New ECHO Research Study Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

Collaborative ECHO research led by Santiago Morales, PhD of the University of Southern California investigates the relationship between maternal education and children’s neurocognitive development over time. This research, titled “Maternal Education Prospectively Predicts Child Neurocognitive Function: An ECHO Study,” is published in Developmental Psychology.

ECHO researchers wanted to examine the relationship between changes in a mother’s education over time and their children’s later neurocognitive functioning, such as executive function and language skills. Studies to date have focused on early childhood outcomes and have treated a mother’s education as unchanging over time.

This study included 2,688 children, adolescents, and young adults from 3 to 20 years of age at ECHO research sites in 42 states across the U.S.

Mothers reported their own education levels during pregnancy and their child’s infancy, and again, years later when their children’s neurocognitive functions were also assessed. For both periods, the study categorized the mother’s education level into one of five groups—less than high school; high school or GED equivalent degree; some college, associate degree or trade school; bachelor’s degree; and graduate degree. The same categories were used to measure maternal education during childhood. Maternal education and income are two commonly used indicators of socioeconomic status. However, missing income data in this study prevented investigators from fully assessing the impact of socioeconomic status and income on neurocognitive skills.

Researchers also measured child participants’ cognitive abilities during childhood, adolescence, or young adulthood using the NIH Toolbox Cognition Battery. These tests assess aspects of cognition including language, memory, and problem solving. Test results created scores that reflected language skills, executive function, and overall brain function. The analysis included child participants who contributed at least one score.

This study found that a mother’s education level during pregnancy and infancy was associated with children’s language and executive function. Increases in maternal education were related to improved language performance but were not associated with executive functioning performance.

“These results suggest that further examining these associations can provide important insights that can help inform policies and interventions designed to foster neurocognitive development,” said Dr. Morales.

Future research can explore the factors involved in the suggested association between maternal education and a child’s neurocognitive development.

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New ECHO Study Finds No Statistically Significant Associations Between Small Molecules During Pregnancy and Childhood BMI

Collaborative ECHO research led by Rachel Kelly, PhD and Nicole Prince, PhD, of Brigham and Women’s Hospital and Harvard Medical School, and Donghai Liang, PhD, MPH of Emory University analyzes the relationship between small molecules in a mother’s blood during pregnancy and childhood BMI. This research, titled “Metabolomic Data Presents Challenges for Epidemiological Meta-Analysis: A Case Study of Childhood Body Mass Index from the ECHO Consortium,” is published in Metabolomics.

A child’s body mass index (BMI) can affect their future health. Some researchers are exploring the connection between factors during pregnancy and childhood BMI. Increasingly, researchers use molecular data to analyze the relationship between pregnancy and childhood health outcomes, sometimes combining molecular data from multiple study sites to increase the statistical power of these analyses.

In this study, ECHO researchers combined the results from multiple ECHO Cohort Study Sites to determine whether a relationship existed between small molecules in the mother’s blood during pregnancy and their child’s later BMI. It also aimed to use these data to test a framework for analyzing molecular data across multiple studies.

The study involved mothers in the second and third trimesters of pregnancy and their children from multiple study sites: the Atlanta ECHO Cohort, the New Hampshire Birth Cohort, and the Vitamin D Antenatal Asthma Reduction Trial. Pregnant participants from these sites provided blood samples, which were then used to measure a range of small molecules that provide information on each participant’s health and environment and the biological or genetic factors that could affect their pregnancy. These participants and their children were observed and assessed across pregnancy and the child’s early life. In this analysis, the authors used data from the aforementioned three study sites to evaluate the relationship between molecules measured during pregnancy and BMI at age 2, aiming to identify relationships that were consistent across all three.

The research team found that of all the small molecules tested, 20 showed up in all study sites, and 127 showed up in at least two. The study found that the levels of only six small molecules, primarily related to maternal diet, were associated with child BMI across all sites. However, statistical analysis across these study sites did not identify significant associations between these molecules and child BMI.

This study demonstrates some of the challenges of harmonizing molecular data across diverse study sites and highlights important considerations for researchers trying to conduct similar analyses.

“Differences in how molecular data were collected and measured between the sites in this study made it difficult to draw strong conclusions on the relationship between small molecules during pregnancy and childhood BMI,” Dr. Kelly said. “Future analyses could involve larger, more standardized studies that all use the same methods for sample collection and measurement of molecules present, which would improve the reliability and reproducibility of results.”

Many ECHO Cohort Study Sites are now measuring small molecules in mothers and children with a standardized approach under the ECHO Cohort Data Collection Protocol. ECHO researchers have an opportunity to use these data to power analyses that can explore the relationship between pregnancy health and child health outcomes.

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ECHO Researchers Find Link Between Phthalate Exposure and Preterm Birth, Estimate Potential Costs

 

Collaborative ECHO research led by Leonardo Trasande, MD, MPP of NYU Langone Health investigates the potential connections between phthalates, their metabolites in the urine of pregnant individuals, and birth outcomes. This research, titled “Prenatal phthalate exposure and adverse birth outcomes in the USA: a prospective analysis of births and estimates of attributable burden and costs,” is published in The Lancet Planetary Health.

Phthalates are widely used chemicals found in some consumer products, and previous research has linked phthalate exposure to preterm birth. In response, the use of di-2-ethylhexyl phthalate (DEHP), a common type of phthalate, has decreased in recent years. However, there is limited research on the effects of the replacement phthalates, and the costs associated with phthalate exposure remain unquantified.

The study included 5,006 mother-child pairs from 13 ECHO Cohort Study Sites across the U.S.  Researchers analyzed levels of 20 phthalate metabolites in urine samples collected at three different points during each participant’s pregnancy. Then, the team looked for associations between these metabolite levels and preterm birth. The team also investigated the differences between specific types of phthalates, comparing di-2-ethylhexyl phthalate (DEHP), a common type of phthalate, with several newer alternatives developed to replace it.

When the researchers grouped mothers based on the amount of DEHP metabolites (substances produced when the body breaks down DEHP) found in their urine, they found that the 10% with the highest levels had a 50% higher chance of giving birth before the 37th week of pregnancy compared to the 10% with the lowest levels.

Some common alternatives to DEHP were associated with an even higher risk of preterm birth. Women exposed to the highest amounts of these alternative chemicals—phthalic acid, di-isodecyl phthalate (DIDP), di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP)—had twice the risk of preterm birth compared to those with little to no exposure to these alternatives. The team also calculated the costs associated with phthalate exposure.

“The number of premature births in the U.S. that could be linked to phthalate exposure in 2018 was between 24,000 and 120,000, potentially costing between $1.6 billion and $8.1 billion in medical expenses over the lifetime of the children,” Dr. Trasande said.

Future research could look at how exposure to replacement phthalates affects child development after birth. The European Union has prohibited the use of certain phthalates in some consumer products—as have California and a few other U.S. states.

Read the research summary here.

New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

Collaborative ECHO research led by Elena Jansen, PhD of Johns Hopkins School of Medicine, and Kristine Marceau, PhD of the College of Health and Human Sciences at Purdue University reviewed existing literature on what is known about a father’s role in child development, highlighting how a father’s history and personal characteristics can influence their child’s health and wellbeing. This research, titled “The Role of Fathers in Child Development from Preconception to Postnatal Influences: Opportunities for the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Developmental Psychobiology.

While few studies on parental health and child development include fathers in any substantial way, a growing body of literature emphasizes their vital role—even before birth. This literature review studied existing research on the role of fathers in child development. It evaluated the quality of this research, focusing on three outcome areas of the ECHO Program: obesity, neurodevelopment, and positive health. The review also discussed how the ECHO Program can address gaps in the literature by designing studies that address unanswered questions.

The review first described data collected by the ECHO Cohort and identified critical gaps in the research related to the role of fathers in ECHO’s five key health outcome areas. After understanding the program’s data collection methods, the research team analyzed multiple research papers categorized into three broad stages of child development—preconception, prenatal, and postnatal.

This review focused on which previously studied characteristics or behaviors of fathers have been connected to children’s development. It demonstrated how studying the effect of fathers on child development has revealed additional insights into children’s health outcomes, including reasons for declines in physical or mental health. Compared to the pregnancy and pre-pregnancy stages, this study allowed researchers to better understand a father’s role once a baby is born.

“One unique aspect of this work is describing how fathers can impact the child by first influencing the mother, for example, by helping her follow healthy behaviors, such as cooking or helping to cook healthy meals and eating healthy food himself,” Dr. Jansen said.

This literature review also revealed gaps in the research community’s understanding of the father’s role in child development, highlighting the need to incorporate maternal and paternal reported data on fathers’ characteristics. While many studies offer insights into the role of fathers, often fathers do not provide this information themselves, or existing data do not allow researchers to compare the roles of fathers and mothers.

Additionally, the study team proposed a new conceptual model to guide future inquiry considering paternal influences, and suggest methods researchers can use to help fill in some knowledge gaps.

“Our model can help guide other researchers to focus on the pieces of the puzzle that we currently know very little about,” Dr. Jansen said. “It may help explain how each parent interacts with their child and which influence has a stronger impact or is more prevalent for which parent.”

With more data becoming available from the ECHO Program, information on fathers’ characteristics can be connected to the rich data on family characteristics, mothers’ influences, and child development. Additional data will be gathered to provide further insights and answer remaining questions.

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New ECHO Research Finds No Association Between Arsenic Exposure and Birth Outcomes

Collaborative ECHO research led by Jonathan Lewis, MHS, Emily Knapp, PhD, MHS, and Amii Kress, PhD, MPH of Johns Hopkins Bloomberg School of Public Health investigates the relationship between arsenic exposure and certain birth outcomes. This research, titled “Associations Between Area-Level Arsenic Exposure and Adverse Birth Outcomes: An ECHO-Wide Cohort Analysis,” is published in Environmental Research.

Researchers captured proxy exposure to arsenic using a residential history of arsenic violations from the preconception period throughout pregnancy, a time when environmental influences could disrupt fetal growth.  Violations were used as a proxy for arsenic exposure. The study used data from 15,000 mother-child pairs at 51 research sites across the U.S., focusing on children born in 2006 or later. In 2006, the Environmental Protection Agency (EPA) revised the enforceable standard for arsenic concentrations in drinking water to 10 parts per billion.

Low birth weight, gestational age at birth, preterm birth, and birth size were not found to be associated with potential arsenic exposure in areas with violations. However, infants whose mothers experienced continuous exposure to arsenic from three months before conception through birth exhibited a statistically significant increase in birth weight compared to those born in areas without violations.

In future studies, researchers aim to improve the identification of the community water systems that serve ECHO participants. Future research could also consider ECHO participants’ exposure to arsenic in foods and from other sources of drinking water.

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ECHO Research Explores Potential Value of Nutrition Data Collected from Pregnancy Through Adolescence for Understanding Child Health

Collaborative ECHO research led by Megan Bragg, PhD, RD and Kristen Lyall, ScD of the A.J. Drexel Autism Institute highlights the opportunity for researchers to access the large amount of diet information already collected from the ECHO Cohort. This research, titled “Opportunities for examining child health impacts of early-life nutrition in the ECHO Program: Maternal and child dietary intake data from pregnancy to adolescence”, is published in Current Developments in Nutrition.

This study aimed to describe dietary intake data available in the ECHO Program as of August 2022, from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health. As of that date, 66 ECHO Cohort Study Sites across the country had collected diet information using a variety of methods, including dietary recalls, food frequency questionnaires, and questionnaires about supplement use. Diet information from these study sites is especially useful because it has been collected from a large group of diverse people, and because many families provided information more than once over the course of pregnancy and childhood.

Often, data collected on diet provide only a snapshot that can’t address how early-life diet affects later child health outcomes. The ECHO Cohort Consortium is addressing these challenges by gathering information over time about the dietary habits of individuals during pregnancy and childhood from a large, diverse group of participants.

“Researchers need information about what people eat during pregnancy and childhood from a large, diverse group of people in order to answer questions about nutrition,” said Dr. Bragg. “ECHO is unique because study sites have collected and continue to collect this information.”

Information from over 33,000 pregnancies and more than 31,000 children in the ECHO Program is now accessible to researchers. This de-identified data is publicly available to researchers through the National Institute of Child Health and Human Development Data and Specimen Hub (DASH) to encourage broad use to answer important questions about nutrition and child health.

Access the brief flash talk from one of the authors in the following video:

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New ECHO Research Characterizes Children Born Preterm into Four Neurobehavioral Profiles Based on a Combination of Health Outcomes

Collaborative ECHO research led by Marie Camerota, PhD of the Warren Alpert Medical School of Brown University studies the health outcomes of children born preterm and characterizes them into four neurobehavioral profiles. This research, titled “Neurodevelopmental and behavioral outcomes of very preterm infants: latent profile analysis in the Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Pediatric Research.

Birth outcomes for infants born very preterm have steadily improved over the past several decades. More children born at earlier gestational ages are surviving into childhood, however, it is unclear how being born very preterm may influence neurodevelopmental or behavioral problems.

Outcomes of children born at a gestational age of less than 33 weeks (“very pre-term”) vary significantly, with some children showing few neurodevelopmental concerns and others showing significant impairment. Most prior research has looked at single outcomes—for example, whether a child born preterm had a lower neurodevelopmental score or higher levels of behavior problems. Understanding how these different outcomes may group together can help researchers and healthcare providers provide more comprehensive treatment plans for children born very preterm.

This study included more than 2,000 babies who were born at less than 33 weeks gestational age from three ECHO Cohort Study Sites. When these children reached the age of two years, researchers conducted a neurodevelopmental assessment and a motor exam on the children while parents completed questionnaires about their children’s behavior. ECHO researchers looked for patterns in these data to understand whether there were groups of children with similar strengths and weaknesses.

Researchers found evidence for four different neurobehavioral profiles based on different combinations of cognitive, motor, and behavioral outcomes of children at the age of two. These profiles range from few or no developmental concerns to severe impairment in one or more domains. The study placed about 85% of children into one of two groups with no/mild developmental delay and a low prevalence of behavioral problems. The remaining 15% fell into one of two profiles with more serious neurodevelopmental problems with (5%) or without (10%) co-occurring behavior problems.

“This study helps us better understand outcomes for children following a very pre-term birth and shows that it is important to measure both neurodevelopmental and behavioral outcomes for children born preterm,” Dr. Camerota said. “The different groups of children we described might require different types of follow-up services or interventions. Therefore, the results of this study could potentially be used to develop personalized interventions for children following a very pre-term birth.”

More research is needed to understand why some preterm children develop neurodevelopmental and/or behavioral problems and others do not. To do this, future studies may study risk factors in pregnancy, the perinatal period, and in early infancy.

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ECHO Researchers Evaluate New Scale for Measuring Pandemic-related Traumatic Stress in Children and Adults

Courtney K. Blackwell, PhD

Collaborative ECHO research led by Courtney K. Blackwell, PhD of Northwestern University evaluated COVID-19 pandemic-related traumatic stress in a large sample of children and adults. In March 2020, ECHO researchers developed the Pandemic-related Traumatic Stress Scale (PTSS) to measure stress related to the COVID-19 pandemic. The PTSS can be used to identify children and adults with higher levels of traumatic stress and who may need additional mental health support. This research, titled “Development and Psychometric Validation of the Pandemic-related Traumatic Stress Scale for Children and Adults,” is published in Psychological Assessment.

The study included 17,830 children and adults from 47 ECHO Cohort study sites representing all 50 states, Washington, DC, and Puerto Rico. Researchers split the sample into four groups including 1,656 pregnant or postpartum individuals; 11,483 adult caregivers; 1,795 adolescents aged 13 to 21; and 2,896 children aged 3 to 12.

Between April 2020 and August 2021, adolescents and adult caregivers (including pregnant or postpartum individuals) completed surveys about their pandemic-related traumatic stress, depressive symptoms, anxiety, general stress, and life satisfaction. Caregivers of children aged 3-12 reported on the behaviors observed in their child.

On average, caregivers had the highest levels of pandemic-related traumatic stress, followed by adolescents, pregnant or postpartum individuals, and children. Within these groups, the researchers found additional differences related to age and gender. Adolescents, females, and caregivers of children under 5 had higher PTSS scores on average than younger children, males, and caregivers of children 5 and older, respectively. Higher levels of pandemic-related traumatic stress were associated with greater symptoms of distress and lower life satisfaction.

The researchers found that the PTSS is a reliable way to measure pandemic-related traumatic stress in the context of the COVID-19 pandemic. Researchers and doctors can use this scale to distinguish general stress, depression, and anxiety from traumatic stress, helping them to identify people who may need more support to improve their mental health.

“The PTSS can be used beyond the immediate COVID-19 pandemic context,” said Dr. Blackwell. “Unlike previous measures that capture traumatic stress reactions to a single event, the PTSS was developed to evaluate potential traumatic stress reactions to ongoing large-scale threats. In the future, the PTSS could be adapted to evaluate reactions to other acute onset stressors with lengthy durations.”

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New ECHO Research Finds No Link Between “Accelerated” Biological Age and Behavioral and Emotional Health Outcomes in Children

Collaborative ECHO research led by Christine Ladd-Acosta, PhD and Heather Volk, PhD, MPH, of Johns Hopkins Bloomberg School of Public Health, investigates the association between accelerated biological age at birth and children’s health outcomes. This research, titled “Accelerated epigenetic age at birth and child emotional and behavioral development in early childhood: A meta-analysis of four prospective cohort studies in ECHO,” is published in Epigenetics.

Previous studies have shown a potential link between early identification and intervention in the development of emotional and behavioral health challenges in children and better long-term health outcomes. Recently, researchers have begun looking at how epigenetic factors affect children’s biological age and health outcomes.

A molecular process known as DNA methylation, or DNAm, adds a tag to DNA to control gene expression. Researchers measure DNAm to estimate a person’s biological age and compare it with their chronological age to better understand the factors that may influence their long-term health outcomes.  In this study, ECHO researchers looked at the link between biological age at birth, the time between conception and birth (chronological gestational age), and emotional and behavioral health outcomes in children.

The study included 592 children at four ECHO research sites in the United States. Researchers calculated each child’s biological age by analyzing DNA samples collected at birth, and they compared this age to the child’s chronological gestational age. They then tested whether newborns who showed increased biological age relative to their chronological age (“accelerated aging”) were more likely to have emotional and behavioral problems in early childhood.

The study indicates that differences between biological age at birth and chronological gestational age are not linked to emotional and behavioral problems in childhood. This study also did not find any difference between boys and girls in terms of the effect of “accelerated” biological age on behavioral and emotional outcomes.

“This study suggests that biological age has no impact on child emotional and behavioral problems in early childhood,” Dr. Ladd-Acosta said. “These results highlight that future research is needed to look into how other biological factors at birth may influence neurodevelopmental health outcomes in early childhood.”

Future studies may use larger sample sizes to replicate this study and further confirm the findings. The relatively small sample size of this study may have made it difficult to observe differences in behavioral or emotional outcomes based on child sex. Future research with larger samples could help investigate potential differences in the results between boys and girls.

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New ECHO Cohort Research Finds Some Teens with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

Collaborative ECHO Cohort research led by Phillip Sherlock, PhD; Maxwell Mansolf, PhD; and Courtney Blackwell, PhD of Northwestern University investigates the COVID-19 pandemic’s impacts on adolescents’ mental health. The findings suggest that some teens with a history of depression, anxiety, autism and ADHD experienced more severe impacts than those without. This research, titled “Life Satisfaction for Adolescents with Developmental and Behavioral Disabilities during the COVID-19 Pandemic,” is published in Pediatric Research.

Although researchers have looked at how the COVID-19 pandemic affected the mental health of children of all ages, few studies have examined the pandemic’s impact on children and teens with pre-existing mental, emotional, behavioral, and developmental (MEBD) disabilities such as depression, anxiety, ADHD, and autism spectrum disorder.

Health policies implemented to prevent the spread of COVID-19 disrupted normal activities for children and families. Schools paused in-person learning, extracurricular activities were canceled, and stay-at-home orders meant children spent more time quarantined with family members instead of engaging with friends and peers.

Adolescence is a critical period for social development. Researchers aimed to identify the groups of adolescents most affected by the pandemic to provide mental health practitioners, pediatricians, and family physicians with better information on potential intervention and prevention practices particularly vulnerable adolescents in the future.

This study included data collected from 1,084 adolescents ages 11–21 years old and their caregivers and included individuals with and without disabilities from seven ECHO observational research sites in the U.S. In addition to using existing ECHO Cohort data about adolescents and their families, researchers administered a COVID-19-specific survey to better understand the physical, mental, and social impact of the pandemic on young people and their families.

This study found that when exposed to certain stresses during the COVID-19 pandemic, adolescents with a history of depression, anxiety, autism spectrum disorder, or ADHD had lower life satisfaction compared to their peers. These stressors included social isolation, stress related to medical care access and fears about the pandemic, and living in a single-caregiver household. Additionally, 80% of adolescents, regardless of pre-existing conditions, reported decreases in social connectedness during the COVID-19 pandemic. Although the negative effects of decreased social connectedness were amplified among adolescents with MEBD disabilities, this risk factor was widespread among the majority of adolescents.

“This study allowed us to identify the groups of adolescents with disabilities who are most vulnerable and may need additional support during future emergencies,” Dr. Sherlock said. “This study also highlights the importance of interventions aimed specifically at increasing social connectedness, family engagement, and access to medical support for all adolescents, and especially for those with disabilities.”

This study revealed potential differences between adolescents with disabilities and their peers in terms of life satisfaction. Future research might include studies that focus on the vulnerable subgroups identified in this study. Future studies may also investigate the long-term effects of decreased social connectedness and other risks resulting from the COVID-19 pandemic during developmentally critical time periods.

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