Pathways to maternal health inequities: Structural racism, sleep, and physiological stress

•Racial inequities in maternal and infant health are vast and well-documented.•Sleep duration and quality is central to overall health and well-being, particularly in perinatal women.•Focus is needed on multi-level influences on maternal sleep health stemming from structural racism.•Moreover understanding the biological underpinnings of health disparities is critical.•This review synthesizes the literature on sleep, racial disparities, and psychoneuroimmunology. Racial inequities in health are vast and well-documented, particularly regarding maternal and infant health. Sleep health, including but not limited to duration and quality, is central to overall health and well-being. However, research has not adequately addressed how racism embedded in structures and systems, in addition to individual experiences, may affect maternal health by impacting sleep. In this critical review, we aim to 1) synthesize findings, emphasizing collaborative studies within our group, 2) highlight gaps in knowledge, and 3) propose a theoretical framework and methodological approach for moving the field forward. Specifically, we focus on findings and future directions linking perinatal sleep, cardiovascular and immune function, and racial disparities in maternal health. Because too few studies look beyond individual-level determinants of sleep deficiencies among Black Americans, we assert a critical need for research that bridges multiple levels of analysis (e.g., individual, community, society) and provides recommendations for specific health parameters that researchers in this area can target. Although the need to understand and address perinatal health disparities is clear, the goal of identifying multilevel mechanisms underlying how racism in one’s environment and daily life may interact to affect health extends far beyond pregnancy research.