Objective prenatal sleep and adverse childhood experiences in a proof-of-concept observational mixed methods study

Adverse childhood experiences (ACEs) have been proposed as a contributor to maternal health risk, and sleep is one pathway through which early adversity may influence physiological functioning during pregnancy. We examined whether ACEs were associated with objectively measured sleep patterns in an observational study of 50 first-time pregnant adults who wore a physiological monitoring device continuously for 30 days during the second trimester. The wearable data provided nightly sleep stage estimates, heart rate, and physical activity. Rapid eye movement (REM) sleep duration emerged as the variable most strongly associated with ACE exposure. Participants with ACEs showed greater REM sleep duration and a larger increase in REM sleep across the monitoring period. Classification models using REM duration distinguished participants with and without ACEs with high accuracy (75.56%), and ACE was a significant predictor of REM duration in regression modeling. These findings suggest a physiological sleep signature linked to early adversity during pregnancy.