A Longitudinal Analysis of Maternal Sleep, Distress, and Social Support Using Echo Study Data

The transition to motherhood is a time of heightened risk for poor sleep health in women due to a confluence of biological, behavioral, environmental, and social factors that influence sleep health. Research regarding sleep health and associated risk and protective factors is limited in this population and may have important public health and clinical implications. The current study uses a socio-ecological and data-driven longitudinal approach to characterize sleep health and related factors during the transition to motherhood (pregnancy to 24 months postpartum). Secondary analyses of the Environmental Influences on Child Health Outcomes (ECHO) program leverage a multi-site, longitudinal dataset (N = 386) to model the relationship between sleep health, distress, and social support using mixed- effects modeling. A subset of participants (n = 54) contributed data used to calculate a composite sleep health score. Results indicated that satisfaction significantly improved over time, whereas sleepiness remained stable. Higher perceived stress was consistently associated with lower satisfaction and greater sleepiness. Unexpectedly, higher social support was associated with greater daytime sleepiness, particularly during periods of elevated stress. The subset with sleep indicators reported notable challenges with sleep timing, consistency, and feeling rested. Despite limited power in modeling due to data limitations, the study contributes insight into the dynamic, multidimensional nature of maternal sleep health. Findings emphasize the importance of applying multidimensional sleep health to both future public health programs and clinical interventions to promote sleep health in this population.