Effects of contextual stress on Black mothers' self-reported and actigraph-estimated postpartum sleep.

Study objectives: To evaluate the impact of contextual stressors on postpartum sleep among Black mothers.

Methods: This prospective observational study examined associations of racial discrimination and financial strain (measured at 1 week postpartum) with self-reported maternal sleep difficulties at 1, 8, and 16 weeks postpartum and actigraph-estimated maternal sleep at 8 weeks postpartum.

Results: Mothers (N = 212) were Black/African American (100%) and non-Hispanic (98.6%) and averaged 22.7 (SD = 4.5) years of age. Multivariate regression models found unique associations between racial discrimination and financial strain and mothers' postpartum sleep, even after controlling for covariates expected to predict mothers' sleep (including infant sleep). Specifically, past-year racial discrimination measured at 1 week postpartum was associated with poorer concurrent self-reported sleep (b = 1.24, p < .001) as well as greater actigraph-estimated night-to-night variability in total sleep time at 8 weeks postpartum (b = 12.89, p = .005). Financial strain reported at 1 week postpartum was prospectively associated with more self-reported sleep difficulties at 16 weeks postpartum (b = 0.52, p = .007) and with more actigraph-estimated sleep timing variability at 8 weeks postpartum (b = 9.77, p = .02).

Conclusions: Experiences of racial discrimination and financial strain may negatively impact Black mothers' sleep in the postpartum period, beyond the effects of their infant's sleep.

Clinical trial: Sleep-Safe: A Strong African American Families Study (https://clinicaltrials.gov/study/NCT03505203, ClinicalTrials.gov ID: NCT03505203).