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

Poor sleep health in pregnancy is associated with pregnancy complications including gestational diabetes and hypertension. Studies have predominantly assessed sleep health in pregnancy by its quality and duration. More recent studies have defined sleep health to be multidimensional. It is important to characterize multidimensional sleep health and identify risk factors to improve sleep health in pregnancy. The first goal of this dissertation was to characterize sleep health in pregnancy through individual dimensions and composite sleep health score. The second and third goals were to identify risk factors related to poor sleep health during pregnancy, including prenatal depression and the experiences of racial discrimination. We used data from the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-Be (nuMom2b). Sleep was characterized through satisfaction, duration, daytime sleepiness, continuity, timing, and bedtime, waketime, and midpoint sleep regularity. To describe multidimensional sleep health, we created the composite sleep health score by summing z scores centering from the specified cutoffs for each dimension. Prenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). We identified cross-sectional and longitudinal associations between prenatal depression and sleep health in early and mid-pregnancy. The experiences of racial discrimination were measured using the Experiences of Discrimination (EOD) scale. We identified the associations between the experiences of racial discrimination and sleep health in early and mid-pregnancy. Our findings suggested that the multidimensional sleep health was consistent from early to mid-pregnancy with changes in specific dimensions. There were declines in satisfaction, duration, and continuity while timing was consistent, and regularity improved from early to mid-pregnancy. There were cross-sectional and longitudinal associations between prenatal depression and satisfaction, duration, sleepiness, continuity, timing, and composite sleep health score. We also found associations between the experiences of racial discrimination and satisfaction, sleepiness, and composite sleep health score during pregnancy. The completion of the dissertation informs multidimensional sleep characteristics in pregnancy. The findings also support the consideration of maternal mental health and racial discrimination as potential risk factors to improve sleep health during pregnancy under individual dimensions and multidimensional sleep health, which may further reduce adverse maternal health outcomes attributed to poor sleep health during pregnancy