Abstract
INTRODUCTION: Poor sleep quality in childhood can predict sleep quality throughout the lifecourse and other health outcomes. Endocrine-disrupting chemicals can affect adults' sleep quality, and prenatal phenol exposure impacts fetal development. OBJECTIVE: To assess associations between prenatal phenol concentrations and child sleep outcomes. METHODS: We used data from the National Institutes of Health-funded Environmental influences on Child Health Outcomes (ECHO) Cohort (n = 1,198) that were collected from 2008 to 2019 at several sites across the United States. The present analysis was conducted in 2023-2024. Using single-pollutant and mixture models, we examined associations between prenatal phenol concentrations and three key child sleep quality outcomes: sleep problems, disturbance, and impairment. Child sleep outcomes were assessed using the Child Behavior Checklist (CBCL) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance and Sleep-Related Impairment scales. Unadjusted and multivariable-adjusted models were examined, with stratified models and interaction terms used to examine interactions with child sex. RESULTS: Of the eight phenols assessed, higher prenatal methylparaben concentrations were associated with lower child sleep-related impairment scores (β = -4.79, 95% CI: -9.45 to -0.14). Sex modified the associations for benzophenone-3 and PROMIS sleep disturbance T-scores, where the association was stronger among boys (tertile 3 vs. 1, β = 3.20; 95% CI: 0.27-6.14; p = 0.033) and did not persist among girls. Bisphenol A was associated with sleep-related impairment among boys (tertile 2 vs. 1, β = -5.69; 95% CI: 0.55-10.82; p = 0.031). Phenol mixtures were not associated with sleep outcomes overall or by sex. CONCLUSION: The findings suggest that phenol exposure during pregnancy may be associated with child sleep quality and that child sex modifies this association.