Environmental Phenol Mixture During Pregnancy and Child Sleep Quality in the ECHO Cohort

Sarah Geiger^1*Xiaoshuang Xun²Aruna Chandran²Cai Zhang¹Kritika Madan¹Grace Kim¹Fatima Naveed¹Megan Woodbury³Dana E Goin⁴Stephanie Eick⁵Courtney Blackwell⁶Maxwell Mansolf⁶Max Aung⁷Akram Alshawabkeh³Dana Dabelea⁸Anne L Dunlop⁵Assiamira Ferrara⁹Jonika B Hash¹⁰Monique Hedderson⁹Erica Jansen¹¹Monique LeBourgeois¹²Louise O'Brien¹¹Yeyi Zhu⁹Susan L Schantz¹

• ¹University of Illinois at Urbana-Champaign, Champaign, United States
• ²Johns Hopkins University, Baltimore, Maryland, United States
• ³Northeastern University, Boston, Massachusetts, United States
• ⁴Columbia University, New York City, New York, United States
• ⁵Emory University, Atlanta, Georgia, United States
• ⁶Northwestern University, Evanston, Illinois, United States
• ⁷University of Southern California, Los Angeles, California, United States
• ⁸University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
• ⁹Kaiser Permanente Northern California, South San Francisco, California, United States
• ¹⁰University of Washington, Seattle, Washington, United States
• ¹¹University of Michigan, Ann Arbor, Michigan, United States
• ¹²University of Colorado Boulder, Boulder, Colorado, United States

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=1198) 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.