Does a pregnant mother's sleep shape her child's development?
Writing a book about stress and illness, Toxic Stress: How Stress is Making Us Ill and What We Can Do About It (2024), has changed the way I read. I now read most scientific articles through a new lens that tries to see what this tells us about our stress response system.
So, when I read an article this week about the effects of the pregnant mother’s sleep on the development of her child, I saw another light shine on the mystery of how stress gets passed from one generation to the next. At first glance, it may seem enough to note that troubled parents often raise troubled children. We know that growing up in any unsafe environment, whether it is an abusive family, a high-crime neighborhood, or as the object of repeated discrimination, can set up patterns of stress that are hard for growing children to break out of, especially if they’re poor.
Now, thanks to this article, we can add to the list of pathways by which stress can be passed down from generation to generation—trauma, role modeling, unsafe living environments, genes—a less intuitively obvious pathway: sleep. Disturbed sleep, if it persists for months, is one pathway to excessive stress for all of us. We need restful sleep to regulate our stress response systems.
For pregnant women, morning sickness during the first trimester and physical discomfort during the third trimester make insomnia a common nuisance. Or is prenatal insomnia more than a nuisance?
The Review
A systematic review published in January of this year brings into focus the collected studies on how the pregnant mother’s sleep may affect the later health of her infant and child. Since we already have evidence that poor sleep during pregnancy increases the risk for pre-term births and low birth weights, the question this review asks is whether the effect of a mother’s poor sleep during pregnancy extends beyond birth. Does prenatal maternal sleep shape child development?
To explore this question, a team of researchers from the University of Denver and the University of California, Irvine, collected the results of 34 original peer-reviewed studies, most of them published between 2019 and 2024. These studies measured prenatal sleep patterns in the mother and then some measure of the offspring’s health or development during infancy or childhood. Following rigorous methods for analyzing collections of observational studies, this review found some notable patterns.
First, poor sleep in the pregnant mother predicted poor sleep in the infant or child—that is, shorter sleep durations, more night awakenings, more daytime sleep, and more hospital admissions for sleep disorders. Every mother knows how intimately tied her sleep is to the sleep patterns of her child.
Second, poor sleep in the pregnant mother predicted a higher chance that the child would be overweight or obese, have high blood pressure, or develop respiratory allergies.
And third, poor sleep in the pregnant mother predicted higher risks for childhood development problems, such as crying and fussiness, ADHD, or language delays.
These findings suggest that the sleep habits of the pregnant mother may affect the sleep habits of her child well after birth, including important aspects of physical and cognitive development.
Though this review finds some surprising effects lasting into childhood years, it’s important to recognize a few limitations of this study before thinking about what we should do differently. Though 70% percent of these 34 studies were rated at least moderately rigorous in their methods, only 9% were rated highly rigorous. And many studies only measured either the mother’s sleep or the childhood outcomes once, whereas several measures would give a more robust picture of each. So, these findings need to be confirmed by more rigorous studies.
The Impacts
In the meantime, we can put this review to use in everyday life by giving higher priority to the mother’s sleep during pregnancy. Here’s another example of science confirming conventional wisdom. Though we don’t yet have evidence that effective sleep management during pregnancy prevents these poor health outcomes in infancy and childhood–-the clinical trials have not yet been done—pregnant women should insist their prenatal care clinicians give their insomnia high priority for effective remedies. Sleep medicine services could open fast tracks for pregnant women ahead of their waiting lists.
Helping a pregnant mother sleep restfully offers another way to invest in the future generation.
But wait. Does it make sense to you that something as common and tolerable as insomnia should have lasting effects on the child’s physical and mental health? It makes sense to me only if the insomnia is a sign of the mother’s dysregulated stress response system, since regular restful sleep is one of the essentials for keeping our stress response systems healthy. Future studies should consider the possibility that the mother’s dysregulated sleep preceded the pregnancy and continued after the birth, passing her toxic form of stress along to the next generation by genes or by example, or both.
This article first appeared in Psychology Today on April 11, 2025.
References:
Wulsin, L.R .(2024). Toxic Stress: How Stress is Making Us Ill and What We Can Do About It. Cambridge, UK: Cambridge University Press.
Melissa Nevarez-Brewster 1, Deborah Han, Erin L Todd, Paige Keim, Jenalee R Doom, Elysia Poggi Davis: Sleep During Pregnancy and Offspring Outcomes From Infancy to Childhood: A Systematic Review. Biopsychosocial Science and Medicine: 87: 7-32.