Black American Mothers’ Lifetime Discrimination Predicts Poor Sleep Quality in Their Toddlers via Prenatal Stress

• In Event: Sleep across the lifecourse

Abstract

Heightened maternal prenatal psychological distress predicts poor sleep quality in toddlers (O’Connor et al., 2007), but less attention has been directed at the precipitating factors that elicit prenatal distress. Compared to White American women, Black American women disproportionately experience chronic racial/ethnic discrimination throughout their lifetimes (Mustillo et al., 2004), and these experiences precipitate heightened prenatal psychological distress (Giurgescu et al., 2012). This is clinically important: mothers’ lifetime experiences of racial/ethnic discrimination have the potential to predict negative health outcomes in their children, as mediated by their prenatal psychological distress (Heard-Garris et al., 2018). To our knowledge, only one study has examined and demonstrated associations between pregnant, Black women’s lifetime experiences of discrimination and the sleep quality of their infants and toddlers (Powell et al., 2020). However, the authors did not examine the aforementioned mediation model. Second, sleep duration was the outcome of interest, not sleep quality. Sleep quality in toddlerhood is concurrently associated with internalizing symptomatology (Mindell et al., 2017) and prospectively associated with emotional and behavioral difficulties at age four (Sivertsen et al., 2015). We propose examining the relationships between maternal lifetime discrimination, prenatal psychological distress, and toddler sleep quality in n = 150 Black American women and their children. We hypothesize that 1) mothers’ lifetime experiences of discrimination will be linked to increased prenatal psychological distress, 2) that mothers’ prenatal psychological distress will predict poor sleep quality in their two-year-old children, and 3) that maternal prenatal psychological distress will mediate associations between mothers’ lifetime discrimination and their children’s sleep quality at age two.

Lifetime experiences of discrimination were retrospectively assessed in early pregnancy using the Experiences of Discrimination measure (Krieger et al., 2005). Maternal psychological distress was assessed during mid pregnancy and at child age two using the Edinburgh Postnatal Depression Scale (Cox et al., 2002), the State-Trait Anxiety Inventory (Spielberger et al., 1970), and the Perceived Stress Scale (Cohen et al., 1983). Toddler sleep quality was assessed using the sleep problems subscale on the Child Behavior Checklist (Achenbach, 2004) and the total sleep disturbance score on the Children’s Sleep Habits Questionnaire – Short Form (Bonuck et al., 2017).

We found support for our hypotheses. First, mothers’ lifetime experiences of discrimination predicted heightened prenatal psychological distress (ΔR2 = 0.04, F (1, 148) = 6.80, p = 0.01). Second, mothers’ prenatal psychological distress was associated with poorer sleep quality in their toddlers (ΔR2 = 0.03, F (1, 147) = 4.19, p = 0.04). Finally, maternal lifetime discrimination had a significant indirect effect on toddler sleep quality via prenatal psychological distress (β = 0.04, SE = 0.02, 95% CI [0.001 - 0.08]), after adjustment for maternal distress at age two. This suggests that Black mothers’ experiences of discrimination prior to birth can negatively impact the sleep quality of their children via their prenatal distress. These findings suggest a critical need to attend to the stress levels of Black American pregnant women, given their lifelong exposure to racism and related distress and the impacts of early childhood sleep quality on later development.

Authors

• Madeleine Flora Cohen, Emory University
  Presenting Author

• Elizabeth Corwin, Columbia University
  Non-Presenting Author

• Nia R. Barbee, Emory University
  Non-Presenting Author

• April Brown, Emory University
  Non-Presenting Author

• Alexis Dunn, Emory University
  Non-Presenting Author

• Anne Dunlop, Emory University
  Non-Presenting Author

• Patricia Brennan, Emory University
  Non-Presenting Author