Author: Jodi Snare

Exposure to Low Levels of Arsenic in Public Drinking Water Linked to Lower Birthweight, Preterm Birth, Study Finds

Posted on by Jodi Snare

Babies born to mothers potentially exposed to low levels of arsenic in public drinking water—even at levels below the federal safety standard—were more likely to be born preterm, with lower birthweight, or be smaller than expected, according to a study funded by the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program.

While the U.S. Environmental Protection Agency sets a maximum contaminant level of 10 micrograms per liter for arsenic in public water systems, this study examines how even lower-level arsenic exposures may still affect pregnancy outcomes in a large population. Previous research largely focused on private wells or smaller study groups.

Because arsenic occurs naturally, water that comes in contact with certain rocks and soils may contain it. Contamination from various industrial processes also contributes to increased levels of arsenic in some areas.

“Most U.S. residents rely on public drinking water, and our findings suggest that further reducing arsenic in public water systems could be an important step to improve infant health across the U.S.,” said Anne Nigra, PhD, of Columbia University’s Mailman School of Public Health. “Even low levels of arsenic in public drinking water were associated with low birthweight and other adverse birth outcomes in U.S. infants.”

Key takeaways include:

  • Potential arsenic exposure during pregnancy—even at levels below the current federal safety standard—may be linked to adverse birth outcomes.
  • Mothers exposed to higher levels of arsenic in public drinking water were more likely to have babies born with low birthweight or smaller than expected for the number of weeks of pregnancy.
  • These patterns were seen across several racial and ethnic groups, including White, Black, and Hispanic/Latino families. Similar risks were also observed among babies born to American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander parents.
  • Babies born to Black parents faced higher risks of being born early, having low birthweight, or being smaller than expected.

Researchers analyzed data from nearly 14,000 mother-infant pairs from the ECHO Cohort. Arsenic exposures during pregnancy were estimated by combining water quality data with the residential histories of participants. No actual arsenic levels were tested for these participants.

This collaborative research was published in JAMA Network Open.

Nigra, A., et al. (2025) Public water arsenic and birth outcomes in the Environmental influences on Child Health Outcomes Cohort. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.14084

###

 

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 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.

First Annual ECHO Science to Action Symposium

Posted on by Jodi Snare

REGISTRATION FOR THIS EVENT HAS CLOSED

The NIH ECHO Program is pleased to announce its first annual ECHO Symposium: Translating Science to Action on September 15, 2025 at the NIH campus in Bethesda, Maryland. The goals of the symposium are to disseminate child health research and inform programs, policies, and practices to enhance child health. The event will bring together professional societies, advocacy organizations, federal partners, Congress, state and local government, research community, and ECHO participants. The symposium will be a free, one-day, hybrid event focusing on early influences on child health outcomes and will feature ECHO investigators as well as speakers from research institutions, think tanks, other relevant organizations, end users of ECHO research, and participants.

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

ECHO Symposium: Translating Science to Action

Posted on by Jodi Snare

I am delighted to announce the inaugural ECHO Symposium: Translating Science to Action on September 15, 2025, at the NIH campus in Bethesda, Maryland, and online.

Register today to join in person or online.

Please join me for this free-to-attend, one-day event that aims to translate child health research findings from ECHO and others into action by informing intervention programs, health policies, and clinical practice. Experts from multiple disciplines will explore factors that influence child health and address opportunities to prevent childhood disorders and enhance well-being. Join representatives of professional societies, advocacy groups, federal partners, Congress, state and local governments, research participants, and others.

Three sequential sessions will cover Chemical Exposures, Social and Neighborhood Factors, and Community Experiences. Each session will feature a chair, presenters, and a discussant to kick off a panel discussion that follows presentations. Both in-person and online attendees will have the chance to ask questions.

I look forward to seeing you there.

Matthew Gillman, MD, SM
Director of the ECHO Program

ECHO to Host First Symposium Focused on Translating Science to Action

Posted on by Jodi Snare

The National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program will hold its inaugural ECHO Symposium: Translating Science to Action on September 15, 2025, at the NIH campus in Bethesda, Maryland, and online.

This free-to-attend, one-day interdisciplinary event seeks to translate child health research into action by informing intervention programs, health policies, and clinical practice. Experts from multiple disciplines will explore factors that influence child health and address opportunities to prevent childhood disorders and enhance well-being. Join representatives of professional societies, advocacy groups, federal partners, Congress, state and local governments, research participants, and others.

Three sequential sessions will cover Chemical and Exposures, Social and Neighborhood Factors, and Community Experiences. Each session will feature a chair, presenters, and a discussant to kick off a panel discussion following presentations. Both in-person and online attendees will have the chance to ask questions.

Register today to join in-person or online.

Early Childhood Weight Patterns May Signal Future Obesity Risk, NIH Study Finds

Posted on by Jodi Snare

Happy boy eating apple while communicating with his teacher during lunch time.Researchers identified growth patterns and early-life factors linked to higher obesity risk at age 9.

Not all children grow the same way. A new study from the Environmental influences on Child Health Outcomes (ECHO) Program suggests that body weight changes in early childhood may be associated with later obesity risk.

Funded by the National Institutes of Health (NIH), the study tracked children’s body mass index (BMI) from infancy through age 9 and found two distinct growth patterns. Most children followed a typical curve, with BMI decreasing in early childhood before gradually rising again. But a smaller group followed a trajectory marked by a sharp rise in BMI, which put them at higher risk of developing obesity by age 9.

Key takeaways:

  • Researchers found two main BMI growth patterns in children. Most children (89.4%) had a typical pattern where their BMI declined from ages 1 to 6, then rose slowly. A smaller group (10.6%) had an atypical pattern where their BMI stayed the same from ages 1 to 3.5, then increased rapidly from ages 3.5 to 9.
  • By age 9, children in the atypical group were more likely to develop obesity, with an average BMI higher than the 99th percentile.
  • Several early-life factors were associated with the child’s risk of developing obesity, including high birthweight, maternal smoking during pregnancy, high maternal BMI before pregnancy, and excessive maternal weight gain during pregnancy.

Childhood obesity—defined as having a BMI at or above the 95th percentile for a child’s age and sex—is often the result of excess body fat. Without support or intervention, children with higher BMI patterns in early life are more likely to carry that weight into adolescence and adulthood, increasing their chances of developing serious health conditions like diabetes and heart disease.

“The fact that we can identify unusual BMI patterns as early as age 3.5 shows how critical early childhood is for preventing obesity,” said ECHO researcher Chang Liu, PhD, of Washington State University.

The study included 9,483 children across the United States who are part of the ECHO Cohort. Researchers looked at weight and height data collected over time from medical records, caregiver reports, and in-person or at-home measurements. They tracked how children's BMI changed as they grew and looked for patterns related to experiences early in life.

“Our findings suggest there are important opportunities to reduce childhood obesity, such as helping pregnant women quit smoking and manage healthy weight gain, as well as closely monitoring children who show early signs of rapid weight gain,” said Liu.

This collaborative research is published in JAMA Network Open.

Liu, Chang, M., et al. (2025) Early-Life Factors and Body Mass Index Trajectories Among U.S. Children in the ECHO Cohort. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.11835

 

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 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.

ECHO Research Finds No Significant Association Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

Posted on by Jodi Snare

Wheezing symptoms occur in 20-40% of infants, contributing to a substantial impact on children’s quality of life and their use of healthcare. Multiple early exposures, such as prenatal exposure to cigarette smoking, have been associated with these wheezing symptoms. Previous studies have suggested a possible link between antibiotic exposure during pregnancy and an increased risk of wheezing and cough in children, caused by an imbalance in the birthing parent’s microbiome due to antibiotic use.

“It is unlikely that a randomized controlled trial could be done to try to answer this question, because antibiotics are necessary treatments for bacterial infections during pregnancy,” said ECHO Cohort investigator Rachel Greenberg, MD, MB, MHS of Duke University. “In the absence of trial data, large studies that observe individuals over time, like the ECHO Cohort, are essential to understand the impact of common interventions during pregnancy.”

This study included 4,721 pregnant participants and their 4,779 infants from 12 study sites in the ECHO Cohort Consortium. Overall, 36% of pregnant participants used at least one antibiotic while pregnant, and about 26% of infants had a report of wheezing.

Key takeaways include:

  • Exposure to antibiotics during pregnancy was not associated with infant wheezing during the first 18 months after birth.
  • Prenatal antibiotic exposure was also not associated with an increase in emergency room visits or hospitalizations for wheeze during infancy.
  • However, prenatal antibiotic use was associated with higher odds of medication use for wheeze or dry cough during infancy, which could imply more severe symptoms and a medical provider’s diagnosis.
  • An association between prenatal antibiotic exposure and medication use for wheeze or cough during infancy was only observed among children born via vaginal delivery and thus exposed to the birthing parent’s microbiota.
  • The researchers also observed an association between prenatal antibiotic exposure and wheeze in research sites that recruited participants who had a family history of asthma, suggesting that a genetic or environmental risk within these families may increase the likelihood of wheeze.

This collaborative research, titled “Association Between Prenatal Antibiotic Exposure and Infant Wheeze Outcomes” is published in Acta Paediatrica.

 

Maternal Cardiometabolic Health During Pregnancy Associated with Higher Blood Pressure in Children, NIH Study Finds

Posted on by Jodi Snare

Children born to mothers with cardiometabolic health issues before or during pregnancy may face a higher risk of elevated blood pressure in childhood and adolescence, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health (NIH).

High blood pressure in childhood often continues into adulthood and is linked to a greater risk of heart problems later in life. This ECHO research offers insights into how a mother’s heart and metabolic health before and during pregnancy may contribute to her child’s long-term cardiovascular well-being.

The study analyzed data from 12,480 mother-child pairs in the ECHO Program. Researchers looked at how three maternal cardiometabolic risk factors—pre-pregnancy obesity, gestational diabetes, and high blood pressure during pregnancy—were related to children’s blood pressure from ages 2 to 18.

Key Findings:

  • 44% of mothers in the study had at least one cardiometabolic risk factor during pregnancy.
  • Children whose mothers had more than one condition, such as gestational diabetes combined with high blood pressure or pre-pregnancy obesity, had higher blood pressure than those whose mothers had only one condition.
  • Children born to these mothers had higher average blood pressure readings, even after accounting for age, sex, and height of the child.
  • These children also experienced an increased rate of change in blood pressure over time, suggesting a long-term impact.
  • The effect was especially strong for diastolic blood pressure in girls and systolic blood pressure in non-Hispanic Black children whose mothers had gestational diabetes or high blood pressure.

“With declines in cardiometabolic health, it’s important to focus on prevention starting as early as possible,” said ECHO researcher Zhongzheng Niu, PhD, of the Keck School of Medicine at the University of Southern California. “Our study suggests that helping people improve their health before and during pregnancy could benefit both mothers and future generations."

The researchers in this study call for further studies to understand how combinations of maternal health issues and broader social and structural factors contribute to these long-term risks.

This collaborative research is published in JAMA Network Open.

Niu, Z. Maternal Cardiometabolic Risk Factors in Pregnancy and Offspring Blood Pressure at Age 2-18 Years. JAMA Network Open, DOI: 10.1001/jamanetworkopen.2025.9205.

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.

Children Born in Lower-Opportunity Neighborhoods May Face Higher Incidence Rates of Asthma with Recurrent Exacerbations, NIH Study Finds

Posted on by Jodi Snare

Children born in neighborhoods with fewer opportunities are more likely to experience repeated asthma flares requiring emergency care or medical treatment, with non-Hispanic Black children having the highest incidence rates of asthma with recurrent exacerbations, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Asthma with recurring exacerbations (AREs) is a more severe form of childhood asthma linked to worsened health, high medical costs, and significant challenges for both the patient and their family, especially compared to well-controlled asthma. ARE affects many children in the U.S., with about 6 and a half cases per 1,000 children per year in the nationwide ECHO program.

Neighborhood factors—such as access to housing, healthy food, transportation, and education—can impact childhood asthma development. The Child Opportunity Index (COI) is one measure used to assess these conditions, connecting residential addresses at different early-life stages to data on neighborhood resources. This index combines information from 29 factors, such as access to good schools, healthy food, parks, clean air, and job opportunities. Studies have shown that neighborhoods with higher COI scores tend to have better conditions that help children grow up healthier and have more opportunities for economic success.

ECHO researchers used the COI to analyze how these factors influenced the development of this severe type of childhood asthma. The study included data from 15,877 children born between 1990 and 2018 across 60 ECHO study sites in the U.S.

“This study suggests that individual- and neighborhood-level exposures may affect the risk for developing childhood ARE,” said Rachel Miller, MD, of the Icahn School of Medicine at
Mount Sinai.

Researchers found that:

  • Children from low-opportunity neighborhoods had significantly higher incidence rates of asthma with recurrent exacerbations (ARE) than those from higher-opportunity areas.
  • Non-Hispanic Black children had the higher rates across all neighborhood categories when compared to Non-Hispanic White children.
  • Among children in very low-opportunity neighborhoods, non-Hispanic Black and Hispanic Black children had rates of ARE several times higher than non-Hispanic White children.
  • Young children (ages 2 to 4) and those with a parent who had asthma had a higher risk of ARE. .

What happened during the study

In this study, researchers followed children from ages 2 to at least 5, and up to age 19. They collected information on asthma diagnoses and the use of corticosteroids, a medication that helps reduce inflammation in the body. ARE was identified if a child used corticosteroids at least twice during the follow-up period while being monitored by ECHO researchers.

The study also examined the link between COI scores and children's birth addresses. Researchers analyzed how neighborhood conditions influenced the development of asthma with recurrent exacerbations while accounting for individual health history and other factors.

“This study adds to the mounting evidence that investing in neighborhood resources may have a myriad of respiratory health benefits for children,” said Dr. Miller.

Additional studies could help researchers further understand the prenatal and early childhood determinants of ARE at both the individual and neighborhood levels.

This collaborative research was published in the Journal of Allergy and Clinical Immunology.

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.

Miller, R. and Johnson, C. Child Opportunity Index at Birth and Asthma with Recurrent Exacerbations in the U.S. ECHO Program. Journal of Allergy and Clinical Immunology, DOI: 10.1016/j.jaci.2025.02.036

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.

ECHO Continues to Produce Impactful Research on the Root Causes of Chronic Childhood Disease

Posted on by Jodi Snare

Now that the NIH ECHO Program is in its 9th year, it’s a good time to see how far we’ve come. ECHO continues to produce impactful research on the root causes of chronic childhood disease, including preterm birth, allergies and asthma, obesity, autism spectrum disorder, ADHD, and mental health challenges, among others. These causes may include what pregnant women and children eat, chemicals to which they are exposed, stress, and many other factors that ECHO researchers explore.

In its second 7-year cycle, the ECHO Cohort is enrolling pregnant women and their children in numbers even beyond what we projected. These new participants add to the potential impact of ECHO Cohort, already the largest longitudinal child health study in the U.S. The ECHO Cohort draws data from more than 130,000 participants, including more than 60,000 children, nationwide.

The ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) has built the capacity to take on more and more complex issues, and its success is also reflected in the funding its sites have secured to address actionable research questions outside the Network’s own priority areas. The ECHO ISPCTN is the only NIH clinical trial network focused on children from rural or underserved communities, and some of its studies have already changed clinical practice in these areas.

I mention these accomplishments, in part, because they are aligned with the new administration’s “Make America Healthy Again” focus. ECHO plays a leading role in NIH research that “addresses the childhood chronic disease crisis.” In addition to pinpointing root causes, ECHO informs prevention of chronic conditions and promotes well-being among America’s children.

Thank you, as always, for helping us achieve ECHO’s mission to enhance the health of children for generations to come.

NIH Study Finds No Association Between Prenatal Dietary Patterns and Autism Diagnoses, But Potential Links with Broader Traits

Posted on by Jodi Snare

Three validated dietary patterns were not associated with diagnosis, but healthy eating during pregnancy showed a modest link with lower scores for traits related to autism

Expectant mothers with higher diet quality—measured by the Healthy Eating Index (HEI) and the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P)—had children with modestly lower scores for traits related to autism spectrum disorder (ASD), according to ECHO Cohort research led by Kristen Lyall, ScD, and Rachel Vecchione, MPH, of Drexel University. However, the study did not find a significant association between these prenatal dietary patterns and a formal ASD diagnosis.

Previous research has suggested potential links between prenatal diet and neurodevelopmental conditions, but most studies focused on individual foods or nutrients rather than overall dietary patterns. In this study, ECHO researchers examined overall dietary patterns to better understand effects of usual dietary intake across foods.

“This study broadly supports the importance of a healthy diet during pregnancy. Autism is a complex condition with many contributing factors. Here, we found some evidence to suggest a healthy diet during pregnancy may be linked with reduced likelihood of broader traits related to autism, but effect sizes were small,” said Dr. Lyall.

The study included up to 6,084 mother-child pairs from 14 ECHO Cohort Study Sites, which included general population sites and sites with a higher chance of ASD occurring in families.

This collaborative research, titled “Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental influences on Child Health Outcomes Consortium,” is published in Nutrients.