Objective <p>Sleep disturbances and adverse social determinants of health (SDoH) disproportionately affect minority pregnant women and may contribute to increased cardiometabolic risk and adverse maternal outcomes. This study aimed to examine associations between perceived sleep environment (primary exposure), other sleep health indicators, and SDoH factors and insulin resistance, a key marker of cardiometabolic risk, in Black/African American Pregnant Women (B/AAPW).</p> Methods <p>his study used baseline data from participants enrolled in the BETTER lifestyle counseling study (NCT05234125). Of the 121 participants enrolled, 2 were excluded due to abnormal lab values, yielding 119 for analysis. Sleep health indicators included validated measures of perceived sleep environment, sleep quality, sleep hygiene, insomnia severity, and sleep apnea. SDoH factors included perceived social support and stress. Insulin resistance was measured using Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Multivariable regression models evaluated associations between perceived sleep environment, other sleep health/SDoH indicators and insulin resistance, adjusting for age, gestational age, BMI, income, and physical activity.</p> Results <p>Among participants (mean age: 29.58 years; gestational age: 18.05 weeks; BMI: 33.41 kg/m²), we found that poorer perceived sleep environment was significantly associated with higher insulin resistance (log-HOMA-IR: B = .027, p = .044), independent of other sleep and SDOH factors.</p> Conclusion <p>Our findings underscore the unique contribution of perceived sleep environment to insulin resistance in B/AAPW. Routine assessment during prenatal care and interventions to improve sleep environment may help mitigate cardiometabolic risk in this population during pregnancy.</p> Clinical Trial and Protocol Registration <p>Data were drawn from a registered lifestyle counseling trial (NCT05234125).</p>