Relationship between prenatal maternal PFAS exposure and child sleep outcomes

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About half of US children experience significant sleep issues, according to the American Academy of Pediatrics. Sleep health is critically important to a child’s overall health, including physical, cognitive, and behavioral development. Further, sleep characteristics in childhood can persist into adolescence and then adulthood. It is possible that sleep health may be affected or programmed by factors experienced in utero. Fetal development is sensitive to common environmental chemicals like perfluoroalkyl substances (PFAS), which are highly prevalent among US mothers. PFAS are endocrine disruptors, meaning they can disrupt the body’s normal hormonal processes, crucial to the healthy development of the fetus. It is clear that chemical exposures in pregnant mothers can lead to health problems for their infants that continue into childhood and adolescence. Further, assessments of PFAS-related health outcomes using a mixtures approach are being called for by regulators, given that typical human exposure involves complex combinations of PFAS. In addition, preliminary IKIDS findings indicate a sex-specific association between certain PFAS and sleep disturbance, where boys’ sleep was more affected by PFAS exposure during pregnancy than girls for two specific PFAS in our current sample. The proposed project would use novel statistical methods to assess associations between PFAS exposure during the prenatal period and child sleep quality longitudinally across early childhood, using multiple measures of sleep. PFAS are measured in maternal blood collected at 16-18 weeks’ gestation, and sleep outcomes in young children are measured with three validated parent-report measures capturing different aspects of sleep—disturbance, impairment and sleep problems. We propose to leverage existing data from a prospective cohort of pregnant women and their children based in central Illinois, known as the Illinois Kids Development Study, or IKIDS. Specifically, we will assess the longitudinal effects of prenatal exposure to 12 perfluoroalkyl substances on sleep problems at ages 2, 3, and 4 (aim 1), as well as PFAS mixtures on sleep disturbance, and impairment at age 4 alone (aim 2). Sleep disturbance and sleep impairment are parent-report Patient-Reported Outcomes Measurement Information System (PROMIS) measures and sleep problems is one of the syndrome scales of the preschool Child Behavior Checklist. Child Prenatal PFAS exposure has been shown to be associated with neurodevelopmental outcomes in children, yet there is no literature pertaining to prenatal PFAS effects on sleep quality during early childhood. Both PFAS and child sleep problems are highly prevalent, and preliminary findings show that PFAS exposure in utero may be responsible for some portion of the attributable risk of sleep problems in children. Yet, the area remains vastly understudied. Given that sleep is so crucial to a child’s overall health and development, identifying prevalent and persistent environmental factors that influence sleep health could have a substantial public health impact.