Author: Jodi Snare

ECHO Researchers Investigate the Mental Health Effects of Life Changes Related to the COVID-19 Pandemic

Posted on by Jodi Snare

Collaborative ECHO research led by Tracy Bastain, PhD, MPH of the University of Southern California and Amy Margolis, PhD of Columbia University, investigates the mental health impacts of the COVID-19 pandemic on mothers in the United States. The study found that mothers who reported more life changes during the pandemic also reported more symptoms of traumatic stress. This research, titled “COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US,” is published in JAMA Network Open.

This study included 11,473 mothers from 62 ECHO cohorts across the U.S. and Puerto Rico and investigated the potential impacts of the COVID-19 pandemic on maternal mental health from April 2020 through August 2021.  ECHO researchers examined patterns of pandemic-associated changes in maternal health and health behaviors, healthcare visits, work and finances, and coping strategies. The researchers used cluster analysis to group the mothers based on their pandemic experiences and then examined whether these groups reported higher or lower symptoms of traumatic stress related to the pandemic.

“As compared to fathers, during the COVID-19 pandemic more mothers have been affected by job and income losses, taken on more childcare burdens related to remote schooling, and have made major adjustments to their daily routines,” said Dr. Margolis.

The mothers who fell into the group that experienced more changes and reported more symptoms of traumatic stress tended to be women with higher incomes and higher education, and these women were more likely to report financial concerns as a cause of that stress. In contrast, mothers who had lower education and lower income were more likely to report fewer pandemic-related changes.

“Our study found that mothers who had the most changes to their work, health, and social support systems also reported the highest amount of traumatic stress due to the pandemic,” said Dr. Bastain.

The study results suggest that the association between sociodemographic, stressful life events and mental health should be considered in future studies examining the long-term outcomes of the COVID-19 pandemic. Future research could examine how changes over the course of the pandemic affect mothers’ stress and well-being.

Read the research summary.

First Public-Use Version of Echo-Wide Cohort Data Now Available

Posted on by Jodi Snare

The ECHO Program is excited to announce that de-identified new and extant ECHO data is now available through the Data and Specimen Hub (DASH). DASH is a centralized resource established by the National Institute of Child Health and Human Development (NICHD) that allows researchers to share and access de-identified data from studies via a controlled-access mechanism.

The ECHO-wide Cohort combines 69 cohorts across the U.S. and allows researchers to access information from a large and diverse population of children followed from the prenatal period through adolescence. This first public-use version of ECHO-wide Cohort data covers information collected on 41,299 participants and provides a valuable resource for the scientific community. This momentous step fulfills both a key strategic goal of the ECHO Program and an obligation to U.S. taxpayers for their investment in our research.

Researchers can now request access to these data by creating a DASH account and submitting a Data Request Form. The NICHD DASH Data Access Committee will review the request and provide a response in approximately two to three weeks. Once granted access, researchers will be able to use the data for three years. See the DASH Tutorial for more detailed information on the process.

ECHO Researchers Find Connection Between Mothers’ Food Quality During Pregnancy and their Duration of Breastfeeding

Posted on by Jodi Snare
Emily Zimmerman
Emily Zimmerman, PhD, CCC-SLP

Collaborative ECHO research led by Emily Zimmerman, PhD of Northeastern University investigates the relationship between mothers’ food sources and preparation during pregnancy and the length of time they breastfed. Pregnant participants who reported eating the least processed food and take-out, tended to breastfeed for an average of 41 weeks (10 months), while pregnant participants who reported eating the most processed food and take-out breastfed for an average of 16 weeks. This research, titled “Association Between Quality of Maternal Prenatal Food Source and Preparation and Breastfeeding Duration in The Environmental influences on Child Health Outcome (ECHO) Program,” is published in Nutrients.

This study included 751 mothers who were at least 18 years old and their infants from 12 ECHO cohorts located across the United States. Mothers reported on their food source and preparation during pregnancy and were placed in one of three groups: high, moderate, or low food source quality. Mothers also reported on their breastfeeding duration.

“This is the first time that maternal food source during pregnancy has been examined and linked to breastfeeding duration in such a large and diverse cohort,” said Dr. Zimmerman. “Our findings are in line with our hypothesis that mothers who reported eating more processed and fast foods and less food prepared at home breastfed for a shorter duration.”

Future studies are needed to understand the relation between breastfeeding duration and maternal food quality over time. These studies can also provide more specific information on maternal diet, food source, and preparation during pregnancy while considering other important factors, like socioeconomic status, that may affect the types of foods mothers have access to.

Read the research summary.

New ECHO Study Finds Prenatal Antidepressant Use Does Not Increase Risk for Child Autism-related Traits

Posted on by Jodi Snare
Patricia Brennen, PhD

Collaborative ECHO research led by Patricia Brennan, PhD of Emory University, investigates whether maternal prenatal antidepressant use affects a child’s risk for autism spectrum disorder (ASD) or autism-related traits. The study included over 3,000 mothers and their children and found no correlation between the use of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), during pregnancy and child autism-related traits. This research, titled “Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study,” is published in Research on Child and Adolescent Psychopathology.

Previous research has not offered conclusive findings on the effect of prenatal antidepressants on child autism-related traits. It is important that pregnant women and the physicians that treat them have the data they need to make informed treatment decisions.

For this study, researchers looked at a large sample of mothers and their children from ECHO cohorts across the United States, collecting data on prenatal antidepressant use and autism-related traits when the children were between 1 and 12 years of age. About 5% of the mothers who participated took antidepressants during pregnancy, according to medical records and self-reported measures. Mothers also reported on whether their child received an ASD diagnosis and completed rating scales about their child’s behavior, including social, language, and other autism-related traits.

“Depression is common during pregnancy, and pregnant women and the physicians who treat them must weigh multiple risks when making treatment decisions,” said Dr. Brennan. “This study suggests that the use of antidepressants and SSRIs during pregnancy does not increase a child’s risk for autism-related outcomes.”

Future studies may consider evaluating if the dose or timing of antidepressant use during pregnancy modifies the effect on child health outcomes.

Read the Research Summary.

New Diabetes Research and Three Major Milestones for the ECHO Program

Posted on by Jodi Snare

November is National Diabetes Month. Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. It can lead to health problems related to your eyes, kidneys, nerves, and heart, and is linked to some types of cancer. Gestational diabetes is diabetes that first appears during pregnancy. This month’s Connector Research Spotlight showcases a recent ECHO study that explores how gestational diabetes, and prenatal depression might be associated with a person’s risk for developing postpartum depression.

Also, around this time each year, I find myself reflecting on how far the ECHO Program has come and where we are heading. I am pleased to announce three major milestones for our program.

First, de-identified data from the ECHO Program are now available as a resource for the entire scientific community. This first public-use version of ECHO-wide Cohort data covers information that our 69 cohort studies collected from 41,299 participants. This momentous step fulfills both a key strategic goal of the ECHO Program and an obligation to U.S. taxpayers for their investment in our research. You can learn more about this data set and how researchers can request access to it in November’s Connector.

Second, our investigators have now published in medical journals more than 1,000 papers about their ECHO research. These publications cover a wide range of topics in child health, and demonstrate how ECHO research is filling evidence gaps on the long-term influences of prenatal and early childhood factors on child and adolescent health. I invite you to visit our ECHO publication database to explore any of these papers.

Finally, we released 7 new Cohort Funding Opportunity Announcements (FOAs) to invite applications to extend and expand the ECHO Cohort to further investigate the influences of a broad range of early exposures from society to biology, including the preconception period, across ECHO’s five key child health outcome areas among diverse populations. I look forward to the next phase of ECHO, and to continued partnership with all of you in our mission to enhance the health of children for generations to come.

First Public-use Version of ECHO-wide Cohort Data Now Available

Posted on by Jodi Snare

The ECHO Program is excited to announce that de-identified new and extant ECHO data is now available through the Data and Specimen Hub (DASH). DASH is a centralized resource established by the National Institute of Child Health and Human Development (NICHD) that allows researchers to share and access de-identified data from studies via a controlled-access mechanism.

The ECHO-wide Cohort combines 69 cohorts across the U.S. and allows researchers to access information from a large and diverse population of children followed from the prenatal period through adolescence. This first public-use version of ECHO-wide Cohort data covers information collected on 41,299 participants and provides a valuable resource for the scientific community. This momentous step fulfills both a key strategic goal of the ECHO Program and an obligation to U.S. taxpayers for their investment in our research.

Researchers can now request access to these data by creating a DASH account and submitting a Data Request Form. The NICHD DASH Data Access Committee will review the request and provide a response in approximately two to three weeks. Once granted access, researchers will be able to use the data for three years. See the DASH Tutorial for more detailed information on the process.

ECHO Study Examines Characteristics Associated with Opioid Use During Pregnancy

Posted on by Jodi Snare

Collaborative ECHO research led by Ruby Nguyen, PhD of the University of Minnesota and Monica McGrath, ScD of Johns Hopkins University Bloomberg School of Public Health, described characteristics that were associated with opioid using during pregnancy. The study included over 20,000 pregnant participants from across the United States and found that the majority of individuals who used opioids during pregnancy were non-Hispanic White and college educated. The researchers also found that opioid use was more common among people who used tobacco or illegal drugs and those who had a history of depression or anxiety. This research, titled “Characteristics of Individuals in the U.S. who Used Opioids during Pregnancy,” is published in the Journal of Women’s Health.

Opioids are a class of drugs commonly used as prescription pain relievers that can cause dependence or addiction. Opioid use has disproportionally impacted pregnant women and their fetuses and previous studies of opioid use during pregnancy have been limited in size and scope. The stigmatization of this population has also affected the collection of data on maternal opioid use during pregnancy. This study utilized a large, geographically diverse group of pregnant participants from 32 ECHO cohorts across the U.S. to investigate rare exposures and factors that may affect an individual’s risk for opioid use during pregnancy.

During this study, the researchers analyzed data from pregnant participants who were enrolled in ECHO cohorts between 1991 and 2021. They used medical records, laboratory tests, and self-reported information to assess opioid use and potentially related factors. Of the 21,905 pregnancies evaluated, only 591 (2.8%) involved opioid use. The majority of opioid use during pregnancy originated from a prescription.

“This was among the largest observational studies of opioid use in pregnancy, and the diverse sample of pregnant women better represents the U.S. population than previous studies,” said Dr. Nguyen. “These findings will help to inform further research on screening tools for opioid use during pregnancy, and the finding that most opioid use originates from prescriptions reinforces the need to better monitor the amount of circulating prescription drugs, particularly in pregnant women.”

Further research is needed to understand the factors that contribute to the use of multiple substances during pregnancy and the interrelationship between substance use and depression or anxiety. The results of this study can contribute to the development of screening tools and procedures for identifying individuals who are potentially at-risk for opioid use during pregnancy.

Read the research summary.

New ECHO Research Finds Significant Changes in Children’s Sleep Habits during the COVID-19 Pandemic

Posted on by Jodi Snare
Maristella Lucchini, PhD

Collaborative ECHO research led by Maristella Lucchini, PhD of Columbia University Irving Medical Center investigates changes in childhood sleep behaviors during the COVID-19 pandemic. The researchers looked at data from 528 children across the United States and found that, during the COVID-19 pandemic, children went to bed later, woke up later, and took longer to fall asleep, but their overall time spent asleep did not change. The study also found that children in minority communities went to bed later, slept less, and took naps more frequently. This research, titled “Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study,” is published in Pediatric Research.

This study included children aged 4 to 12 from 14 ECHO cohorts across the United States. The ECHO Program’s Sleep Health of Children and Adolescents Questionnaire was used to evaluate children’s sleep habits before the pandemic began and at two time periods during the pandemic. The researchers also collected sociodemographic information from self-reports and medical records.

ECHO researchers found significant changes in children’s sleep habits, as well as differences in children’s sleep behaviors between racial/ethnic groups. However, parental knowledge of the importance of sleep might have contributed to children sleep health. Interviews with 38 participant caregivers revealed they prioritized routines to maintain their children’s amount of sleep but were generally more flexible about bedtimes.

“This is the first study investigating changes in childhood sleep habits in the United States during the COVID-19 pandemic using data collected before and during the pandemic,” said Dr. Lucchini. “The results highlight potential targets for future interventions and support the need to examine and address the root causes of racial and ethnic sleep disparities in childhood.”

Using data from the same cohort of children, ECHO researchers are in the process of analyzing and publishing results on changes in diet, physical activity, and screen time during the COVID-19 pandemic.

Read the research summary.

ECHO Researchers Examine Associations Between Gestational Diabetes, Prenatal Depression, and Postpartum Depression

Posted on by Jodi Snare

Collaborative ECHO research led by Lauren C. Shuffrey, PhD of Columbia University examines the effects of gestational diabetes, a type of diabetes that develops during pregnancy, and prenatal depression on a person’s risk for developing postpartum depression. The study found that people with gestational diabetes were more likely to be classified as having prenatal depression. Those with both gestational diabetes and prenatal depression were at an increased risk for postpartum depression. But gestational diabetes on its own, without prenatal depression, was not associated with increased risk for postpartum depression.

This research, titled “Gestational Diabetes Mellitus, Prenatal Maternal Depression, and Risk for Postpartum Depression: An Environmental Influences on Child Health Outcomes (ECHO) Study,” is published in BMC Pregnancy and Childbirth.

Previous research has yet to examine the association between the combination of gestational diabetes and prenatal maternal depression and postpartum depression. To address this question, the researchers looked at data from 5,822 participants in 16 ECHO cohorts across 13 U.S. states and Puerto Rico. A total of 4,606 participants had neither gestational diabetes nor prenatal maternal depression, 416 had gestational diabetes only, 689 had prenatal maternal depression only, and 111 had both gestational diabetes and prenatal maternal depression. Participants self-reported on their depression symptoms during and after pregnancy using the PROMIS-D (Patient-Reported Outcomes Measurement Information System) scale. The researchers used this data to evaluate the relationships between maternal depression symptoms and gestational diabetes.

“Our findings underscore the importance of universal depression screening during pregnancy and in the first postpartum year,” said Dr. Shuffrey. “Future studies should examine potential biological mechanisms underlying the relationship between gestational diabetes and maternal depression.”

The ECHO program is currently working towards analyzing blood samples collected during pregnancy to identify potential factors involved in the relationship between gestational diabetes, prenatal depression, and postpartum depression.

Read the research summary.

Childhood Obesity and the COVID-19 Pandemic

Posted on by Jodi Snare

September is Childhood Obesity Awareness Month. Obesity can affect children’s physical and psychosocial health and can lead to substantial health problems later in life, including type 2 diabetes and heart disease.

Obesity is one of ECHO’s five child health outcome areas. This month’s Research Spotlight highlights a recent ECHO study that found that school-age children, on average, gained weight at a higher rate during the first year of the COVID-19 pandemic than they did during the couple of years before.

ECHO researchers also asked what behaviors could explain this excess pandemic-related weight gain. In another recent study of children from before to during the pandemic, they found that screen time—both educational and recreational—increased substantially, whereas sleep duration, diet, and physical activity hardly changed. Screen time takes many forms in kids’ lives these days. Reducing non-productive screen time can lead to less weight gain in children and adolescents.

Both of these studies suggested worse effects among Hispanic or non-Hispanic Black children. Research leading to reducing health disparities and improving health equity are ECHO priorities.

Both of these studies also took advantage of the fact that ECHO began before the pandemic and continues during these many months since it began. That means that ECHO is one of the very few large research programs that has followed individual children over time (“longitudinally”) to see how the pandemic has affected them and their families. Many ECHO researchers are characterizing these wide-ranging effects, and are starting to identify solutions that may offer resilience in the face of hardships.

In addition to my enthusiasm about the burgeoning research coming from ECHO, I am also excited to announce that the next phase of ECHO is within sight. The ECHO Program Office recently released Cohort Funding Opportunity Announcements (FOAs) to invite applications to extend and expand the ECHO Cohort to further investigate the influences of a broad range of early exposures from society to biology, including the preconception period, across ECHO’s five key child health outcome areas among diverse populations.

Frequently Asked Questions and pre-recorded informational webinars regarding these funding opportunities are now available on the NIH ECHO website. I encourage your to use our toolkit to share these FOAs with your networks.