses of long sleep duration excluded those who reported <7 hours of sleep. Some analyses included fewer than 50 participants in a cell of the crosstab between pregnancy status and the sleep outcome.