Author: Jodi Snare

Perceived Stress During Pregnancy Associated with Autism-related Traits in Children

Posted on by Jodi Snare

Higher perceived stress during pregnancy may be associated with greater severity of autism-related traits in children, according to a recent ECHO Cohort study led by Luke Grosvenor, PhD, of Kaiser Permanente Northern California.

Many mothers experience higher levels of stress and other mental health challenges during pregnancy. Previous studies have found that pregnancy stress may be associated with increased risk of autism spectrum disorder (ASD) in children, but these studies have mostly focused on the occurrence of isolated adverse or stressful events that occur in the mother’s life during pregnancy. Fewer studies have measured general perceived stress among mothers during pregnancy. To better understand whether this prenatal exposure may be associated with severity of autism-related traits in children, researchers collected information from over 4,000 mothers and their children enrolled in 20 ECHO Cohort Study Sites across the United States.

Key Takeaways include:

  • Higher perceived stress during pregnancy was associated with slightly more severe autism‑related traits in children.
  • At higher prenatal perceived stress levels, children showed slightly higher scores on tests measuring social and behavioral traits related to autism. Children whose mothers had either moderate or high categorical stress scored higher than those whose mothers reported low or no stress.
  • The link between pregnancy stress and autism‑related traits did not differ between boys and girls.
  • The relationship between prenatal stress and autism‑related traits remained consistent even when the researchers accounted for mothers’ co-occurring prenatal depressive symptoms.
  • Stress during pregnancy is normal and common to experience. While the results of this study indicate that there may be a small association between pregnancy stress and autism-related traits, they do not imply that stress during pregnancy causes autism spectrum disorder or autism-related traits to occur in children.

“This study provides evidence for small yet significant associations between higher prenatal perceived stress and greater severity of autism-related traits,” said Dr. Grosvenor. “These results could have implications for prenatal mental health screening and behavioral interventions aimed at improving child outcomes.”

Future studies could help researchers better understand the specific periods during pregnancy during which stress may have the greatest association with child health and development and how other related social and emotional factors may influence this effect.

This collaborative research, titled “Associations between Prenatal Perceived Stress and Child Autism-Related Traits in the ECHO Cohort,” is published in The Journal of Pediatrics.

Read the research summary.

 

Exposure to Flame-retardant Chemicals During Pregnancy Linked to Differences in Child Growth Patterns

Posted on by Jodi Snare

Prenatal exposure to certain flame-retardant chemicals may be associated with differences in how children grow from early childhood through age 10, according to a recent ECHO Cohort study by Anne P. Starling, PhD,  and Jessie P. Buckley, PhD, of UNC Chapel Hill, and Deborah Bennett, PhD, of University of California, Davis.

Organophosphate esters (OPEs) are widely used as flame retardants and plastic softeners in a variety of household and industrial products. Because these chemicals can be found in everyday environments, pregnant women are commonly exposed. While previous research has examined OPE exposure during pregnancy in relation to birth outcomes, less is known about whether prenatal exposure may be linked to children’s growth patterns beyond infancy.

To better understand these potential relationships, researchers measured nine chemical markers of OPE exposure in urine samples collected from pregnant participants. They then analyzed children’s weight and height measurements collected between ages 2 and 10 years and calculated body mass index (BMI). Using statistical models, the team examined whether prenatal OPE exposure was associated with differences in the rate of change in children’s weight, height, and BMI over time.

Researchers looked at 4,566 mother-child pairs from 14 ECHO Cohort Study Sites across the United States.

Key Takeaways :

  • Prenatal exposure to specific OPEs was associated with differences in child growth rates between ages 2 and 10.
  • Higher prenatal exposure to bis (1,3-dichloro-2-propyl) phosphate (BDCPP) was associated with faster increases in weight and height during early childhood (ages 2–5).
  • In mid-childhood (ages 6–10), higher prenatal exposure to diphenyl phosphate (DPHP) was associated with faster increases in BMI and weight.
  • Prenatal exposure to bis(1-chloro-2-propyl) phosphate (BCPP) was associated with slower growth across multiple periods.
  • Some associations differed by child sex and by maternal pre-pregnancy body mass index.

“This work increases our understanding of the potential long-term effects on child health from typical levels of exposure to these chemicals during pregnancy. The results may inform future guidance on the production and use of OPEs,” said Dr. Starling.

Additional research could help clarify the biological mechanisms involved and explore whether reducing exposure during pregnancy could support long-term child health.

This collaborative research, titled “Gestational exposure to organophosphate ester flame retardants and child growth in weight, height, and body mass index at age 2-10 years: the Environmental influences on Child Health Outcomes Program,” is published in Environmental Research.

Prenatal Smoking Associated with Higher Risk of Mental Health Challenges in Children

Posted on by Jodi Snare

Mother and toddler laughingChildren exposed to maternal smoking before birth are more likely to experience behavioral and mental health challenges, according to a large study funded by the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program.

While previous research had linked prenatal smoking to acting out or rule-breaking, it was less clear whether smoking during pregnancy also affects broader mental health outcomes and whether effects differ by sex.  The new study sheds light on these questions, examining thousands of children across the U.S. and identifying periods when exposure may be most impactful.

“These findings show that prenatal nicotine exposure can affect more than just acting-out types of behavior problems—it can influence children’s overall mental health and experiences of both emotional and behavioral problems at the same time,” said Kristine Marceau, PhD, of Purdue University. “Understanding when kids are most vulnerable can help families and healthcare providers provide support at the right time.”

Researchers analyzed data from 16,335 children ages 1 to 18 from 55 ECHO Cohort Study Sites. Behavioral assessments measured emotional and behavioral symptoms using standardized questionnaires.

Key Findings

  • Widespread Impact: Children exposed to prenatal smoking were more likely to have multiple mental health or behavioral symptoms at the same time.
  • Critical Windows: The strongest effects appeared in early childhood (under age 7) and early puberty (ages 9–12).
  • Similar Effects for Boys and Girls: Both sexes were affected in comparable ways, with slightly higher symptom levels in boys only at ages 13–14.
  • Independent of Family Background: Associations persisted even after considering family history and other environmental factors, such as maternal age, education, and additional substance exposures.

Future studies could take a closer look at the timing, amount, and frequency of smoking during pregnancy. Researchers could also work to better understand which effects are due to smoking itself—rather than other family factors—and how nicotine and other chemicals in smoke may affect how children grow and develop.

This collaborative research, titled “Prenatal Smoking and Child Psychopathology Associations by Age and Sex in the ECHO Cohort,” is published in Development and Psychopathology.

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

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

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Follow the ECHO Program on LinkedIn and X for the latest updates.

Prenatal Stress and Maternal Adverse Childhood Experiences Linked to Higher Risk of Child Mental Health Problems

Posted on by Jodi Snare

Stress during pregnancy and a mom’s own adverse childhood experiences (ACEs) may be associated with higher risk of mental health problems for their children, according to a recent ECHO Cohort study led by Shaikh Ahmad, PhD, Alexandra Sullivan, PhD, and Nicole Bush, PhD of University of California, San Francisco, and Marie Churchill, MS and Rosa Crum, MD, MHS of Johns Hopkins Bloomberg School of Public Health.

The global rise in pediatric mental health problems has highlighted the importance of identifying factors that may affect children’s mental health. Previous research has suggested that maternal stress—both adverse experiences during the mother’s own childhood and stress during pregnancy—may affect child mental health. To better understand how these exposures affect child mental health, researchers collected information from over 6,000 mothers and their children enrolled in 34 ECHO Cohort Study Sites across the United States.

Key Takeaways include:

  • Mothers’ own ACEs and experiences of stress during pregnancy were each independently associated with a higher risk of mental health problems in their children, suggesting that maternal stressors during each period may have contributed to the child’s risk in a potentially accumulative manner.
  • These effects on children included both internalizing (e.g., anxiety, depression) and externalizing (e.g., ADHD, behavior problems) mental health issues.
  • The effects of maternal ACEs and pregnancy stress on child mental health problems were similar for boys and girls and were seen throughout childhood and adolescence.

“Using a large and diverse sample, this study highlights the potential two-generational benefits of early screening and intervention related to maternal stress and adversity—not only in improving maternal health, but also in reducing mental health problems in offspring,” said Dr. Ahmad.

Additional research could help researchers identify other factors that may influence the risk of child mental health problems (e.g., paternal ACEs) and factors that could improve support for pregnant women.

This collaborative research, titled “Maternal Adverse Childhood Experiences and Prenatal Stress: Intergenerational Transmission and Offspring Mental Health in the ECHO Cohort,” is published in Psychological Medicine.

Read the research summary.

Second Annual ECHO Translating Science to Action Symposium

Posted on by Jodi Snare

On May 6, 2026, ECHO will host the second annual ECHO Translating Science to Action Symposium, a hybrid event that this year focuses on plastics and air quality, highlighting how evidence on these widespread exposures can inform programs, policy, and practice. This free event will bring together researchers, policymakers, health professionals, and advocates to examine how chemical exposures affect child health and development and how science is being translated into meaningful action.

This is a hybrid event, with a robust in-person experience designed to support connection and collaboration. Attendees joining onsite will have the opportunity to engage and network at interactive information stations hosted by researchers, advocates, professional organizations, and community partners.

For additional information and registration options please visit the Event website.

Deepening our Understanding of How Environmental Exposures during Pregnancy and Childhood Influence Health Outcomes

Posted on by Jodi Snare

As the ECHO Program moves into 2026, we continue to deepen our understanding of how environmental exposures during pregnancy and childhood influence health outcomes. By studying these early windows of development, ECHO helps identify opportunities for action that strengthen trajectories of health throughout kids’ lives.

On May 6, 2026, ECHO will host the 2nd annual ECHO Translating Science to Action Symposium, a hybrid event that this year focuses on plastics and air quality, highlighting how evidence on these widespread exposures can inform programs, policy, and practice. Feedback on our inaugural Symposium in 2025 was highly positive, and we’ll build on that momentum in this and coming years.

The symposium underscores ECHO’s role in both maximizing scientific insights and translating evidence into action. You can read more about the event in the latest issue of the Connector, and I hope you’ll register to attend.

I look forward to continuing to engage with you—our research community and partners—to enhance child health in 2026 and beyond.

Matthew Gillman, MD, SM
Director of the ECHO Program

Early‑Pregnancy Exposure to Fine Particulate Air Pollution Linked to Lower Birthweight in New ECHO Study

Posted on by Jodi Snare

Exposure to fine particulate matter (PM2.5)—tiny inhalable particles found in air pollution—during the earliest weeks of pregnancy was associated with babies being slightly smaller for gestational age, according to a new ECHO Cohort study led by Whitney Cowell, MPH, PhD, of NYU Langone Health.

Low birthweight is a known risk factor for a range of health issues in infancy and later life. Prior studies have shown links between PM2.5 exposure and birth outcomes, but many examined average exposure over time, leaving uncertainty about which specific weeks may be most harmful. This study aimed to pinpoint sensitive windows in early pregnancy when exposure may have the greatest impact.

Using data from 16,868 pregnant women at ECHO Cohort sites across the United States, researchers estimated weekly PM2.5 exposure during pregnancy and analyzed how it related to birthweight. They also evaluated whether associations varied by infant sex, parent race and ethnicity, or region the mother lived in during pregnancy.

Key takeaways:

  • Higher PM5 exposure during early pregnancy—particularly weeks 1–5—was associated with lower birthweight.
  • Male newborns appeared more sensitive to these early‑pregnancy exposures than female newborns.
  • Effects varied by U.S. region, with stronger associations in the Northeast, South, and Midwest, and weaker effects in the West—likely due to differences in particle types.

“The findings from this study support the need to periodically reevaluate National Ambient Air Quality Standards to ensure recommendations protect the health of the most sensitive subgroups, including pregnant women and fetuses,” said study author Dr. Cowell.

Understanding precisely when fetuses are most vulnerable to air pollution can help guide public health strategies and shape future investigations into biological mechanisms. The findings highlight the need for closer examination of pollutant composition, maternal factors, and other influences—such as diet or lifestyle—that may modify risk.

This collaborative research, titled “PM2.5 in relation to birthweight: exploring windows of susceptibility in the ECHO Cohort,” was published in JAMA Network Open.

Maternal Smoking During Pregnancy May Be Linked to Higher Blood Pressure in Children

Posted on by Jodi Snare

Maternal smoking during pregnancy may be associated with higher blood pressure and increased risk of hypertension in children, according to a new ECHO Cohort study led by Lyndsey Shorey-Kendrick, PhD, of Oregon Health & Science University and Christine Ladd-Acosta, PhD, of Johns Hopkins University.

Blood pressure that is higher than normal in childhood, including diagnosed high blood pressure, can increase the risk of developing high blood pressure later in life, a major risk factor for heart disease. Previous studies examining prenatal smoking exposure and childhood blood pressure have produced mixed findings. Many relied on self-reported smoking or focused only on systolic blood pressure, the top number in a blood pressure reading that reflects pressure when the heart beats. Fewer studies examined diastolic blood pressure, the bottom number that reflects pressure when the heart rests between beats.

To address these gaps, researchers used data from the ECHO Cohort to examine how smoking during pregnancy was related to both systolic and diastolic blood pressure in children. The study included 13,120 children born between 1999 and 2020 from 52 ECHO Cohort Study Sites across the United States, including Puerto Rico. Researchers assessed smoking during pregnancy using self-reports, medical records, and urine samples collected during pregnancy, and measured children’s blood pressure between ages 3 and 18.

Children whose mothers smoked during pregnancy were more likely to have higher blood pressure and a greater risk of hypertension. The study distinguished between “any reported smoking,” which is based on what mothers shared in surveys or medical records, and “active smoking,” which is confirmed by a urine test for cotinine, a marker of recent tobacco use. Active smoking during pregnancy was linked to even higher blood pressure in children.

Key Takeaways include:

  • Self-reported smoking during pregnancy was associated with higher diastolic blood pressure and increased risk of childhood hypertension.
  • Associations were stronger among female children and tended to increase with age.
  • Active smoking during pregnancy, identified using urine samples, was associated with higher systolic and diastolic blood pressure and greater risk of hypertension.
  • Self-reported secondhand smoke exposure during pregnancy was not associated with higher blood pressure in children.

“These findings suggest that reducing maternal smoking during pregnancy could lower hypertension rates in children and adults,” said Dr. Ladd-Acosta.

This collaborative research, titled “Association of Maternal Smoking During Pregnancy with Childhood Blood Pressure and Hypertension in the ECHO Cohort,” is published in Circulation.

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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 connector

Check 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 the ECHO Program on LinkedIn and X for the latest updates.

Limited Access to Medical Services Linked to Differences in Children’s Sleep Patterns, New ECHO Cohort Study Finds

Posted on by Jodi Snare

Children living in communities with too few healthcare providers may experience different sleep patterns than those in better-resourced areas, according to a new ECHO Cohort study led by Brittany Lancaster, PhD, of Mississippi State University, Christy W. Hockett, PhD, of the Avera Research Institute, and Anna Wallisch, PhD, of the University of Kansas Medical Center.

Most prior research on child sleep has focused on individual and family-level behaviors—such as routines or screen use—without fully considering how living in rural or medically underserved communities shapes access to health-promoting resources. Families in these areas often face barriers such as long travel distances, limited medical services, and fewer health supports. These challenges can indirectly influence key behaviors, such as sleep.

This study included 22,234 youth ages 1–17 years, categorized into four groups based on whether they lived in rural areas, medically underserved areas, both, or neither. Using parent or self-reported questionnaires, researchers examined sleep duration, bedtimes, wake times, time to fall asleep, and bedtime habits, then compared patterns across these community types. A medically underserved area is defined as having too few primary care providers, high infant mortality, or high poverty and/or high elderly population.

Key Takeaways Include:

  • Children in medically underserved areas tended to go to bed later, wake up later, and were less likely to get the recommended amount of sleep, especially among children aged 12 and under.
  • Rural versus non‑rural differences were small; rural children generally went to bed and woke up earlier, while preschoolers in non‑rural areas slept longer due to more frequent naps.
  • Bedtime habits differed slightly: toddlers and teens in well‑resourced areas were more likely to have consistent bedtime routines, while preschoolers in underserved communities were more likely to use electronics before bed.
  • Results suggest that limited access to medical services—not rurality alone—may contribute more meaningfully to disparities in children’s sleep health.

“Our findings highlight an increased need to support families in medically underserved areas with practical strategies for bedtime routines and reducing screen time before bed, as these approaches may meaningfully improve sleep duration and quality among young children,” Dr. Lancaster said.

Targeted community programs through daycares, schools, and community centers may help support healthier sleep practices, particularly in medically underserved areas. Future research will continue to examine how environment, resources, and community characteristics influence children’s sleep.

This collaborative research, titled “Exploring Sleep Outcomes in Youth Across Settings: Are There Differences based on Rurality or Medically Underserved Status in the ECHO Cohort?”, is published in Sleep Medicine.

Family Lifestyle and Behavior Changes During COVID-19 Pandemic Associated with Youth Mental Health

Posted on by Jodi Snare

Children and teens who experienced significant changes in their lifestyle and health behaviors during the COVID-19 pandemic may be more likely to experience symptoms of pandemic-related post-traumatic stress (PTS), according to a recent ECHO Cohort study led by Amy Margolis, PhD of The Ohio State University.

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. To understand how changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic influenced youth PTS symptoms, researchers collected information from 7,786 children and 1,353 teens and young adults and their parents or caregivers across the United States between April 2020 and August 2021.

Key Takeaways include:

  • Two groups of families were identified based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.
  • Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes.
  • Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children. Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores.
  • Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors associated with PTSS scores. Stability in these areas was linked to lower PTSS scores.
  • The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability for parents to isolate safely as key factors in reducing youth PTS symptoms.

This collaborative research, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” is published in the Journal of Clinical Child & Adolescent Psychology.

Read the research summary.