Prenatal Exposure to Phthalates, But Not Alternatives, May Influence Children’s Behavior, ECHO Study Finds

Posted on August 26, 2025August 26, 2025 by Jodi Snare

Exposure to certain phthalates during pregnancy is associated with small to modest increases in behavioral issues, such as aggression and attention problems, in children aged 1.5 to 5 years, according to ECHO Cohort research led by Jiwon Oh, PhD and Deborah Bennett, PhD of the University of California Davis.

Researchers analyzed 27 phthalate and 6 alternative plasticizer metabolites in a large and diverse group of participants, exploring how these chemicals relate to both internalizing behaviors (like anxiety and depression) and externalizing behaviors (such as emotional reactivity, aggression, and attention difficulties).

The study found that higher levels of two specific phthalate metabolites—mono-benzyl phthalate (MBzP) and mono-hexyl phthalate (MHxP)—were connected to more externalizing behaviors, such as aggression or attention problems. However, these chemicals weren’t strongly linked to internalizing behaviors like anxiety or depression. The study also looked at a newer plasticizer called DINCH but didn’t find any effects on children’s behavior.

“While this study did not observe neurobehavioral impacts of the alternative plasticizer DINCH, a broader range of alternative plasticizers deserves attention due to their increasing use and potential neurotoxicity observed in laboratory studies,” said Jiwon Oh, PhD, of the University of California, Davis, who led the research.

The impact of these chemicals varied between boys and girls and depended on the neighborhood where the children lived. Some chemicals had stronger associations in kids from neighborhoods with more resources, while others were more impactful in areas with fewer resources.

These findings highlight the importance of understanding how prenatal exposure to widely used chemicals may affect early childhood behavior and underscore the need for further research on plasticizers that are used as replacements for phthalates.

This collaborative research titled “Prenatal exposure to phthalates and alternative plasticizers and emotional and behavioral outcomes in early childhood in the Environmental influences on Child Health Outcomes (ECHO) Cohort” is published in Environment International.

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Prenatal Exposure to Phthalates, But Not Phthalate Replacements, Linked to Children’s Behavior, ECHO Study Finds

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Prenatal Exposure to Phthalates, But Not Phthalate Replacements, Linked to Children’s Behavior, ECHO Study Finds

Author(s): Jiwon Oh, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Phthalates are widely used chemicals that make plastics more flexible. During pregnancy, these chemicals can cross the placenta and may affect brain development. Although exposure to some phthalates has decreased over the past two decades, these chemicals and their replacements—such as DINCH and DEHTP—are still common, and little is known about their effects on children’s brain development. In this study, researchers examined many chemicals that form when the body breaks down phthalates and other plasticizers to see if exposure to these chemicals during pregnancy might be associated with behavioral problems in young children, including emotional reactivity, anxiety, depression, aggression, and attention problems.

What were the study results?

Researchers found that higher levels of two phthalate metabolites, mono-benzyl phthalate (MBzP) and mono-hexyl phthalate (MHxP), during pregnancy were associated with small to modest increases in externalizing behaviors (aggression and attention problems) in children aged 1.5–5 years. They did not find strong links between phthalate exposure and internalizing behaviors (emotional reactivity, anxiety, and depression), or between prenatal exposure to the phthalate replacement DINCH and any behavioral outcomes. The impact of these chemicals varied between boys and girls and depended on the neighborhood where the children lived. Some chemicals had stronger associations in kids from neighborhoods with more resources, while others were more impactful in areas with fewer resources.

What was the study's impact?

The study suggests that prenatal exposure to certain phthalates, but not to the alternative chemical DINCH, may be associated with increased externalizing behaviors in young children.

Who was involved?

Participants included 2,617 mother–child pairs from 13 ECHO Cohort study sites. Children’s behaviors were assessed at ages 1.5–5 years, and maternal urine samples were collected mostly during mid- to late-pregnancy.

What happened during the study?

During the study, prenatal maternal urine samples were analyzed for 27 chemical markers of phthalate exposure and six markers of exposure to non-phthalate replacements. Later, the children's behaviors were assessed using the Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5). The researchers then used statistical methods to explore how levels of specific chemicals in the pregnant women’s body were linked to behaviors like emotional reactivity, anxiety, depression, aggression, and attention problems, and whether these links differed by child sex and neighborhood opportunity.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future studies could show how much pregnant women are exposed to di-n-hexyl phthalate (the parent compound of MHxP) and its effects on children’s brain development across different populations. Researchers may also study how different newer plasticizers affect brain development by looking at more recent participants and testing samples taken from mothers at several stages during pregnancy.

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to phthalates and alternative plasticizers and emotional and behavioral outcomes in early childhood in the Environmental influences on Child Health Outcomes (ECHO) Cohort,” in Environment International.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August, 2025

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Prenatal Exposure to Phthalates, But Not Phthalate Replacements, Linked to Children’s Behavior, ECHO Study Finds

NIH Study Suggests Behavioral and Emotional Challenges More Common in Children with Autism Spectrum Disorder (ASD)

Posted on February 28, 2025 by Jodi Snare

Children with autism spectrum disorder (ASD) showed higher levels of emotional and behavioral problems, including depression, anxiety, and ADHD, compared to their peers without ASD, according to a new study funded by the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program.

Key Takeaways:

Children with ASD had higher scores on the Child Behavior Checklist (CBCL)—a questionnaire that helps identify emotional and behavioral challenges in children and adolescents—showing they may experience more emotional and behavioral challenges overall.
Higher CBCL scores were linked to the likelihood of receiving an ASD diagnosis, particularly for children scoring in the top 30%.
Among children with ASD, girls experienced significantly higher levels of anxiety and depression compared to boys, with age-related differences in symptom severity.
Autism-related traits measured by the Social Responsiveness Scale (SRS) were associated with higher CBCL scores, suggesting that children with more autism traits may face additional emotional and behavioral challenges.

These findings highlight the importance of monitoring and addressing emotional and behavioral health in children with ASD to better inform early interventions. To learn more, access the study online.

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ECHO Study Suggests Children with Autism Are More Likely to Experience Emotional & Behavioral Challenges Like Anxiety, Depression, & ADHD

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ECHO Study Suggests Children with Autism Are More Likely to Experience Emotional & Behavioral Challenges Like Anxiety, Depression, & ADHD

Authors: Heather E. Volk, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, National Institutes of Health supported this research.

Why was this study needed?

The study aimed to understand how common behavioral and emotional problems are in children with autism spectrum disorder (ASD), using a large national group of participants and looking at differences between boys and girls. It also explored whether children with greater difficulties in social communication related to ASD tend to have more behavioral and emotional challenges.

What were the study results?

Children with ASD had higher scores on the Child Behavior Checklist (CBCL)—a questionnaire that helps identify emotional and behavioral problems in children and adolescents. Higher CBCL scores among children with ASD indicate a possible connection to greater emotional and behavior problems overall—including depression, anxiety, and ADHD—compared to children without ASD. Conversely, higher CBCL scores were strongly linked to the likelihood of receiving an ASD diagnosis, especially for children scoring in the top 30%. Among children with ASD, girls showed significantly higher levels of anxiety and depression compared to boys, with differences depending on their age. As autism-related traits measured by the Social Responsiveness Scale (SRS) increased, CBCL scores also rose, suggesting that children with more autism-related traits might also experience other emotional or behavioral challenges.

What was the study's impact?

This study suggests that increased monitoring of behavioral and emotional problems may be beneficial for children with ASD. The results of this study indicate that children with ASD may be more likely to experience these issues throughout their early life.

Who was involved?

The study included 7,998 children from 37 ECHO Cohort Study Sites across the United States. This included 553 children who had a clinician diagnosis of ASD, including 432 boys and 121 girls.

What happened during the study?

The study surveyed parents of children aged 2.5 years to 18 years to collect information about their child's demographics, ASD diagnoses from a doctor, and scores from two behavior assessments: the SRS and the CBCL. Researchers compared average CBCL scores, which measure emotional and behavioral problems, based on whether the child had ASD and whether they were male or female. They also used statistical methods to see if children with ASD were more likely to have higher CBCL scores and to understand how SRS scores related to CBCL scores.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Additional research could help researchers understand what kinds of support and interventions could be effective for children with ASD, who may be more likely to experience emotional and behavioral challenges.

Where can I learn more?

Access the full journal article, titled “Co-occurring Psychopathology in Children with and without Autism Spectrum Disorder (ASD): Differences by Sex in the ECHO Cohorts,” in Journal of Autism and Developmental Disorders.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published January 6, 2025

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ECHO Study Suggests Children with Autism Are More Likely to Experience Emotional & Behavioral Challenges Like Anxiety, Depression, & ADHD

New ECHO Research Finds Children with Autism at Higher Risk for a Range of Health Outcomes

Posted on October 2, 2024April 1, 2025 by Jodi Snare

Collaborative ECHO research led by Elizabeth Kaplan-Kahn, PhD, Kristen Lyall, ScD of the A.J. Drexel Autism Institute at Drexel University and Heather Volk, PhD, MPH of the Bloomberg School of Public Health at Johns Hopkins University investigates the factors that influence the overall health and well-being of people on the autism spectrum. This research, titled “Describing Multidomain Health Outcomes in Autistic Children in the ECHO Program,” is published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Approximately 3% of children in the United States have a diagnosis of autism spectrum disorder (or autism). A large proportion of autism research focuses on understanding the factors that influence the development of autistic traits. However, many people on the autism spectrum report that they would rather prioritize research into the factors that influence their overall health and well-being. This study addressed that priority by investigating the physical, emotional, and overall health outcomes of children on the autism spectrum.

The study included over 4,500 children and adolescents at 29 ECHO research sites across the United States, including 286 participants with autism, with participants varying in age from 5 to 20 years old. The research team conducted an initial analysis on the 4,511 participants by comparing data on their health outcomes and demographic characteristics. They then used a subsample of 1,809 participants, of which 116 were autistic, to group children with similar physical health, emotional health, and overall well-being outcomes into one of three categories, “positive health,” “poorer health,” and “mixed health.”

These profiles were categorized based on data from the research team’s primary outcome measures—multiple Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scores, the Child Behavior Checklist (CBCL) Dysregulation score, the Social Responsiveness Scale, Second Edition (SRS-2), and standardized Body Mass Index (BMI). These measures evaluated participants’ peer relations, life satisfaction, behavior dysregulation, sleep disturbances, physical activity, etc. The three profiles of participants were then further analyzed to study differences in health outcomes between children on the autism spectrum to non-autistic children.

The study results indicate that autistic children are at higher risk than non-autistic children for poorer health outcomes indicated by lowest scores in Global Health and highest dysregulation scores (e.g. attention problems, aggressive behavior, and anxious-depressive symptoms). However, there is variability in health outcomes within autistic youth as shown by a group of autistic participants who showed high scores on positive health outcomes across domains. Additionally, compared to non-autistic children, more autistic children were born prematurely, had diagnoses of intellectual disability and ADHD, and had a sibling with autism.

“The results of this study offer a glimpse into the range of emotional, physical, and overall health outcomes for children on the autism spectrum,” Dr. Kaplan-Kahn said. “A deeper understanding of the range of health outcomes children with autism experience, and the factors that can affect these outcomes, may help families and practitioners identify and target areas for support or intervention.”

Future work may focus on understanding the factors that influence poor or positive health for children with autism and how those factors change over time. This work might identify opportunities to support these children and promote positive health outcomes.

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

Authors: Jiwon Oh, Julie B. Schweitzer, Deborah H. Bennett, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, supported this research.

Why was this study needed?

Phthalates are widely used chemicals found in many everyday items such as food packaging, flooring, building materials, medicine coatings, medical supplies, cosmetics, and personal care products. When phthalates enter the body, they are metabolized and converted into various smaller molecules, known as metabolites.

Animal studies suggest that exposure to phthalates during early life may negatively affect the nervous system, but there has been limited investigation into potential associations between early childhood phthalate exposure and attention-deficit/hyperactivity disorder (ADHD) behaviors in later childhood and adolescence.

For this study, ECHO researchers wanted to investigate whether exposure to phthalates in children at ages 2-5 years was associated with ADHD symptoms when these children were ages 8-18 years.

Learn how to say phthalate.

What were the study results?

ECHO Cohort researchers evaluated the levels of several metabolites that result from phthalate exposure. They saw that in children ages 2-5 years, most of these molecules were not associated with ADHD behaviors in these children at ages 8-18 years.

However, among children who had been diagnosed with autism spectrum disorder (ASD), one of these metabolites—mono-2-heptyl phthalate (MHPP)—was associated with more ADHD behaviors. Among typically developing children, a different small molecule—mono-carboxy isooctyl phthalate (MCiOP)—was associated with more hyperactive/impulsive behaviors.

What was this study's impact?

This study suggests that early childhood exposure to certain phthalates may be associated with having both ASD and ADHD traits. Since ADHD behaviors are more commonly found in children with ASD, deepening the understanding of how exposure to environmental chemicals, such as phthalates, could contribute to this comorbidity may be important for managing and treating these conditions effectively.

Note: The results reported here are from a single study. Other or future studies may provide new information or different results. You should consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

Who was involved?

This study included 243 children living in Northern California and taking part in the ReCHARGE (Revisiting Childhood Autism Risks from Genetics and Environment) study. This study included both neurotypical and neurodiverse children, with about 60% of them having ever had neurodevelopmental concerns. Therefore, the children included in the study tended to have more ADHD behaviors compared with children in the general population.

What happened during the study?

Phthalate metabolites can be measured in biological samples, such as urine, to assess exposure to phthalates. In this study, the researchers measured 15 phthalate metabolites in urine samples of young children ages 2-5 years. Parents answered questions about each child’s ADHD symptoms at ages 8-18 years.

What happens next?

While the metabolite MHPP and the phthalate it’s derived from, di-n-heptyl phthalate (DHPP), are commonly found in children’s urine, their influence on neurodevelopment has not been studied as much as other phthalates. Since exposure to DHPP has been linked to problems with development and behavior in animals, further studies need to look more closely at this compound to understand its effects on how the brain develops in children.

Where can I learn more?

Read the full research article, titled “Early childhood exposures to phthalates in association with attention-deficit/hyperactivity disorder behaviors in middle childhood and adolescence in the ReCHARGE study,” in the journal International Journal of Hygiene and Environmental Health.

Learn more about ECHO’s other chemical exposure research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published June 2024

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

ECHO Researchers Examine the Effect of Perinatal Synthetic Oxytocin Exposure and Maternal BMI on Child Neurodevelopmental Outcomes

Posted on May 28, 2024May 29, 2024 by Jodi Snare

Collaborative ECHO Cohort research led by Lisa Kurth, PhD of the University of Colorado, Anschutz Medical Campus investigates the potential influence of maternal exposure to synthetic oxytocin during childbirth—and the contribution of maternal obesity—on neurodevelopmental outcomes in children. Synthetic oxytocin (e.g., Pitocin, Syntocinon) is a drug commonly used to assist women during childbirth by stimulating uterine contractions.

The researchers examined data from over 12,000 mother-child pairs to look at possible associations between maternal exposure to synthetic oxytocin, maternal pre-pregnancy body mass index (BMI), and childhood ADHD and Autism Spectrum Disorder (ASD). The results of this study found no significant correlation between synthetic oxytocin exposure and the risk of ADHD and ASD in children. However, an unexpected finding in this study was that synthetic oxytocin exposure was associated with a decreased childhood risk of ADHD in children born to mothers with pre-pregnancy obesity. Additionally, mothers with pre-pregnancy obesity demonstrated a modest trend toward labor intervention with synthetic oxytocin. This research, titled “Intrapartum Exposure to Synthetic Oxytocin, Maternal BMI and Neurodevelopmental Outcomes in Children within the ECHO Consortium,” is published in the Journal of Neurodevelopmental Disorders.

Previous studies on the association between synthetic oxytocin and children’s risk of ADHD and ASD have been decidedly mixed, and the potential impact of the mother’s pre-pregnancy BMI on this association has, until now, not yet been examined. This study analyzed data from participating mothers, 48% of whom were exposed to synthetic oxytocin during childbirth, and their children from ECHO Cohort research sites across the U.S.

Although no significant correlation was found between synthetic oxytocin-assisted childbirth and neurodevelopmental outcomes in children, future research may further unravel the effects of childbirth factors such as synthetic oxytocin dosage, maternal labor duration, maternal gestational obesity and Caesarean delivery rationale, indicators of newborn health (e.g., initial Apgar score, meconium stain, newborn birthweight), and maternal BMI at time of delivery on infant well-being in relationship to child neurodevelopmental outcomes. Important next steps include analysis of biospecimens (placental tissue and cord blood) aimed at understanding the specific mechanism(s) of action involved in synthetic oxytocin exposure.

“Casting a wider net and including additional factors will allow future studies to more precisely examine the effects of important perinatal factors, including environmental exposures, and effect modifiers, such as maternal obesity, on child neurodevelopmental outcomes,” said Dr. Kurth.

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No Significant Correlation Found Between Labor-inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

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No Significant Correlation Found Between Labor-Inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

Synthetic oxytocin was associated with lower ADHD risk among children born to mothers with pre-pregnancy obesity. Mothers with pre-pregnancy obesity were more inclined to receive labor-inducing medication.

Authors: Lisa Kurth, PhD, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

Why was this study needed?

More than 50% of U.S. childbirths are assisted with synthetic oxytocin (sOT)—known by trade names such as Pitocin or Syntocinon—a drug that promotes labor by stimulating the muscles in the uterus to contract. As rates of child ADHD and autism spectrum disorder (ASD) diagnoses are steadily rising, researchers have attempted to identify risk factors that might be contributing to these increases. There have been conflicting results from previous studies investigating the link between sOT exposure and childhood risk of ADHD and ASD. Additionally, the potential effect of the mother’s pre-pregnancy body mass index (BMI) on this association has not yet been studied.

What were the study results?

Analysis of data from a large and diverse ECHO Cohort sample suggests that maternal exposure to sOT during childbirth was not associated with an increased risk for ADHD or ASD in offspring. Associations did not differ by sex. Unexpectedly, sOT was associated with lower ADHD risk among children born to mothers with pre-pregnancy obesity.

The study also found that 48% of laboring mothers received sOT. Researchers saw slightly higher usage of sOT in mothers with pre-pregnancy obesity.

What was this study's impact?

The findings raise questions about how these drugs might affect health outcomes, especially when combined with maternal obesity during pregnancy. Additionally, the findings indicate that maternal obesity may influence the need for interventions during childbirth. These results do not currently support a need to modify the clinical use of sOT during childbirth.

What happened during the study?

A team of researchers used statistical analysis to examine the association between sOT exposure during labor and child ADHD or ASD diagnosis. Investigators also evaluated whether maternal pre-pregnancy BMI and child sex affected this correlation.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

Who was involved?

This study included over 12,000 mother-child pairs from 44 ECHO Cohort research sites across the U.S. Of the mothers participating in this study, 48% were exposed to sOT during childbirth.

What happens next?

More research is needed to evaluate if the dosage and duration of sOT has any influence on children's neurodevelopment. Future studies may clarify how environmental exposures and other contributing factors, such as delivery method and maternal obesity at delivery, influence a child’s neurodevelopment. Examining maternal/fetal biospecimens could also reveal how this exposure affects mothers and babies.

Where can I learn more?

Access the full journal article, titled “Intrapartum Exposure to Synthetic Oxytocin, Maternal BMI, and Neurodevelopmental Outcomes in Children within the ECHO Consortium” in the Journal of Neurodevelopmental Disorders.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published May 26, 2024

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No Significant Correlation Found Between Labor-Inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

New ECHO Research Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Problems in Children

Posted on October 27, 2023April 9, 2025 by Jodi Snare

Collaborative ECHO research led by Claudia Lugo-Candelas, PhD, Tse Hwei, MPH, Seonjoo Lee, PhD, and Cristiane Duarte, MPH, PhD of the Columbia University Irving Medical Center and New York State Psychiatric Institutes investigates the effect of prenatal sleep on children’s health outcomes, including neurodevelopment disorders and sleep quality. This research, titled “Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: A prospective analysis of timing and sex differences in the ECHO Cohort,” is published in The Lancet Regional Health – Americas.

Sleep difficulties are common in pregnancy. Poor prenatal sleep may relate to negative outcomes for both parent and child, including pregnancy complications and certain birth outcomes. The impact of poor prenatal sleep may also extend beyond pregnancy and birth and may increase the risk for neurodevelopment disorders in offspring, particularly attention-deficit/hyperactivity disorder (ADHD).

In this study, ECHO researchers aimed to study potential associations between poor prenatal sleep and an increased risk of ADHD symptoms and sleep problems in offspring. The research team used data from 794 mother-child pairs across five ECHO research sites and all enrolled pairs with available prenatal sleep and offspring ADHD assessments before age 7 were included. The pregnant participants reported on their sleep during pregnancy using self-report questionnaires and reported on children’s symptoms and behaviors when children were between 3 and 5 years old. The study assessed the children’s ADHD symptoms and associated characteristics using the Child Behavior Checklist Preschool Version, a widely used parent report that measures behavior problems in children.

The study found that prenatal sleep quality and duration, particularly in the second trimester, appeared related to children’s risk for ADHD, emotional reactivity, and sleep problems at age 4. Longer sleep duration in the second trimester was associated with fewer ADHD symptoms in children. Poorer sleep quality scores in the second trimester were associated with greater offspring ADHD symptomatology. Shorter duration and poorer quality of sleep during the second trimester were also associated with more sleep difficulties in children.

“This study extends prior work by examining the associations between self-reported prenatal maternal sleep health and offspring ADHD symptoms in early childhood in a large, socio-demographically diverse sample,” Dr. Lugo-Candelas said. “This study was also the first looking to understand if sleep at a particular time in pregnancy is specifically related to offspring outcomes. Our research suggests we need to better study the role of sleep in pregnancy on both the health of the pregnant woman and their offspring to understand these potential associations.”

Future studies are needed to replicate these findings, as well as investigate the possible mechanisms. Poor sleep may impact inflammation in pregnancy and offspring development, but studies have not examined that association.

Read the research summary.

ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Authors: Claudia Lugo-Candelas, Tse Hwei, Seonjoo Lee, Cristiane Duarte, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Sleep difficulties are common in pregnancy. Poor prenatal sleep may relate to negative outcomes for both parent and child, including pregnancy complications and certain birth outcomes. The impact of poor prenatal sleep may also extend beyond pregnancy and birth and may increase the risk for neurodevelopment disorders in offspring, particularly attention-deficit/hyperactivity disorder (ADHD).

In this study, ECHO researchers aimed to study potential associations between poor prenatal sleep and an increased risk of ADHD symptoms and sleep problems in offspring.

What were the study results?

Prenatal sleep quality and duration, particularly in the second trimester, appeared related to children’s risk for ADHD, emotional reactivity, and sleep problems at age 4. Longer sleep duration in the second trimester was associated with fewer ADHD symptoms in children. Poorer sleep quality scores in the second trimester were associated with greater offspring ADHD symptomatology. Shorter duration and poorer quality of sleep during the second trimester were also associated with more sleep difficulties in children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study extends prior work by examining the associations between self-reported prenatal maternal sleep health and offspring ADHD symptoms in early childhood in a large, socio-demographically diverse sample in the U.S., including Puerto Rico.

Who was involved?

The research team used data from 794 mother-child pairs across five ECHO research sites. All enrolled pairs with available prenatal sleep and offspring ADHD assessments before age seven were included. The pregnant participants were between 27 and 37 years old.

What happened during the study?

Pregnant participants reported on their sleep during pregnancy using self-report questionnaires and reported on children's symptoms and behaviors when children were between 3 and 5 years old. The study assessed the children’s ADHD symptoms and associated characteristics using the Child Behavior Checklist Preschool Version, a widely used parent report that measures behavior problems in children.

What happens next?

Future studies are needed to replicate these findings, as well as investigate the possible mechanisms. Poor sleep may impact inflammation in pregnancy and offspring development, but studies have not examined that association.

Where can I learn more?

Access the full journal article, titled “Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: A prospective analysis of timing and sex differences in the ECHO Cohort,” in The Lancet Regional Health - Americas.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 9, 2023

Access the associated article.

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Prenatal Exposure to Phthalates, But Not Phthalate Replacements, Linked to Children’s Behavior, ECHO Study Finds

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ECHO Study Suggests Children with Autism Are More Likely to Experience Emotional & Behavioral Challenges Like Anxiety, Depression, & ADHD

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

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No Significant Correlation Found Between Labor-Inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

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