Unraveling intersectional risks: Postnatal adversities condition the impact of prenatal alcohol exposures on early childhood sleep outcomes

The current study aimed to examine the influence of distinct patterns of prenatal alcohol exposure (PAE) and postnatal threat and deprivation during infancy on sleep outcomes at three-years. Data were derived from a longitudinal cohort originating from predominately low-income hospital settings in Australia (<i>n</i> = 1952 children; 50.6% female; 80.1% maternal education of trade school or less; 87.4% born in Australia or UK; 2.1% identified as Aboriginal and/or Torres Strait Islander) across three developmental waves (prenatal, 12 months, and three years). Children with two distinct patterns of heavy PAE, heavy reducer and heavy throughout, showed statistically significantly reductions in sleep duration at age three in the context of early threat exposure, relative to children with no PAE (11 minute reduction per threat exposure & 30 minute reduction per threat exposure, respectively; small effects). Threat exposure during infancy also independently predicted more night waking (11% increase in frequency per threat exposure; moderate effects) at three years. Overall, Overall, addressing children's intersectional pre- and post-natal risks remains a critical way forward.