Smoking During Pregnancy Linked to Mental Health Challenges in Children, ECHO Study Finds

Authors: Kristine Marceau, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Previous research has shown that children whose mothers smoked during pregnancy are more likely to develop behavior problems, particularly difficulties with acting out or following rules. However, it has been less clear whether prenatal smoking also increases the risk of mental health problems generally, or if it’s a specific risk for difficulties with acting out or following rules alone. Researchers from this study wanted to understand whether prenatal smoking contributes to co-occurring emotional and behavioral symptoms or specifically behavioral symptoms, and whether its effects differ by age or sex. This study helps address these gaps by examining which developmental periods may be especially sensitive to prenatal smoking effects and whether boys or girls are more vulnerable.

What were the study results?

Children exposed to smoking before birth were more likely experience multiple co‑occurring emotional and behavioral symptoms, and also to show more externalizing problems—such as attention problems, aggressive behavior, and rule‑breaking. These associations were observed across nearly all age groups and remained even after accounting for family history, background, and other exposures.

The strongest effects on mental health symptoms were seen in early childhood (under age 7) and early puberty (ages 9 to 12). There were very few differences between boys and girls. Only at ages 13-14 did boys seem to have more co‑occurring emotional and behavioral symptoms and externalizing-specific problems than girls. In general, both boys and girls were affected in similar ways.

What was the study's impact?

These results suggest that prenatal exposure to nicotine may increase the risk of mental health and behavioral problems. Because this study included a large number of children from different backgrounds, it helps clarify past research and contributes new insight about when certain problems tend to appear and how different symptoms may occur together.

Who was involved?

The study included 16,335 children and adolescents ages 1 to 18 from 55 U.S. ECHO Cohort Study Sites. All participants completed Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ) behavioral assessments.

What happened during the study?

Researchers gathered standardized information about children’s behavior and created a simple score to show how many symptoms a child had and whether those symptoms were more emotional (such as sadness, anxiety) or behavioral (such as acting out, rule breaking). They then looked at these patterns across different age groups, while taking into account important factors such as the mother’s age and education, family mental health history, and exposure to smoke or other substances during and after pregnancy.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future work could help researchers understand how timing, dose, and frequency of smoking during pregnancy correlates with child mental health. Future research could also use methods to separate the effects of family background from the effects of smoking itself and look more closely at how nicotine and other chemicals in smoke might affect children’s development.

Where can I learn more?

Access the full journal article, titled “Prenatal Smoking and Child Psychopathology Associations by Age and Sex in the ECHO Cohort,” in Development and Psychopathology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published April 6, 2026

Read the associated news release.

Download this summary

Smoking During Pregnancy Linked to Mental Health Challenges in Children, ECHO Study Finds

Maternal Smoking During Pregnancy May Be Associated with Increased Childhood Blood Pressure, ECHO Study Finds

<< Back to Research Summaries

Maternal Smoking During Pregnancy May Be Associated with Increased Childhood Blood Pressure, ECHO Study Finds

Authors: Lyndsey E. Shorey-Kendrick, Christine Ladd-Acosta, et. al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Blood pressure that is higher than normal in childhood, including diagnosed high blood pressure, can increase the risk of developing high blood pressure as an adult, which is a major risk factor for heart disease. Past studies looking at smoking during pregnancy and children’s blood pressure have had mixed results. Many relied on parents’ self-reports of smoking or focused only on systolic blood pressure, the top number in a blood pressure reading that reflects pressure when the heart beats. Fewer studies examined diastolic blood pressure, the bottom number that reflects pressure when the heart rests between beats.

To better understand these links, researchers needed a large U.S. study that included objective lab measures of smoking during pregnancy. Using data from the ECHO Cohort, researchers examined how smoking during pregnancy was related to both systolic and diastolic blood pressure in children.

What were the study results?

Children whose mothers smoked during pregnancy—whether occasionally or regularly—were more likely to have higher blood pressure and a greater risk of hypertension (higher than normal blood pressure at three or more doctors’ visits). The study distinguished between “any reported smoking,” which is based on what mothers shared in surveys or medical records, and “active smoking,” which is confirmed by a urine test for cotinine, a marker of recent tobacco use. Active smoking, identified by these lab tests, was linked to even higher blood pressure in children.

What was the study's impact?

This study reinforces that smoking during pregnancy is a risk factor for increased childhood blood pressure and hypertension and underscores the importance of smoking reduction during pregnancy for children’s heart health. The use of objective laboratory measures strengthens these findings and more accurately identifies children at risk.

Who was involved?

The study included 13,120 children born between 1999 and 2020 from 52 ECHO Cohort Study Sites in the U.S. All children had at least one blood pressure measurement taken between the ages of 3 and 18 years. A nearly equal number of male and female children from a range of sociodemographic groups were included.

What happened during the study?

Researchers collected smoking data from pregnant women using self-report surveys, medical records, and/or urine specimens. Children’s blood pressure was measured when they were between 3 and 18 years of age. Using these measurements, the researchers performed a statistical analysis to compare blood pressure levels between children exposed to smoking during pregnancy and children not exposed. The researchers also assessed whether there were any differences in the relationships between smoking and blood pressure by child sex.

What happens next?

More studies could help researchers better understand how smoking during pregnancy may contribute to higher blood pressure in children. Future studies could use biological measures of prenatal smoke exposure, which may help capture individual differences in how children are affected and make it easier to identify those at higher risk

Where can I learn more?

Access the full journal article, titled “Association of Maternal Smoking During Pregnancy with Childhood Blood Pressure and Hypertension in the ECHO Cohort,” in Circulation.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 16, 2026

Read the related press release.

Download this summary

Maternal Smoking During Pregnancy May Be Associated with Increased Childhood Blood Pressure, ECHO Study Finds

Read Related Research Summaries

The BREATHE Study: Bronchiolitis Recovery and Use of HEPA Filters

<< Back to Research Summaries

Study Summary: Lay Summary for Participant Families

The BREATHE Study: Bronchiolitis Recovery and Use of HEPA Filters

Author(s): The BREATHE Study Team

Why was this study conducted?

Bronchiolitis is an infection that affects the airways of a child. Babies with bronchiolitis may need hospital treatment. These babies may still have breathing problems, such as coughing and wheezing, after they go home.

Many things can affect a person’s ability to breathe. One of those things is the level of very small particles in the air. These particles are called PM2.5, which are particulate matter that is less than 2.5 micrometers across. That size is smaller than the size of most pollen and mold. The level of these very small particles in the air in someone’s home can be lowered by special air filters called high efficiency particulate air (HEPA) filters.

The BREATHE study was done to find out if HEPA filters used in a baby’s house can help them breathe better than if no filter is used in their house. Specifically, the study looked at how many days infants, who previously had bronchiolitis, had specific breathing problems such as coughing, wheezing, or other breathing problems.

What was done?

Babies chosen for this study were less than 12 months old and had been hospitalized for bronchiolitis for the first time. Babies were selected from 17 hospitals, each in a different state. A total of 228 families were given either 2 HEPA units or 2 control units (identical units but with filters removed). One unit was to be used in the baby’s sleep space and the other unit in a common room of the home. Families did not know which types of units they were given. Air quality monitors measured the level of very small particles (PM2.5) in their homes. Families reported the number of days that their babies had breathing troubles. These reports were done weekly for 6 months. At the end of the study, families learned whether they had been using HEPA units or control units. All families were then given new HEPA filters. They also received individual reports about the PM2.5 levels in their home.

What was found?

The number of days babies had breathing problems were counted. The number of problem days for the babies living in homes with HEPA filters were compared to the number of problem days for the babies living in homes that had control units. Generally, babies in homes with working HEPA units had fewer breathing problems than babies in homes with the control units. Babies in homes with HEPA units had an average of 5 fewer days with breathing problems than did babies in homes with the control units. However, because the difference between the 2 groups is quite small, it is not clear if the breathing improvement was related to HEPA filter use or due to chance. This does not mean that the HEPA filters were not useful. It only means that it could not be proven with this study.

Compared to those with control units, babies who had HEPA filter units in their home had a 9% lower chance of unscheduled healthcare visits, such as hospitalizations, emergency room visits, and doctor’s office visits for breathing problems, but the difference between the 2 groups is small and may be due to chance. Babies who had HEPA filter units running most of the time during the study had a 25% lower chance of unscheduled doctor’s office visits for breathing problems.

On average, homes with working HEPA units had average common room PM2.5 equal to 11 micrograms per cubic meter (μg/m3). On average, levels were higher in the common room of homes with control units (15 μg/m3). The difference was even bigger in the infant’s sleep space. On average, homes with HEPA units had sleep space PM2.5 equal to 11 μg/m3. On average, homes with control units had sleep space PM2.5 equal to 21 μg/m3.

What do the results mean?

Filtering air with a HEPA unit may help infants who have been in the hospital for bronchiolitis. Infants in houses with HEPA units may have fewer days of breathing trouble than infants in houses without HEPA units. However, we would need to do a larger study to know for sure.

Who sponsored the study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, National Institutes of Health.

Appreciation

The authors appreciate the children and families whose participation made the research possible.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Lay Summary for the BREATHE Study (for participant distribution)
cIRB # 274137 V-01 (27-October-2025)

ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

<< Back to Research Summaries

ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

Authors: Amy Margolis, Andrew Law, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. This study examined changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic and evaluated whether these changes were associated with youth pandemic-related post-traumatic stress (PTS) symptoms.

What were the study results?

The study identified two groups of families based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.

Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes. Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children. Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores. Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors related to PTSS scores. Stability in these areas was linked to lower PTSS scores. The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

What was the study's impact?

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

Who was involved?

The participants included 9,139 youth and their parents or caregivers from across the United States, including 7,786 children (aged 2-12 years) and 1,353 teens and young adults (aged 13-21 years).

What happened during the study?

The study looked at information from ECHO families between April 2020 and August 2021 to understand how the pandemic affected them. Researchers grouped families into different categories based on their experiences and background characteristics from before the pandemic. The researchers then looked at symptoms of PTS in both children and teens within these family groups. The study explored how COVID-19 influenced family hardships, changes in parent and child behavior, and the ways families coped.

What happens next?

Future studies could help researchers examine what factors contribute to ongoing PTS symptoms or the occurrence of mental health diagnoses. Interviewing participants about acute stress when collecting PTSS survey responses could also help researchers confirm the validity of the survey.

Where can I learn more?

Access the full journal article, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” in the Journal of Clinical Child & Adolescent Psychology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 17, 2025

Read the associated article.

Download this summary

ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

Prenatal Vitamin D Levels Associated with Children’s Brain Development, ECHO Study Suggests

<< Back to Research Summaries

Prenatal Vitamin D Levels Associated with Children’s Brain Development, ECHO Study Suggests

Authors: Melissa Melough, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Vitamin D deficiency is one of the most common nutrient deficiencies in the world. In the U.S., it affects 80% of Black pregnant women and nearly half of pregnant women with incomes below the federal poverty level. Low vitamin D during pregnancy may harm childhood brain development, leading to lower academic achievement in adolescence. This study aimed to clarify how vitamin D levels during pregnancy may influence children’s brain development, particularly in varied groups and into later childhood. While prior research suggests prenatal vitamin D plays an important role in early brain development, few studies have examined whether these effects persist beyond early childhood or vary across groups that may be at higher risk for vitamin deficiencies. For example, Black people often have lower vitamin D levels because their skin has more pigment, which makes it harder for the skin to produce vitamin D from sunlight. Researchers sought to build on previous evidence by studying a varied cohort of mothers and their children, followed until ages 7 to 12.

What were the study results?

Researchers found that children whose mothers had higher vitamin D levels while pregnant tended to perform better on cognitive tests assessing skills like problem-solving and processing new information at ages 7 to 12. However, vitamin D levels were not linked to skills based on learned knowledge, such as vocabulary. The link between vitamin D and thinking skills was stronger in children of Black mothers compared to other racial groups. Results also suggested that vitamin D levels early in pregnancy were most important for children’s brain development. The largest differences in children’s cognitive skills—between those with the highest and lowest scores—were linked to their mothers’ vitamin D levels early in pregnancy, suggesting this may be a critical time for brain development.

What was the study's impact?

The study provides evidence that early pregnancy may be a critical period when vitamin D has the greatest potential to support brain development. Interventions prior to or earlier in pregnancy, and those focused on Black women and others at high risk of deficiency, may have the greatest impact.

Who was involved?

The study included 912 biological mother-child pairs from five ECHO Cohort research sites. Approximately 38% of participants were vitamin D-deficient.

What happened during the study?

Researchers measured vitamin D levels in pregnant women’s blood during pregnancy or in their babies’ cord blood at birth. They tested the children’s fluid and crystallized cognition when they were 7 to 12 years old using a standard set of cognitive tests. They analyzed how vitamin D levels during pregnancy were linked to children’s cognitive scores, while considering other factors that could affect the results. They also looked at whether certain times during pregnancy mattered more by comparing vitamin D levels across pregnancy in mothers of children with higher versus lower cognitive scores. This helped them identify when vitamin D might have the greatest impact on brain development.

What happens next?

Future research, including randomized trials, could help researchers identify the optimal dose and timing of vitamin D supplementation for children’s cognitive development.

Where can I learn more?

Access the full journal article, titled “Gestational vitamin D concentration and child cognitive development: a longitudinal cohort study in the Environmental influences on Child Health Outcomes Program,” in The American Journal of Clinical Nutrition.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 2025

Read the related research article.

Download this summary

Prenatal Vitamin D Levels Associated with Children’s Brain Development, ECHO Study Suggests

Read Related Research Summaries

A Diet High in Refined Grains and Low in Whole Grains in Pregnancy Linked to Lower Birthweights and Pre-term Births

<< Back to Research Summaries

A Diet High in Refined Grains and Low in Whole Grains in Pregnancy Linked to Lower Birthweights and Pre-term Births

Analyzing Diets Based on Racial and Ethnic Groups May Better Predict Outcomes

Authors: Luis E. Maldonado, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Researchers wanted to understand how a pregnant person’s diet, especially in relation to their blood sugar levels (fasting blood glucose), affects birth outcomes—like the baby’s weight and whether the baby is born early. Higher fasting blood glucose during pregnancy is known to increase the risk of adverse birth outcomes. However, little is known about whether culturally influenced combinations of foods and beverages play a meaningful role across different racial and ethnic groups. This question is important because, in the U.S., Hispanic pregnant women are disproportionately affected by adverse birth outcomes, such as preterm birth and low birthweight (under 5.5 pounds). By examining dietary patterns within racial and ethnic groups, the researchers aimed to uncover more precise links between diet and birth outcomes. These links might be overlooked when analyzing the population as a whole, since average diets often reflect the eating patterns of the most represented groups in the study.

What were the study results?

Refined grains, such as white bread or white rice, showed the strongest association with higher fasting blood sugar levels among Hispanic and non-Hispanic White women. People who ate diets high in refined grains and low in whole grains were more likely to have babies born with low birthweight, smaller for gestational age, or born preterm.

When dietary patterns were analyzed by racial and ethnic group, the associations between diet, blood sugar, and birth outcomes were stronger than when using a single pattern for the full population. In the group that included non-Hispanic White and Hispanic participants, nuts, seeds, and solid fats such as butter and lard were linked to lower blood sugar. Among non-Hispanic White participants, whole grains and solid fats had the strongest association with improved blood sugar control. In contrast, among Hispanic participants, higher fruit consumption was associated with elevated blood sugar levels. These food-specific associations should be considered within the overall dietary pattern, as individual foods can influence blood sugar – beneficially or adversely – within the broader diet.

What was the study's impact?

The results of this study show the importance of looking at dietary patterns within racial and ethnic groups, particularly in studies with varying representation of different racial and ethnic populations. Analyzing a single, combined group may mask group-specific associations between diet and birth outcomes, as the effects of diet can differ across racial and ethnic backgrounds.

Who was involved?

The study included 420 Hispanic and 564 non-Hispanic White pregnant participants from two ECHO Cohort study sites.

What happened during the study?

During the study, participants shared details about what they ate over a 24-hour period. The researchers analyzed the diets, along with the mother’s blood sugar, to help determine which combinations of foods eaten together in an overall diet are most closely linked to changes in blood sugar levels. They then tested whether the links between diet and birth outcomes were different across racial and ethnic groups by comparing findings from diets derived using group-specific versus combined fasting blood glucose, which have also been previously shown to vary by racial and ethnic population.

What happens next?

Future research could continue exploring how dietary patterns affect birth outcomes in diverse populations, especially by identifying patterns that are specific to different racial and ethnic groups.

Where can I learn more?

Access the full journal article, titled “Racial/Ethnic-Derived Maternal Diets Predict Birth Outcomes Better than a Diet Derived from a Combined Sample among Hispanic/Latina and non-Hispanic White Pregnant Individuals in the ECHO Cohort,” in Nutrition.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published June 12, 2025

Read the related research article.

Download this summary

A Diet High in Refined Grains and Low in Whole Grains in Pregnancy Linked to Lower Birthweights and Pre-term Births

Read Related Research Summaries

Pregnancy and birth

Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

<< Back to Research Summaries

Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

Authors: Chang Liu, Jody Ganiban, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Childhood obesity is defined as having a body mass index (BMI) 0at or above the 95^th percentile for age and sex. Without early support or intervention, children who show patterns of high BMI during childhood are more likely to become overweight or obese as teenagers and adults. This increases their risk for long-term health issues, including diabetes and heart disease. To prevent these outcomes, it's important to understand how children's BMI changes over time and identify early-life factors—especially those that can be changed—that influence childhood growth patterns. This study aimed to identify unusual BMI patterns (sometimes called atypical BMI trajectories) in early childhood and understand which early-life factors may contribute to them.

What were the study results?

In this study, researchers found two common patterns in how children’s BMI changes over time. Most children (89.4%) had a typical pattern where their BMI went down from ages 1 to 6, then slowly increased. A smaller group (10.6%) had an atypical pattern where their BMI stayed the same from ages 1 to 3.5, then showed rapid increases from ages 3.5 to 9. By age 9, these children were more likely to develop obesity, with an average BMI higher than the 99th percentile. Some factors that associated with the risk of a child developing obesity included high birthweight, maternal smoking during pregnancy, high maternal BMI before pregnancy, and greater maternal weight gain during pregnancy.

What was this study's impact?

The study highlights key prenatal risk factors and early childhood growth trajectories related to childhood obesity, offering opportunities for early prevention and intervention to help children stay on a healthy growth path and reduce their chances of becoming obese.

Who was involved?

The study included 9,483 children from diverse racial, geographical, and socioeconomic backgrounds from the ECHO Cohort.

What happened during the study?

Researchers looked at data collected over time about children’s weight and height from medical records, measurements taken by staff, reports from caregivers, or measurements taken at home. They tracked how children's BMI changed as they grew and looked for patterns.

What happens next?

Future studies could help researchers understand the biological mechanisms and social/environmental factors linked to childhood obesity, helping to develop targeted intervention programs that can redirect unhealthy BMI trajectories.

Where can I learn more?

Access the full journal article, titled “Early-Life Factors and Body Mass Index Trajectories Among U.S. Children in the ECHO Cohort,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published May 22, 2025

Access the associated press release.

Download this summary

Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

<< Back to Research Summaries

Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

Authors: Courtney K. Blackwell, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Teens spend a significant amount of time using social media, raising questions about how their digital and social experiences intersect. Recent concerns outlined by the U.S. Surgeon General’s Advisory suggest potential negative influences of social media on youth mental health. A 2021 national survey of 8th and 10th graders, cited in the U.S. Surgeon General’s report on social media and youth mental health, found that teens spent an average of 3.5 hours per day on social media. More recently, a 2023 Gallup survey of 13- to 19-year-olds reported that the average had increased to 4.8 hours per day. While a large number of previous studies focus on negative mental health outcomes such as depression and anxiety, ECHO researchers examined teen social media use in relation to both positive and negative mental health effects.

What were the study results?

High-quality peer relationships were the strongest predictor of teen well-being, regardless of social media use, with a magnitude nearly three times as large as the association between social media use and poor mental health. Teens who reported high quality peer relationships were more likely to experience positive mental health, while teens who reported poor quality relationships were more likely to report worse mental health, even at similar levels of social media use.

What was the study's impact?

The study highlights the importance of improving the quality of peer relationships rather than merely limiting social media use to enhance teens’ mental health.

Who was involved?

The study included 963 teens aged 13 to 18 from three ECHO Cohort Study Sites across the United States.

What happened during the study?

Teens ages 13 to 18 reported how much time they spend on social media and whether they use it actively (like posting and commenting) or passively (like scrolling and browsing). Researchers used the PROMIS® assessment tools and the Strengths and Difficulties Questionnaire to measure teens’ mental well-being, including life satisfaction, sense of purpose, symptoms of depression, and the quality of their friendships.

What happens next?

Studying social media use and mental health over the course of adolescence could help researchers better understand how these factors influence each other throughout this sensitive stage of development. Future research could also focus on finding ways to strengthen peer relationships to support teens' mental health.

Where can I learn more?

Access the full journal article, titled “Adolescent social media use and mental health in the Environmental influences on Child Health Outcomes (ECHO),” in the Journal of Adolescent Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 5, 2025

Download this summary

Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

<< Back to Research Summaries

ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

Authors: Monique Hedderson, Assiamira Ferrara, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Nearly one-third of children in the U.S. have overweight or obesity, putting them at risk of adverse health outcomes later in life. More research is needed to inform prevention strategies during critical periods of growth, including pregnancy. This study aimed to understand the association between diet quality during pregnancy and infant growth. Rapid growth from birth to 24 months has been identified as a strong predictor of obesity later in life. ECHO researchers looked at how a mother’s nutrition during this crucial period of development might influence the baby’s size at birth and their growth over time.

What were the study results?

Researchers used two indexes to measure healthy eating patterns: the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP). These scales measure how well foods in a person’s diet align with the U.S. Dietary Guidelines and the diet’s inflammatory potential, respectively. Expectant mothers with higher HEI scores were more likely to have babies with a healthy birthweight and fewer growth issues. Specifically, higher HEI scores were associated with a 12% lower chance of having a baby born large for gestational age (LGA) and a lower chance of rapid growth from birth to 6 months and birth to 24 months. By contrast, a lower score on the EDIP, indicating a less inflammatory diet, was associated with a 24% higher chance of LGA and slower growth to 6 months but faster growth from birth to 12 months. This association was less clear and warrants further study.

What was this study's impact?

The study's findings support the idea that a prenatal diet aligning with U.S. Dietary Guidelines, measured by the HEI, may promote healthy birthweight and infant growth through 24 months. The findings suggest that following USDA dietary guidelines during pregnancy may improve long-term infant growth. This highlights the need for programs or interventions to help pregnant individuals adopt healthy diets.

Who was involved?

The study included 2,854 mother-child pairs from eight ECHO Cohort Study Sites. Among the children, 48.7% were girls, 23.3% were White, 22.4% were Black, 35.8% were Hispanic, 7.8% were Asian, and 7.8% came from other racial backgrounds.

What happened during the study?

The study examined data from mothers and their children in eight different groups that were part of the ECHO Program between 2007 and 2021. Researchers used medical records and study weight and height measurements to track the babies' sizes and growth over time. The mothers' diets during pregnancy were evaluated to calculate HEI and EDIP scores. The study then explored how these diet patterns were associated with babies' size at birth and their growth up to 6, 12, and 24 months old.

To assess rapid growth, the study relied on a measurement called the weight-for-length z-score (WLZ) a tool used to track an infant's growth, it compares a baby’s weight to their length, and tells you how far a baby's weight is from the average weight of babies of the same length. Rapid growth was defined as a significant increase in WLZ scores from birth to 6, 12, or 24 months. Babies whose WLZ scores jumped more than expected moved to a higher percentile on the growth chart, meaning they weighed more relative to their peers of the same length.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

More research is needed to understand the potential benefits of low-inflammatory prenatal dietary patterns in fetal and infant growth. Future studies could investigate how an infant's appetite and feeding habits might influence the connection between a mother's diet during pregnancy and the baby's long-term growth.

Where can I learn more?

Access the full journal article, titled “Prenatal Diet and Infant Growth from Birth to Age 24 months,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published November 21, 2024

Read the associated press release.

Download this summary

ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

<< Back to Research Summaries

ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

Authors: Rachel Vecchione, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Diet during pregnancy plays a major role in fetal development. Prior research has shown associations between several dietary factors and certain neurodevelopmental conditions in children, including autism spectrum disorder (ASD). ASD is a neurodevelopmental condition that affects social communication and behaviors, and presents in a wide variety of behaviors, abilities, and challenges.

This study helped to fill gaps in understanding the relationship between maternal dietary patterns during pregnancy and ASD-related outcomes in children. Most previous studies examining links between prenatal diet and ASD and other neurodevelopmental outcomes have focused on individual foods or nutrients, rather than overall dietary patterns. Dietary patterns may be useful to examine because they summarize the usual intake of a wide range of foods and may capture combined effects across many nutrients. Dietary patterns that capture the intake of recommended foods may also help to provide clearer communication than summaries across individual nutrients. This study therefore aimed to provide a comprehensive assessment by examining several established dietary patterns and their associations with ASD-related traits and diagnoses.

What were the study results?

Dietary patterns examined in this study included the Healthy Eating Index (HEI) and the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P), as well as the Empirical Dietary Inflammatory Index (EDIP). Both the HEI and AHEI-P are validated dietary patterns that are measures of overall diet quality. Higher scores on these patterns indicate better adherence to dietary guidelines. In contrast, higher scores on the EDIP indicate a more pro-inflammatory diet.

The study found that higher prenatal scores on the HEI the AHEI-P were associated with modest decreases in ASD-related traits. However, there were no significant associations between prenatal intake of these dietary patterns and ASD diagnosis. The findings suggest that while there may not be strong associations between prenatal dietary patterns and ASD diagnosis itself, there may be subtle associations with broader traits like social communication difficulties that warrant further investigation.

What was the study's impact?

This study contributes to the understanding of how prenatal diet may relate to ASD-related characteristics in children. It also highlights the need to further study the potential mechanisms linking prenatal diet to ASD-related traits and to consider broader dietary patterns in addition to individual nutrients and foods.

Who was involved?

The study included 6,084 mother-child pairs from 14 ECHO Cohort Study Sites. The participants were socioeconomically and demographically diverse, drawn from a large U.S.-wide sample, including general population sites and sites with a higher chance of ASD occurring in families.

What happened during the study?

Researchers collected data from individual sites that used Food Frequency Questionnaires to assess diet during pregnancy and enable the calculation of dietary patterns. The study examined associations between three dietary patterns and ASD-related outcomes while adjusting for potential confounding factors such as maternal age, pre-pregnancy BMI, sociodemographic factors, and child characteristics.

What happens next?

Future studies could help researchers confirm the results of this study and explore the subtle associations between prenatal diet and ASD-related traits. Further research could also examine multiple ASD-related outcomes, using larger and more diverse samples, and investigate potential mechanisms linking prenatal diet to ASD-related traits.

Where can I learn more?

Access the full journal article, titled “Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental influences on Child Health Outcomes Consortium,” in Nutrients.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published November 6, 2024

Read the related research alert.

Download this summary

ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis