Author: Jodi Snare

New ECHO Research Investigates Relationship Between Phthalate Exposure and High Blood Pressure, Related Complications During Pregnancy

Posted on by Jodi Snare

Collaborative ECHO research led by John Meeker, ScD of the University of Michigan, and Jordan Kuiper, PhD of George Washington University, investigates the relationship between phthalate exposure and high blood pressure during pregnancy. This research, titled “Urinary concentrations of phthalate metabolites in relation to preeclampsia and other hypertensive disorders of pregnancy in the Environmental influences on Child Health Outcomes (ECHO) program,” is published in Environment International.

This study aimed to evaluate whether phthalate exposures could be linked to ongoing high blood pressure during pregnancy and more severe pregnancy complications like preeclampsia or eclampsia.

“The findings of this study suggest that exposure to certain phthalates found in plastics and other consumer products may be associated with pregnancy complications such as gestational hypertension or preeclampsia,” said Meeker.

Researchers evaluated data from 3,430 participants from eight ECHO sites across the U.S., which enrolled pregnant participants from 1999 to 2019. In the study, researchers measured the levels of 13 metabolites linked to phthalate exposure in urine samples collected at least once during pregnancy. They then evaluated the association between individual phthalates, as well as the combined mixture of phthalates, with the risk of developing preeclampsia, eclampsia, or ongoing high blood pressure during pregnancy.

The researchers measured phthalate exposure by checking urine levels of certain small molecules, called metabolites, that the body makes when it breaks down chemicals. They found that higher levels of these metabolites were linked to a higher risk of pregnancy complications like preeclampsia, eclampsia, and ongoing high blood pressure. For example, if the level of a metabolite called mono (3-carboxypropyl) phthalate (MCPP) doubled, the risk of developing preeclampsia or eclampsia increased by 12%. MCPP is related to phthalates found in PVC plastics and insect repellents.

The researchers also examined combined phthalate exposure by dividing participants into four groups based on their exposure levels. Each increase in exposure level was linked to a 27% higher risk of preeclampsia or eclampsia, which was generally higher for pregnant women carrying female fetuses.

Future studies can help researchers understand how exposure to phthalates might be linked to high blood pressure during pregnancy, how this happens in the body, and what we can do to reduce the risk of these pregnancy complications.

Read the research summary.

ECHO Researchers Examine the Effect of Perinatal Synthetic Oxytocin Exposure and Maternal BMI on Child Neurodevelopmental Outcomes

Posted on by Jodi Snare
Lisa Kurth, PhD

Collaborative ECHO Cohort research led by Lisa Kurth, PhD of the University of Colorado, Anschutz Medical Campus investigates the potential influence of maternal exposure to synthetic oxytocin during childbirth—and the contribution of maternal obesity—on neurodevelopmental outcomes in children. Synthetic oxytocin (e.g., Pitocin, Syntocinon) is a drug commonly used to assist women during childbirth by stimulating uterine contractions.

The researchers examined data from over 12,000 mother-child pairs to look at possible associations between maternal exposure to synthetic oxytocin, maternal pre-pregnancy body mass index (BMI), and childhood ADHD and Autism Spectrum Disorder (ASD). The results of this study found no significant correlation between synthetic oxytocin exposure and the risk of ADHD and ASD in children. However, an unexpected finding in this study was that synthetic oxytocin exposure was associated with a decreased childhood risk of ADHD in children born to mothers with pre-pregnancy obesity. Additionally, mothers with pre-pregnancy obesity demonstrated a modest trend toward labor intervention with synthetic oxytocin. This research, titled “Intrapartum Exposure to Synthetic Oxytocin, Maternal BMI and Neurodevelopmental Outcomes in Children within the ECHO Consortium,” is published in the Journal of Neurodevelopmental Disorders.

Previous studies on the association between synthetic oxytocin and children’s risk of ADHD and ASD have been decidedly mixed, and the potential impact of the mother’s pre-pregnancy BMI on this association has, until now, not yet been examined. This study analyzed data from participating mothers, 48% of whom were exposed to synthetic oxytocin during childbirth, and their children from ECHO Cohort research sites across the U.S.

Although no significant correlation was found between synthetic oxytocin-assisted childbirth and neurodevelopmental outcomes in children, future research may further unravel the effects of childbirth factors such as synthetic oxytocin dosage, maternal labor duration, maternal gestational obesity and Caesarean delivery rationale, indicators of newborn health (e.g., initial Apgar score, meconium stain, newborn birthweight), and maternal BMI at time of delivery on infant well-being in relationship to child neurodevelopmental outcomes. Important next steps include analysis of biospecimens (placental tissue and cord blood) aimed at understanding the specific mechanism(s) of action involved in synthetic oxytocin exposure.

“Casting a wider net and including additional factors will allow future studies to more precisely examine the effects of important perinatal factors, including environmental exposures, and effect modifiers, such as maternal obesity, on child neurodevelopmental outcomes,” said Dr. Kurth.

Read the research summary.

May Observances Present Opportunity to Highlight Breadth of ECHO Program Research Efforts

Posted on by Jodi Snare

This month several observances shed light on crucial areas of ECHO research. From Clinical Trials Day to Air Quality Awareness Week, and from Asthma and Allergy Awareness Month to Children’s Mental Health Awareness Week, May presents an opportunity to highlight the breadth of research efforts the ECHO Program makes to achieve its mission to enhance child health for generations to come.

Clinical Trials Day, celebrated on May 20, allows us to highlight important advancements of ECHO’s intervention component, the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN). In the network, researchers test carefully designed interventions, particularly among rural or underserved pediatric populations, to enhance children’s health in at least one of ECHO’s five health focus areas. I’m grateful to all our ECHO ISPCTN investigators, staff, and participants for their dedication to furthering the ECHO mission through clinical trials research.

One of these clinical trials is the BREATHE—Bronchiolitis Recovery and the Use of High Efficiency Particulate Air (HEPA) Filters—study. The goal of this ECHO ISPCTN research is to determine the extent to which indoor air filtration improves breathing symptoms among infants who have been hospitalized for bronchiolitis, a common respiratory disease in very young children. As we mark Air Quality Awareness Week and Asthma and Allergy Awareness Month, the BREATHE study reminds us of the influences that toxic environmental factors like indoor air pollution can have on children’s lungs.

In the May ECHO Connector’s News from the NIH section, please read about our current Request for Information (RFI) to inform ongoing strategic planning for the ECHO Program. I encourage you and your colleagues to participate by submitting your feedback and suggestions by May 31, 2024.

New ECHO Research Suggests Harsh Parenting and High Socioeconomic Stress May Be Associated With Higher Internalizing Problems in Children

Posted on by Jodi Snare

Collaborative ECHO research led by Lue Williams, MA, MS, Veronica Oro, PhD and Leslie Leve, PhD of the Prevention Science Institute at the University of Oregon investigates the relationship between two early childhood stress factors, harsh parenting and socioeconomic stress, and children’s development from childhood through adolescence. This research, titled “Influence of Early Childhood Parental Hostility and Socioeconomic Stress on Children’s Internalizing Symptom Trajectories from Childhood to Adolescence,” is published in Frontiers in Psychiatry.

Internalizing problems in childhood may be early indicators of problems associated with disorders such as depression and anxiety. Internalizing by children can be influenced by biological and environmental factors, including parent-child relationships and socioeconomic status. This study looked at how harsh parenting and socioeconomic stress were associated with internalizing problems in children. The researchers characterized harsh parenting, or “parental hostility,” as non-supportive and controlling parenting practices, displays of anger and disappointment in children, and discipline through punishment. Socioeconomic stress reflects disadvantages associated with factors like household income.

The study included two samples—a nationwide sample of 481 children who were adopted at birth and a sample of 1,053 children from six predominantly low-wealth, rural communities in eastern North Carolina and central Pennsylvania. Adopted children from the Early Growth and Development Study (EGDS) have lived in their adoptive homes since birth and were recruited into the study between 2003 and 2009. Children from the Family Life Project (FLP) were raised by their biological parents and were recruited into the study at birth, from September 2003 through 2004.

The researchers analyzed data collected from the EGDS and FLP, and observed that, within the study sample, children fell into three main groups based on the severity of their internalizing behaviors and how those behaviors progressed with age: low, moderate-increasing, and higher-increasing. Some of the internalizing behaviors reported include feeling anxious or depressed, being withdrawn, and complaining of aches and sickness. Parents who reported more negative interactions with children in early childhood had children who were more likely to be in the group with the highest internalizing behaviors.

Children with more socioeconomic stress in their households were also most likely to be in the highest internalizing behaviors group, as compared with both the low- and moderate-internalizing symptoms groups. Researchers also observed that household socioeconomic stress directly predicted children’s mental health, but did not find any significant relationship between child sex assigned at birth and how likely they would be to show internalizing behaviors.

“Not many studies have examined early childhood predictors of internalizing behavior developments, so our research fills an important gap by examining the role of diverse risk factors in early life on patterns of internalizing symptoms later in childhood,” Williams said. “Our findings suggest that in addition to focusing on children’s symptoms when treating internalizing problems, health service providers may also wish to consider the broader context of caregiver behavior and access to resources for care.”

Future studies are needed to further support programming and research efforts by exploring how socioeconomic stress and parenting styles can influence children’s internalizing behaviors identified in the current study.

Read the research summary.

Health Scientist Administrator and Supervisory Health Scientist Administrator Positions

Posted on by Jodi Snare

APPLICATIONS ARE NO LONGER BEING ACCEPTED

Are you interested in working in a collaborative environment that will enhance the health of children for generations to come? If so, then consider joining the NIH Environmental influences on Child Health Outcomes (ECHO) Program.

The ECHO Program, launched in 2016, is a nationwide program focused on children’s health. The ECHO Cohort comprises more than 64,000 children plus their family members, who are contributing data and biospecimens to advance our understanding of the roles of a broad range of early exposures from society to biology, on ECHO’s five key child health outcomes: pre-, peri- and postnatal outcomes; upper and lower airway health; obesity; neurodevelopment; and positive health. ECHO investigators have published more than 1500 papers.

From September 2023 through May 2030, the ECHO Cohort Consortium will follow more than 30,000 current ECHO Cohort child and adolescent participants and their families, while adding more than 30,000 new pregnant participants and their offspring. In addition, researchers will follow at least 10,000 women and, when available, their partners, to examine how preconception exposures may influence child health outcomes.

The ECHO Program Office is seeking to add a motivated and team-oriented Health Scientist Administrator. Candidates should have expertise to support activities related to observational epidemiologic studies and maternal and child health research. The incumbent will manage a portfolio of cooperative agreements and serve on several working groups/committees related to child health. This position requires working both independently and collaboratively. Strong organizational, oral, written, and communication skills are also required.

The ECHO Program Office is also seeking to add a motivated and team-oriented Supervisory Health Scientist Administrator. Applicants must possess a Ph.D., M.D., or equivalent doctoral degree and have expertise related to observational epidemiologic studies and maternal and child health research. The incumbent will provide leadership and supervise an interdisciplinary team of Program Officials. The incumbent should also have strong knowledge of cooperative agreements and an understanding of NIH processes and procedures. The position requires strong leadership, organizational, written, communication, and interpersonal skills.

Interested candidates can apply through the links below. Please contact Dr. S. Sonia Arteaga at Sonia.arteaga@nih.gov with any questions.

Delegated Examining (Open to Public)

Merit Promotion (Open to Status Candidates)

Living Near Green Space Associated With Fewer Emotional Problems in Preschool-Age Kids, NIH Study Finds

Posted on by Jodi Snare

FOR IMMEDIATE RELEASE

 

Children who live in areas with natural spaces (e.g., forests, parks, backyards) from birth may experience fewer emotional issues between the ages of 2 and 5, according to a study funded by the NIH Environmental Influences on Child Health Outcomes (ECHO) program.

While research has suggested that time in nature is important for mental health, studies examining the effects on young children are limited. ECHO investigators addressed this research gap by analyzing information from parents about the behavior of their children from ages 2 to 11. They combined this data with the family’s residential address when the child was born and satellite data on live vegetation density around their homes.

What researchers found in their analysis, published in JAMA Network Open, was that higher levels of green spaces up to three-fourths of a mile from a child’s home were linked with lower anxiety and depression symptoms from ages 2 to 5 years. The association persisted even after researchers factored in the child’s sex, parent education, age at birth, and neighborhood socioeconomic vulnerability. Researchers did not find a significant association between green space around the home and mental health symptoms in later childhood years from ages 6 to 11, when children spend more time at school.

“Our research supports existing evidence that being in nature is good for kids,” said Nissa Towe-Goodman, PhD, an ECHO researcher from the Frank Porter Graham Child Development Institute at the University of North Carolina, Chapel Hill. “It also suggests that the early childhood years are a crucial time for exposure to green spaces.”

Most research so far has been limited to studying one or a few cities at a time, and focused on adult health. Because the ECHO Program collects data nationwide, researchers were able to examine data from children in 199 counties across 41 U.S. states, exploring the connection between exposure to green spaces from birth and anxiety, depression, aggression, and other symptoms during early or middle childhood.

The study included children born between 2007 and 2013 and whose parents completed the Child Behavior Checklist, a common survey to rate a child’s emotional and behavioral symptoms. The 2,103 children included in the study ranged in age from 2 to 11, spanning early and middle childhood.

Green space exposure was measured using the Normalized Difference Vegetation Index (NDVI), a widely used metric for quantifying vegetation density using sensor data. NDVI values range from -1 to 1. High NDVI values (approximately 0.6 to 0.9) represent dense vegetation, such as forests; values close to zero represent areas without live vegetation.

“In the future, researchers could look into what kinds of experiences in nature are connected to kids' early mental health,” said Dr. Towe-Goodman. “Also, we should study how creating or preserving natural areas around homes and schools might make a difference in a child’s mental health.”

Dr. Towe-Goodman lead this collaborative research in JAMA Network Open.

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About ECHO:

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

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

 

Media Contacts

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

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

Connect With Us

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

To receive the ECHO Connector through email, subscribe here.

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

NIH ECHO Issues Request for Information on Potential Strategic Priorities as Part of Strategic Planning Process

Posted on by Jodi Snare

THE DEADLINE FOR THIS RFI HAS PASSED

The National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program Office has released the following Request for Information:

In 2016, the NIH launched the nationwide ECHO Program. Its mission is to enhance the health of children for generations to come. To achieve this mission, ECHO investigators study the effects of a broad range of early environmental influences on five key child health outcome areas with high public health impact: pre-, peri- and postnatal outcomes; upper and lower airways; obesity; neurodevelopment; and positive health or well-being.

The ECHO Program supports both observational and intervention research. ECHO’s observational research allows investigators to follow children from preconception through adolescence to learn about the relationship between children’s environments and ECHO’s five health outcome areas. ECHO’s intervention research lets investigators test interventions, particularly among rural or underserved pediatric populations, to enhance children’s health in at least one of ECHO’s five health outcome areas.

This RFI seeks input from interested members of the public including but not limited to these communities:

  • scientific research
  • advocacy
  • clinical practice

The NIH seeks input regarding considerations for ECHO’s strategic priorities through year 2029 for:

  • Observational Research Priorities
  • Intervention Research Priorities
  • Operational and Capacity-building Priorities

NIH encourages respondents to address diversity, equity, inclusion, and accessibility within each request.

Respondents can find additional context about each of the three requests, as well as information about how to respond, on the NIH website.

Responses must be received by 11:59 pm (ET) on Friday, May 31, 2024.

NIH ECHO Program Office Extends Funding Opportunity Due Date and Updates Budget Information for Data Coordinating and Operations Center for the ECHO IDeA States Pediatric Clinical Trials Network RFA-OD-24-009

Posted on by Jodi Snare

THE APPLICATION DEADLINE HAS PASSED

The NIH has released a Notice of Change (NOT) NOT-OD-24-094 for RFA-OD-24-009. This notice changes the application receipt date and the budget.

  • The application receipt date has changed from April 15, 2024, to June 14, 2024.
  • Award budget text has changed to reflect revisions to the Data Coordinating and Operations Center direct costs for Core Infrastructure Costs and capitation costs for Protocol-Specific Costs distributed to clinical sites.

Please see this webpage, which includes a revised pre-recorded webinar video and a revised Frequently Asked Questions document.

Ways ECHO Investigators Conduct Important Research on How Maternal Health, Exposures, and Habits Influence Child Health

Posted on by Jodi Snare

ECHO has already produced several exciting publications so far this year, many of which have amassed media attention. The year is off to a great start for the ECHO Program. In the March 2024 ECHO Connector, we focus on the ways ECHO investigators are conducting important research on how maternal health, exposures, and habits influence child health. Learn about two recent research articles, one of which reports on ECHO Cohort studies of chemical exposure and the other on the benefits of early breastfeeding, in the News You Can Use section.

In the January ECHO Connector, I highlighted the public availability of de-identified ECHO data and new NIH funding opportunities for the intervention research arm of ECHO. Both are important to the future success of the ECHO Program. Here are more details:

  • De-identified data from the ECHO Cohort are available to any qualified researcher through the Eunice Kennedy Shriver National Institute for Child Health and Development (NICHD) Data and Specimen Hub (DASH). This resource, containing data from over 60,000 ECHO Cohort participants, allows members of the broad scientific community to answer important research questions about the origins of child health outcomes. Learn more about this dataset and how to request access.
  • The ECHO Program Office recently announced two Notices of Funding Opportunity (NOFOs) for a third 5-year cycle of the ECHO Institutional Development Award (IDeA) States Pediatric Clinical Trials Network (ISPCTN). We also recently posted Frequently Asked Questions and prerecorded webinars regarding these opportunities. We welcome applications from entities/institutions in IDeA-eligible states to participate in the ECHO ISPCTN as either a Clinical Site or the Data Coordinating and Operations Center (DCOC). These awards will support state-of-the-art pediatric clinical trials in states with historically low rates of NIH funding. Applications are due April 15; please spread the word!

I’m glad the word is getting out about ECHO results, the fruits of efforts of hundreds of researchers and tens of thousands of participants. On behalf of the entire ECHO Program, I thank you for partnering with us to disseminate our research, which is enhancing the health of children for generations to come.

—Matthew W. Gillman, MD, SM

New ECHO Research Reveals Link Between Phthalate Exposure During Pregnancy and Multiple Health Outcomes in Children

Posted on by Jodi Snare

Drew Day, PhD

Collaborative ECHO research led by Drew Day, PhD of Seattle Children’s Research Institute uses machine learning statistical algorithms to explore patterns of health outcomes in children. The researchers also investigated how exposures during pregnancy to phthalates—chemicals widely used in plastics that have previously been linked with preterm birth—can influence the development of multiple health conditions during childhood. This research, titled “Subpopulations of children with multiple chronic health outcomes in relation to chemical exposures in the ECHO-PATHWAYS consortium,” is published in Environment International.

Chronic health conditions, such as asthma and obesity, can develop together during childhood but are usually studied separately. The goal of this study was to use data from ECHO Cohort research sites across six U.S. cities to characterize “clusters,” or patterns, of obesity-related, lung health, and brain development outcomes in children and to investigate how these patterns relate to mothers’ exposures to phthalates during pregnancy.

ECHO researchers looked at 15 health outcomes in 1,092 children between the ages of 4 and 9 across six U.S. cities and collected measurements of phthalate exposure during pregnancy from 856 of these children’s mothers. Outcomes collected during this study included body mass index (BMI), IQ, anxiety, depression, irritability, learning disabilities, speech problems, asthma, wheeze, and nasal allergies. The researchers evaluated how children developed multiple outcomes and investigated how the probability of being in a particular group was affected by exposure to 15 plastic-associated phthalate chemicals during pregnancy. The researchers measured phthalate exposure during pregnancy using urine samples collected from 2007–2014 from mothers during late pregnancy.

The researchers identified three groups of children with a pattern of health outcomes that occurred together:

  1. A group of relatively healthy children;
  2. A group of children with lower IQs, elevated obesity, and slightly elevated asthma-related outcomes such as asthma, wheezing, and allergies; and
  3. Another group of children with high asthma-related outcomes along with elevated obesity and some increase in anxiety- and depression-related outcomes.

Compared to children in the healthy group, other groups had more male children, mothers with higher BMI and lower education attainment, and lower household incomes. The researchers found that children—particularly boys—were more likely to be in the third group if their mothers were exposed to phthalates during pregnancy.

These findings suggest that exposure to phthalates during pregnancy might be associated with an increased risk of developing not only asthma and related lung outcomes, but also obesity and mental health issues such as anxiety and depression. This study also suggests that low-income households are at higher risk for worse childhood health outcomes.

“The three patterns of health outcomes seen in this study reveal more about how pediatric diseases might arise together,” said Dr. Day. “The insights from this study could help inform future research on what biological processes contribute to these health outcome patterns as well as better treatments and interventions to enhance child health.”

This study’s multi-outcome approach can be used in future studies to identify public health risks that may affect central biological processes that result in multiple negative health outcomes. ECHO Cohort researchers are working to extend this method to include several additional U.S. research sites, which will allow them to evaluate whether similar patterns are observed in a larger dataset. Larger studies will also help researchers characterize how demographic differences like income and sex may influence the development of multiple health outcomes during childhood.

Read the research summary.