Postpartum inflammation and sleep: The effect of cumulative and dimensional adverse childhood experiences

Sleep plays a critical role in both physical and mental health, and poor sleep has been linked to mood disorders, decreased neurocognitive function, chronic health conditions, poor immune function, and elevated inflammation. Research supports a bidirectional relationship between inflammation and sleep such that sleep problems can increase inflammation and high levels of inflammation can lead to sleep-related problems. This relationship is especially relevant in the postpartum period, when inflammation is naturally elevated due to childbirth recovery and hormonal shifts, and sleep disturbance is common due to caregiving demands and pain related to healing. Research also indicates that women with histories of early adversity are more likely to experience sleep problems postpartum, and that distinct types of adversity (e.g., threat vs. deprivation) may differentially shape physiological processes. However, little research has examined how adversity may contribute to the association between inflammation and sleep during the postpartum period. This study explored associations between childhood adversity, postpartum sleep, and inflammation (IL-6, CRP and TNF-α) at 6-weeks postpartum and examined whether cumulative adversity, threat, and deprivation moderated associations between inflammation and sleep. Participants included 151 women recruited during pregnancy from a diverse community sample. During pregnancy, participants completed a demographic questionnaire and the Maltreatment and Abuse Chronology of Exposure scale (Teicher & Parigger, 2015). At 6-weeks postpartum, participants self-reported on sleep using the Women’s Health Initiative Insomnia Rating Scale (Levine et al., 2003) and completed a blood draw to assess levels of IL-6, CRP, and TNF-α. Three moderation analyses were estimated for each inflammatory marker: one using cumulative adversity, one using threat, and one using deprivation. Findings support that higher cumulative, threat-, and deprivation-related adversity were consistently associated with more postpartum sleep problems, and inflammatory markers showed mixed main effects. TNF-α predicted fewer sleep problems, CRP predicted greater sleep problems, and IL-6 was not significantly associated with sleep. Childhood adversity did not moderate the association between inflammation and sleep, with one exception (TNF-α x Threat). Overall, findings suggest that adversity and inflammation may contribute to postpartum sleep problems through independent pathways, underscoring the importance of trauma-informed perinatal screening and targeted sleep interventions.