Using ECHO Cohort Data to Explore Critical Scientific Questions in Child Health

Posted on by Jodi Snare

Happy New Year! In this first message, I highlight how the entire scientific community can use ECHO data to explore critical scientific questions in child health.

De-identified data from the ECHO Cohort are available to any qualified researcher through the Eunice Kennedy Shriver National Institute for Child Health and Development (NICHD) Data and Specimen Hub (DASH). Over 60,000 ECHO Cohort participants have generously shared their data on this platform, including information about demographics, early development, environmental exposures, pregnancy and birth, and public health crises, as well as child health outcomes. I hope that a large number of scientists will use these data for teaching and research. I think they will be particularly fruitful for researchers in training, who often look for meaningful data to answer their research questions in a relatively short period of time.

This month’s spotlight story highlights one example of the richness of ECHO Cohort data available in DASH—data on nutrition. We know from animal experiments and smaller studies of human populations that diet early in development can have long-lasting consequences. Now, longitudinal ECHO data on over 25,000 pregnancies and over 25,000 children, from 34 states, are ready for researchers to explore questions of diet and child health in a nationwide sample. You can learn more in the January ECHO Connector about the publication that describes this nutritional resource and how researchers can request access to ECHO Cohort data in DASH.

—Matthew W. Gillman, MD, SM

NIH Study Finds Flame-Retardant Chemicals May Increase Risk Of Preterm Birth, Higher Birth Weight

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

An NIH Environmental influences on Child Health Outcomes (ECHO) Cohort study finds that certain organophosphate esters (OPEs) were linked to increased odds of preterm birth, especially in girls. 

Pregnant individuals exposed to specific classes of flame-retardant chemicals known as organophosphate esters (OPEs) may face an increased risk of preterm birth, especially for baby girls, or higher birth weights for girls and boys, according to a recently published study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Manufacturers commonly use OPEs in products such as furniture, baby items, electronics, clothes, and building materials to prevent fires and make plastics more flexible. People can come into contact with OPEs in various ways, including swallowing or breathing indoor dust or absorbing it through the skin.

In the past decade, OPEs have been increasingly used as flame retardants after polybrominated diphenyl ether (PBDE) flame retardants were phased out due to health risks. ECHO researchers wanted to learn how these now more widespread OPE chemicals might affect pregnancy outcomes such as preterm birth and birth weight.

"The widespread use of products with new flame retardants among pregnant people in the U.S. means that a significant number of births could be affected by these compounds," said Deborah Bennett, PhD, of the University of California, Davis. “In fact, ECHO researchers learned that more than 85% of the study participants had three specific markers of OPE exposure in their bodies.”

Those three substances—diphenyl phosphate (DPHP), a combination of dibutyl phosphate and di-isobutyl phosphate (DBUP/DIBP), and bis(1,3-dichloro-2-propyl) phosphate—were associated with shorter pregnancies and higher risks of preterm birth only among female infants. Among male infants, higher concentrations of DPHP were associated with longer pregnancies.

Babies born to mothers with detectable levels of three other OPE markers—bis(1-chloro-2-propyl) phosphate, bis(2-methylphenyl) phosphate, and dipropyl phosphate—tended to have higher birth weights compared to those whose mothers had no detectable levels of these substances. Babies with a higher birth weight might be more likely to have jaundice, breathing problems, or congenital disorders.

Researchers measured a total of nine OPE markers in urine samples collected from 6,646 pregnant participants across 16 ECHO Cohort Study Sites—often during their third or second trimesters. The researchers assessed birth outcomes, including the length of pregnancy and birth weight, using medical records or parent reports.

“These substances tend to stay in the body for short periods, usually just hours to days,” said Dr. Bennett. “Conducting more thorough studies with various urine tests can help us figure out how they might be linked to birth outcomes.”

Dr. Bennett led this collaborative research published in Environmental Health Perspectives.

###

About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X (formerly known as Twitter).

Early Breastfeeding Linked to Lower Risk of Childhood Obesity, Regardless of Mother’s Weight, NIH Study Finds

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

Consistently breastfeeding infants in any amount during their first three months was associated with a lower risk of childhood obesity, regardless of the mother's body mass index (BMI) before pregnancy, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

While previous studies have shown that breastfeeding may protect children against obesity and other chronic conditions, this relationship has not been studied much in women with obesity. ECHO Cohort researchers wanted to explore the possible link between breastfeeding practices in women with obesity and overweight before pregnancy and a child’s BMIz score. Researchers use BMIz scores to compare children’s height and weight to those of their peers, while the more familiar BMI assesses body weight in relation to height.

In this ECHO Cohort study, researchers found that any amount of consistent breastfeeding during an infant’s first three months was associated with lower BMIz scores, calculated later at ages between 2 and 6 years, regardless of the mother’s pre-pregnancy BMI. This protective association appeared stronger for children with mothers who had obesity before pregnancy compared to those categorized as overweight during the same time. (A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or higher is considered obese.)

“Our findings highlight that each additional month of breastfeeding, whether a consistent amount or exclusively, may contribute to a lower weight later in childhood, especially for mothers who had obesity before pregnancy,” said Gayle Shipp, PhD, RDN of Michigan State University.

The study looked at BMI measurements from 8,134 pairs of mothers and kids at 21 study sites in 16 states and Puerto Rico. The researchers calculated BMI and BMIz scores from measurements taken at study visits, medical records, or self-reported data for the mother and child. Additionally, the study examined two breastfeeding situations: whether the mother ever breastfed or whether the mother was exclusively breastfeeding the infant at 3 months old. This continuous breastfeeding measure included the duration of any breastfeeding allowing for formula or other food and the duration of exclusive breastfeeding with no formula feeding or other food.

Exclusive breastfeeding at three months was associated with a lower child BMIz score only among women with a pre-pregnancy BMI in the normal range. Each additional month of any or exclusive breastfeeding correlated with a significantly lower child BMIz, particularly for mothers categorized as overweight (in the case of any breastfeeding) or as having obesity (for any or exclusive breastfeeding) prior to pregnancy.

“Health professionals can use this study’s findings as an opportunity to encourage and promote breastfeeding among all women, especially those who have obesity,” said Shipp.

Dr. Shipp led this collaborative research published in Pediatrics.

###

About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X (formerly known as Twitter).

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

Posted on by Jodi Snare

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.

Read the research summary.

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

Posted on by Jodi Snare

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:

Read the research summary.

Celebrating ECHO’s Successes and Anticipating Even Greater Impact in 2024

Posted on by Jodi Snare

The end of the calendar year is a time for celebration. Today we celebrate ECHO’s many recent successes and how they showcase the principles that guide our work, and we anticipate even greater impact in 2024.

ECHO’s solution-oriented approach means that we focus our research on informing programs, policies, and practices to promote long-lasting health for our country’s children. For example, our work on child health disparities demonstrates that they may be present as early as infancy, how they widen as children grow, and, equally importantly, what may drive them in the first place. This type of research emphasizes our approach to real-world solutions, aided by collaboration with many organizations, like yours, with whom we share our commitment to enhancing child health for generations to come.

The next year holds great promise for both the observational work of the ECHO Cohort Consortium, which has just launched its second 7-year cycle, and the intervention research of the ECHO Institutional Developmental Award (IDeA) States Pediatric Clinical Trials Network (ISPCTN). In early 2024, ECHO Cohort Study Sites will launch our new protocol that will follow over 30,000 current child participants and will enroll approximately 30,000 new pregnancies and their offspring. A novel addition is our preconception cohort that will follow several thousand women and their partners to examine how environmental factors even before pregnancy begins can affect their children.

Our investigators have published many papers in peer-reviewed journals this year, bringing our program lifetime total to more than 1500. These publications span a broad spectrum of topics across ECHO’s child health focus areas, highlighting our collaborative team approach to science. We are excited to continue producing high-impact research in the next year and beyond. Please see the ECHO publication database to explore these papers and check back often to find our most recent work.

—Matthew W. Gillman, MD, SM

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

Posted on by Jodi Snare

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.

Read the research summary.

 

NIH Study Validates New Scale for Measuring Pandemic-Related Traumatic Stress in Children and Adults

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

The Pandemic-related Traumatic Stress Scale (PTSS) can be used to effectively measure stress related to the COVID-19 pandemic and identify children and adults with higher levels of stress who may need additional mental health support, according to a new study funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

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, participants or their caregivers completed surveys about their pandemic-related traumatic stress, depressive symptoms, anxiety, general stress, and life satisfaction. On average, caregivers had the highest PTSS scores, 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 PTSS can be used beyond the immediate COVID-19 pandemic context,” said Courtney Blackwell, PhD, an ECHO Cohort Investigator at Northwestern University. “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.”

Dr. Blackwell led this collaborative research published in Psychological Assessment.

Blackwell, C. et al. Development and Psychometric Validation of the Pandemic-related Traumatic Stress Scale for Children and Adults. Psychological Assessment. DOI: 10.1037/pas0001211.

###

About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

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

Posted on by Jodi Snare

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.”

Read the Research Summary.

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

Posted on by Jodi Snare

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.

Read the research summary.