Associations between distant and proximal negative life events and sleep quality in pregnant women: independent, cumulative and interaction effects

Poor sleep quality is a common yet often overlooked complaints among pregnant women. The relationship between adverse childhood experiences (including dimensions of abuse, neglect, and family dysfunction), negative life events during pregnancy (categorized as distant and proximal negative life events respectively), and sleep quality remains ambiguous. This study explores the independent, cumulative, and interaction effects of these factors from a life course perspective, utilizing the cumulative risk model, stress-sensitization and stress-inoculation models. We recruited 736 pregnant women from a prenatal clinic in Shandong province. Data on childhood adversity, negative life events during pregnancy, and sleep quality were collected through self-reported questionnaires. The study employed the eXtreme Gradient Boosting, linear regression model and hierarchical regression analysis to examine the relationship between the distant and proximal negative life events on sleep quality. Emotional abuse (gain = 0.184) and changed sleep, diet, or clothing habits (gain = 0.103) were the most strongly associated distant and proximal negative life events related to poor sleep quality respectively. Cumulative scores of distant (β = 0.421, 95%CI, 0.172-0.670) and proximal (β = 0.383, 95%CI, 0.299-0.467) negative life events demonstrated a significant positive correlation with poor sleep quality. The interaction effects of distant (abuse dimension) and proximal negative life events on sleep quality aligned with the stress-sensitization model. Distant and proximal negative life events play an important role in sleep quality among pregnant women. Healthcare professionals should consider these factors when providing recommendations and interventions.