Author: Jodi Snare

ECHO researchers study the effects of neighborhood environmental and social conditions on pregnancy and infant health

Posted on by Jodi Snare

Collaborative ECHO research led by Sheena Martenies, PhD, MPH of the University of Illinois at Urbana-Champaign investigates the combined effects of environmental hazards and social stressors on pregnancy and infant health. This research included information on more than 13,000 infants born between 2010 and 2019 from 41 ECHO cohorts located throughout the United States. In this study, researchers found that pregnant women living in neighborhoods with higher combined exposures had shorter pregnancies and smaller babies. This research, titled “Associations between combined exposure to environmental hazards and social stressors at the neighborhood level and individual perinatal outcomes in the ECHO-wide cohort,” is published in Health & Place.

Previous studies have found that neighborhood conditions can influence pregnancy and infant health, but few have examined the effects of exposure to a combination of environmental and social conditions. It is important to look at multiple exposures simultaneously because this more closely mirrors real-world experiences. There are existing tools for looking at combined exposures to environmental hazards and social stressors in neighborhoods, but they either do not have national coverage or they do not cover the time frames needed.

ECHO researchers developed an exposure index which combined data on multiple environmental hazards and social circumstances—including air pollutants, vehicle traffic, poverty, and crowded housing—into a single measure of neighborhood conditions. Pregnant participants were assigned an index score based on where they lived during their pregnancy. Then, the researchers looked at how this index score was associated with birthweight, length of pregnancy, and other pregnancy outcomes.

The researchers found that pregnant women living in neighborhoods with higher combined exposures had shorter pregnancies and smaller babies. For Black pregnant participants, there was a higher risk of preterm birth associated with increased combined exposures during pregnancy compared to White pregnant participants. The researchers also found that pregnant participants living in rural areas had shorter pregnancies and smaller babies compared to pregnant participants living in urban areas who had similar index scores.

More research is needed to determine which factors included in the exposure index are most important in pregnancy and child health outcomes. Some members of the research team are currently studying data from two ECHO cohorts (Healthy Start and MADRES) to explore how neighborhood-level exposures might interact to influence obesity later in life.

Read the research summary.

Chemical Exposures’ Influence on Maternal, Infant, and Childhood Health Outcomes

Posted on by Jodi Snare

Chemical exposures can have a substantial influence on maternal, infant, and childhood health outcomes. ECHO Program investigators have recently released several publications detailing research on how exposures to certain chemicals can influence the health of mothers and children.

For example, a recent ECHO study of more than 100 chemicals in a diverse population of pregnant women in the United States found that they have been exposed to a wide range of chemicals, including replacement chemicals.  Replacement chemicals are those that industries use in place of others they have phased out.  While we have some evidence on the health effects of older chemicals, we know much less about these replacements. ECHO investigators are looking at effects of both traditional and replacement chemicals.

You can read more about this and other ECHO research in July’s issue of the Connector.

I am also pleased to share that ECHO recently released Notices of Intent to Publish Funding Opportunity Announcements (FOAs). These FOAs will invite applications to extend and expand the capacity of the ECHO Cohort to further investigate the roles 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 encourage you to share these Notices of Intent to Publish with your networks. When the NIH publishes the actual funding announcements, the ECHO Program Office will post that information on the NIH ECHO website, so please check back for links to the FOAs and resources for potential applicants.

NIH Program Study Suggests Racial/Ethnic Sleep Disparities During Pregnancy

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

 

Maristella Lucchini, PhD

Pregnant Black women may sleep less and wake up more often than pregnant White women, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health (NIH). Poor sleep during pregnancy is common, and it’s associated with poor outcomes in late pregnancy and after birth. Although minority groups in the United States often experience worse sleep than non-Hispanic White people, sleep disparities during pregnancy are understudied. Better understanding maternal sleep disparities—and what causes them—can help improve health outcomes for pregnant women and their children.

“Research shows poor sleep contributes to adverse maternal outcomes that disproportionately affect racial and ethnic minority communities,” said Maristella Lucchini, PhD, of Columbia University Irving Medical Center. “We wanted to know if sleep was a factor that contributed to racial and ethnic disparities in overall maternal health.”

Dr. Lucchini, an ECHO Program investigator, led this collaborative research effort, which is now published in Sleep.

The research team analyzed data from 2,500 pregnant participants in 14 ECHO cohorts nationwide. They found that compared to non-Hispanic white participants:

Non-Hispanic black participants reported:

    • Shorter sleep duration
    • More sleep disturbances
    • Similar sleep quality

Hispanic participants reported:

    • Longer sleep duration
    • Better sleep quality
    • Fewer sleep disturbances

Lucchini, M. et al. Racial/ethnic disparities in subjective sleep duration, sleep quality, and sleep disturbances during pregnancy: an ECHO study. Sleep. DOI: 10.1093/sleep/zsac075

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims 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.

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ECHO Research Explores Sleep Differences Among Pregnant Participants Across Racial and Ethnic Groups

Posted on by Jodi Snare

Maristella Lucchini, PhD

Findings from a collaborative research effort led by Maristella Lucchini, PhD of Columbia University Irving Medical Center, report differences in pregnant individuals’ sleep quality across racial and ethnic groups. Based on the team’s research, pregnant non-Hispanic Black participants slept less and had more sleep disturbances compared with non-Hispanic White participants. Hispanic participants slept longer, had better sleep quality, and experienced fewer sleep disturbances compared with non-Hispanic White participants. This research, titled “Racial/ethnic disparities in subjective sleep duration, sleep quality and sleep disturbances during pregnancy: an ECHO study” is published in Sleep.

The team analyzed data from 2500 pregnant participants in 14 ECHO cohorts nationwide. Information was collected via questionnaire, in which participants reported sleep duration, quality, and disturbances, as well as education level, height, age, and pre-pregnancy weight.

The size of the ECHO cohort created an avenue to investigate and report differences in pregnant individuals’ sleep quality across racial and ethnic groups. “Research shows that pregnant individuals from minority groups are more likely to experience complications during pregnancy, and there is an association between poor sleep and poor maternal health,” said Dr. Lucchini. “We wanted to know if sleep was a factor that contributed to racial and ethnic disparities in overall maternal health.”

Expanding on these findings in future studies may suggest the need for targeted interventions to improve sleep health in pregnancy. Additionally, future studies should explore the factors that contribute to sleep disparities on various levels, including personal, family, neighborhood, and societal.

Read the Research Summary.

New ECHO Research Reveals Depression is More Common Among New Mothers of Preterm Babies

Posted on by Jodi Snare

New ECHO research reveals that increasing symptoms of depression may be more common among women who give birth to preterm babies compared to women who have their babies at full term. Mothers of preterm babies were also more likely to experience depression that lasted years after birth, and for many of these women, their symptoms of depression got worse over time. These findings resulted from a collaborative effort between ECHO researchers Danielle Roubinov, PhD of the University of California, San Francisco (UCSF) and Rashelle Musci, PhD of Johns Hopkins University, along with senior author Nicole Bush, PhD, of UCSF and other ECHO researchers.

Their research, titled “Trajectories of Depressive Symptoms Among Mothers of Preterm and Full-Term Infants in a National Sample,“ is published in Archives of Women’s Mental Health. 

The research team collected data from approximately 11,300 women from 35 different ECHO cohorts across the United States that documented self-reported depression measures for women when they were pregnant and after they had their babies. Of these women, 11% had preterm births, and 89% had full-term babies. Follow-up assessments from the two groups of women were collected at least once within the first five years following childbirth to better understand the long-term trajectories of depressive symptoms s and potential opportunities for treatment.

“Having a baby is exciting, but it can also be stressful, and some women feel sad or anxious before and after their baby is born,” said Dr. Roubinov. “This period can be especially difficult for mothers when babies are born prematurely.”

Many mothers can struggle with their mental health after giving birth, and women who give birth prematurely may be particularly at risk of experiencing depressive symptoms related to the birth experience, neonatal care challenges, and ongoing concerns about the infant’s health and development.

“Currently, many doctors only ask women about how they feel when they are pregnant and for six months after birth,” said Dr. Musci. “This study showed us that we should be continuing to ask women about their mental health for years following their pregnancy while helping them to find the support they need.”

Future ECHO studies can add to this research by assessing intervention programs that can help support the mental health of new mothers, as maternal mental health is a critical influence on children’s development.

Learn more about depression during and after pregnancy through the Centers for Disease Control and Prevention and NIH.

Read the Research Summary.

ECHO Researchers Report Higher Levels of Oxidative Stress among Socioeconomically Disadvantaged Pregnant Women

Posted on by Jodi Snare

A collaborative research effort led by Stephanie Eick, PhD, MPH of Emory University’s Rollins School of Public Health and Rachel Morello-Frosch PhD, MPH of the University of California, Berkeley investigated the relationship between various biological, behavioral, and social factors and higher levels of oxidative stress in pregnant women, which is often associated with poor prenatal health outcomes. Pregnant participants who were 30+ years old and had a college degree had lower levels of oxidative stress. In contrast, levels of oxidative stress were higher among pregnant participants who were overweight or obese, or unmarried. Levels of oxidative stress biomarkers were also higher among pregnant participants who were current smokers or had less than a high school education.

This research, titled “Associations between social, biologic, and behavioral factors and biomarkers of oxidative stress during pregnancy: Findings from four ECHO cohorts,” is published in Science of the Total Environment.

To measure oxidative stress, the researchers collected urine samples from approximately 2,000 pregnant participants in the mainland United States and Puerto Rico who were enrolled in one of four ECHO cohorts. They measured the levels of oxidative stress biomarkers at up to three time points during pregnancy and calculated the association between biomarker levels and biological, behavioral, and social factors. Maternal age, pre-pregnancy body mass index, marital/partnered status, parity, and smoking status were included as biological and behavioral factors while race/ethnicity, maternal education, and stressful life events were considered social factors.

“This is the largest study to date to examine the relationship between biologic, social, and behavioral factors and oxidative stress during pregnancy,” said Dr. Eick. “Our results provide important clues into how social and economic inequalities lead to poor health in pregnant women.” This study may also inform future studies looking at risk factors for preterm birth.

As for ongoing research, the team is examining the impact of oxidative stress on adverse pregnancy outcomes, such as preterm birth.

Read the Research Summary.

ECHO PRO Core Publishes Series of Articles on PROMIS® Early Childhood

Posted on by Jodi Snare

ECHO’s Person-Reported Outcomes (PRO) Core published a series of articles on the Patient-Reported Outcome Measurement Information System (PROMIS®) Early Childhood measures in this month’s online edition of the Journal of Pediatric Psychology.

The PROMIS® measures use recent advances in information technology and health survey research to measure person-reported outcomes—such as pain, fatigue, physical functioning, emotional distress, and social role participation—that have a major impact on quality of life.

The PRO Core developed 12 early childhood measures to evaluate common mental, social, and physical health outcomes for children ages 1-5. See below for links to the individual articles. The ECHO Program Office also wrote an introduction to this special series.

The PRO Core, located at Northwestern University in Evanston, Ill., captures the experiences of children and their families who are taking part in ECHO. Led by principal investigators Richard Gershon, PhD, and David Cella, PhD, the PRO Core is responsible for keeping and providing PRO information for researchers, helping researchers use PRO assessments in their study designs, and coordinating plans for updating, approving, and using PRO information in studies.

ECHO-funded Research Finds Higher Asthma Rates Among Black and Hispanic Children Regardless of Neighborhood Income or Density

Posted on by Jodi Snare

A new ECHO study found that although there is a correlation between childhood asthma and being born into a densely populated or lower-income neighborhood, Black and Hispanic children had consistently higher rates of asthma than White children, even in wealthier neighborhoods.

The study, led by ECHO investigators, Dr. Antonella Zanobetti, Harvard T.H Chan School of Public Health, Department of Environmental Health, and Dr. Patrick H. Ryan, Cincinnati Children’s Hospital Medical Center, included data from 5,809 children born over four decades throughout the United States, providing important insight into how racial and ethnic health inequities may cause children to develop wheezing – a symptom involving whistling breathing sounds due to narrowed airways – and asthma.

Of the 5,809 children studied, 46% reported wheezing prior to age 2 and 26% reported persistent wheeze through age 11. Diagnosis of asthma by age 11 varied by cohort, with an overall median prevalence of 25%. Children in neighborhoods with higher population density, and with more families with lower incomes and living below the poverty level, experienced more asthma and early and persistent wheezing. Black and Hispanic children remained at higher risk for asthma than White children, even in neighborhoods with more resources.

Researchers used questionnaires and interviews to collect information such as wheezing and asthma occurrence, medical history, and demographics from participating families over many years. Each child’s home address was matched to U.S. Census tract data for the decade closest to their birth year. Researchers examined the relationship between incidence of wheezing and asthma with children’s race and ethnicity, their mother’s education level and smoking habits, and socioeconomic conditions of the neighborhood in which they were born.

“Neighborhood- and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities,” Dr. Zanobetti said. “Reducing these inequities requires identifying and repairing differences between and within neighborhoods to create equal access to healthy living conditions.”

This research, titled “Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium,” is published in JAMA Pediatrics.

Read the Research Summary.

ECHO Researchers Explore How Study Results Can Help Pregnant Mothers Take Action to Reduce Chemical Exposures

Posted on by Jodi Snare

Collaborative ECHO research led by Amy Padula, PhD, MSc from the University of California, San Francisco and Rachel Morello-Frosch, PhD, MPH from the University of California, Berkeley found that many ECHO participants are motivated to engage in individual and collective action to protect their families and communities from the negative effects of chemical exposures. These findings may be used to improve report-back of chemical results and shift responsibility of chemical exposures from individuals to policymakers.

“When it comes to chemical exposure results, participants were interested in receiving timely, accessible, and straightforward information on how to reduce chemical exposures at the personal and community level,” said Dr. Padula.

This research, titled “Perspectives of peripartum people on opportunities for personal and collective action to reduce exposure to everyday chemicals: Focus groups to inform exposure report-back,” is published in Environmental Research.

In the summer of 2020, the researchers held three online focus groups with a diverse set of 18 mothers from ECHO pregnancy cohorts in Illinois and California. Focus groups, held in both English and Spanish, involved discussions around knowledge of chemical exposures and their sources, chemical exposure report-back preferences, and participants’ interest and willingness to engage in collective action.

Study results demonstrate the usefulness of chemical exposure report-back tools, like the Digital Exposure Report Back Interface (DERBI), for informing and empowering research participants. “Report-back can provide opportunities for participants to learn more about environmental health and how to lower exposure both in their homes and in their communities,” said Dr. Padula.

The next steps for this research include examining surveys from participants who are using DERBI to learn about their chemical exposures. These surveys may reveal more about how chemical exposure reports influence participant engagement with collective action efforts. Drs. Padula and Morello-Frosch encourage other ECHO cohorts to use DERBI to report back individual chemical results to their participants.

More information about the Digital Exposure Report Back Interface (DERBI) or how to use DERBI in your cohort, please visit the Silent Spring Institute website.

Read the Research Summary.

May is National Mental Health Awareness Month

Posted on by Jodi Snare

May is National Mental Health Awareness Month. During this month, my ECHO colleagues and I join the national conversation to raise awareness about mental health, and I’m pleased to highlight two recent examples of our research in this area.

Positive health, or a child’s sense of well-being, is one of ECHO’s five health outcome focus areas. For ECHO, this means that in addition to looking at what diseases or conditions kids get, like asthma, obesity, and autism spectrum disorders, we also look at the positive side of the ledger. In fact, ECHO research shows that kids can feel quite satisfied with their lives even if they have one or more of those conditions. In a recent collaborative publication, ECHO researchers showed that life satisfaction was about the same among kids with and without most childhood chronic diseases. The main exceptions were depression and conditions with chronic pain. These findings raise the possibility that efforts to support mental health treatment could also improve children’s sense of well-being.

In another collaborative effort, ECHO Program investigators came together to study how the COVID-19 pandemic has influenced the well-being of children. As detailed below, they found that stresses of the pandemic were related to lower life satisfaction, but that family and social supports have the potential to moderate this effect of stress. Thus, these results point to potential interventions to enhance children’s mental health and well-being as we emerge from the worst of the pandemic.

You can read more about both of these publications in May’s ECHO Connector.