ECHO Study Finds No Association Between Arsenic Exposure and Birth Outcomes

Authors: Jonathan Lewis, Emily A. Knapp, Amii M. Kress, 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?

Arsenic is a naturally occurring, toxic chemical that can be present in groundwater and surface water. Drinking water, as a result, is one of the most common ways people are exposed to arsenic in the U.S. and globally. There have been a limited number of small studies of the association between arsenic and birth outcomes, mostly outside of the U.S. In this study, ECHO researchers examined a diverse group of pregnant participants from across the country to determine if birth outcomes—birth weight, gestational age at birth, preterm birth, and size at birth—are influenced by arsenic concentrations that are above regulatory action levels.

What were the study results?

Researchers found that low birth weight, gestational age at birth, preterm birth, and birth size were not associated with potential exposure to arsenic among pregnant women living in a county with active arsenic level violations. There was a statistically significant increase in birth weight among infants whose mother’s experienced continuous exposure (from three months before conception through birth) compared with infants from areas without violations.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was this study's impact?

Overall, drinking water violations for arsenic that could indicate the presence of the chemical above regulatory action levels are relatively uncommon. Researchers captured proxy exposure using residential history arsenic violations from the preconception period throughout pregnancy, a time when environmental influences could disrupt fetal growth.

Who was involved?

The study included over 15,000 mother-child pairs at 51 ECHO Cohort Study Sites across the United States. The children were born in 2006 or later, as the U.S. Environmental Protection Agency (EPA) changed the enforceable standard for arsenic concentrations in drinking water to 10 parts per billion during that year. Only 794 participants experienced arsenic violations.

What happened during the study?

Researchers grouped pregnant participants based on where they lived three months before conception and during pregnancy. Within those areas, investigators determined which public water systems had violations for arsenic. Then they looked at how living in a county with an arsenic violation might affect birth outcomes.

What happens next?

Future research could better identify ECHO participants’ exposure to arsenic by considering other sources of drinking water (e.g., bottled or filtered water) and exposure to arsenic in foods.

Where can I learn more?

Access the full journal article, titled “Associations Between Area-Level Arsenic Exposure and Adverse Birth Outcomes: An ECHO-Wide Cohort Analysis,” in Environmental Research.

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

Published November 1, 2023

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ECHO Study Finds No Association Between Arsenic Exposure and Birth Outcomes

ECHO Cohort Researchers Find Association Between Some Prenatal Chemical Exposures and Postpartum Depression

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ECHO Cohort Researchers Find Association Between Some Prenatal Chemical Exposures and Postpartum Depression

Authors: Melanie Jacobson, 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?

Postpartum depression affects up to 20% of new mothers, making it the most common pregnancy complication to occur after delivery. Postpartum depression can impact a mother’s daily functioning, quality of life, and long-term health. Furthermore, it is associated with poor mother-child attachment, which can impact child health and development.

Factors like genetics and stress can make some people more likely to experience postpartum depression, but researchers are still trying to understand how synthetic chemicals might also play a role. Chemicals such as phenols, phthalates, and parabens can be found in plastics and personal care products. While these chemicals are nonpersistent, meaning that they don’t linger in the environment, their presence is widespread due to frequent exposure through diet, absorption through skin, and inhalation. The investigators in this study wanted to examine the extent to which exposure to these chemicals might be associated with postpartum depression symptoms.

What were the study results?

Prenatal phthalate concentrations were associated with increased odds of slightly higher postpartum depression scores, and the condition was observed to be more likely in people who were Hispanic, had lower education levels, and had prenatal depression.

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 was the study's impact?

Of the many synthetic chemicals investigated, only prenatal phthalate concentrations were associated with increased odds of postpartum depression. This suggests that finding ways to reduce prenatal exposure to phthalates might reduce the frequency of postpartum depression.

Who was involved?

Researchers used data from 2,174 pregnant individuals across five study sites. This information included data on urinary chemical concentrations from at least one point during the pregnancy and a self-reported postnatal depression assessment between two weeks and 12 months after delivery.

What happened during the study?

Researchers measured the concentrations of nonpersistent chemicals in urine samples. Researchers also collected, between two weeks and 12 months after delivery, data using self-reported postnatal depression assessments completed by the same individuals. Screening instruments indicated the presence or absence of postnatal depressive symptoms. Data was then harmonized to the Patient-Reported Measurement Information System (PROMIS) Depression scale.

What happens next?

While this is believed to be the largest study to-date examining the effects of environmental chemicals on postpartum depression, future studies are needed to replicate this research with larger sample sizes in diverse populations.

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to nonpersistent environmental chemicals and postpartum depression,” in JAMA Psychiatry.

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

Published September 20, 2023

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ECHO Cohort Researchers Find Association Between Some Prenatal Chemical Exposures and Postpartum Depression.

ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

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ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

Authors: Sheena Martenies, 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?

There is growing interest in understanding the combined effect of environmental hazards and social stressors on the health and development of children. While there are a number of tools for assessing the impact of environmental and social stressors, these tools can be limiting in the number of indicators they measure, the geographical area they cover, or the period of time they include for their observations. In this study, researchers developed a combined exposure index with national coverage that compiled available data on several environmental and social indicators during prenatal and early-life periods. This index is now being used to facilitate ECHO-wide analyses that consider multiple neighborhood-level exposures at the same time.

What were the study results?

The combined exposure index, which summarized exposures to multiple environmental hazards and social stressors at the neighborhood level, differed by region. The level of combined exposures were highest in the western and northeastern regions of the United States. Researchers also found that pregnant participants who identified as Black and Hispanic had higher exposures compared to White and non-Hispanic participants. Exposure values were also higher for pregnant participants with lower educational attainment.

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 was the study's impact?

The study analyzed how the combined exposure to several environmental hazards and social stressors during pregnancy may impact health. Researchers found that pregnant participants from minority groups were more likely to have higher exposures to these hazards. These results support findings from similar studies that suggest that neighborhood quality might influence maternal and child health outcomes, and may contribute to health disparities.

Who was involved?

This study included data from 14,072 pregnancies from 46 different ECHO research sites across the United States.

What happened during the study?

Researchers developed a combined exposure index using publicly available data on environmental hazards and social stressors. The data included variables such as air pollution, features of the built environment, and neighborhood socioeconomic status, and then estimated the likelihood of exposure to these variables for participants in the study, based on where they lived.

What happens next?

Researchers can use this exposure index in future studies to look at how neighborhood features influence child health outcomes. Future studies would benefit from national datasets for key environmental health concerns, such as water contaminants and pesticides, and social stressors that may disproportionally affect certain groups.

Where can I learn more?

Access the full journal article, titled “Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort,” in the International Journal of Environmental Research and Public Health.

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

Published July 10, 2023

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ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

Maternal PFAS Exposure During Pregnancy Increases Children’s Risk of Obesity

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Maternal PFAS Exposure During Pregnancy May Increase Children’s Risk of Obesity

Authors: Yun Liu, Joseph Braun, et al.

Who sponsored this study?

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

Why was this study needed?

Per- and polyfluoroalkyl substances (PFAS) are long-lasting chemicals that can be found in many household materials, as well as food and drinking water. Maternal PFAS exposure during pregnancy may be linked to increased weight and a higher risk of obesity among children and adolescents. However, existing studies looking at these associations have had inconsistent findings.

What were the study results?

The study found that higher levels of some PFAS were linked with slightly higher BMIs in children and an increased risk of obesity. This trend was seen across male and female children and wasn’t affected by the presence of other factors linked to childhood obesity.

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 was this study's impact?

Recently, there has been growing interest in understanding the effects of PFAS exposure on children’s health and establishing policies to address PFAS pollution. The US Environmental Protection Agency (EPA) has created a Roadmap to address PFAS contamination. Studies like this one can help better understand the risks of PFAS to take effective actions to protect vulnerable populations.

Who was involved?

The researchers used data from 1,391 children between the ages of 2 and 5 years and their mothers who were enrolled in eight ECHO cohorts across United States from 1999 to 2019.

What happened during the study?

The researchers measured levels of seven different PFAS in maternal blood samples collected during pregnancy. The researchers also used data on children’s weight and height to calculate each child’s body mass index (BMI), an approximate measure of body fat.

What happens next?

Future studies are needed to examine potential links between maternal PFAS exposure during pregnancy and obesity-related health concerns in older children.

Where can I learn more?

Access the full journal article, titled “Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI Z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts,” in Environmental Health Perspectives.

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

Published June 7, 2023

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Maternal PFAS Exposure During Pregnancy May Increase Children’s Risk of Obesity

ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

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ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

Authors: Liz Conradt, et al.

Who sponsored this study?

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

Why was this study needed?

Little is known about how a pregnant mother’s exposure to multiple substances, like tobacco, alcohol, or opioids, during pregnancy may be associated with outcomes for their children when they reach middle childhood. Most research looks at the effects of single-substance exposures or focuses on the effects of prenatal exposures on the child’s health exclusively during birth or early childhood. In this study, the research team evaluated the effects of prenatal exposure to multiple substances (alcohol, tobacco, marijuana, and opioids) on children’s reasoning skills and behavior during middle childhood.

What were the study results?

The team identified two groups of children based on their reasoning skills and problem behavior scores. Group 1 had average verbal reasoning skills, average spatial reasoning skills, and normal levels of problem behavior. Children in this group were exposed to fewer substances before birth. Group 2 included children with multiple substance exposures before birth. This group had below average verbal reasoning skills, but average spatial reasoning skills, and higher levels of problem behavior. Children in Group 2 were significantly more likely to be exposed to tobacco before birth. The effects of tobacco exposure on problem behavior and reasoning skills were stronger than expected.

What was the study's impact?

This study suggests that children exposed to tobacco and other substances before birth may be at increased risk for problem behaviors and lower verbal reasoning skill scores during middle childhood. These findings will help pediatricians identify children who are at risk for behavior problems and poorer reasoning skill scores. If replicated, this information might help pregnant women and their doctors to recognize how prenatal tobacco, especially in the context of other substance exposure, might affect their child’s verbal reasoning and behavior in middle childhood.

Who was involved?

This study involved pairs of mothers and their biological children. There were 256 mother-child pairs from two ECHO research sites with locations in Rhode Island, Minnesota, Washington, California, and New York. Children were ages six to 11 at the time of the behavioral and reasoning skills assessments.

What happened during the study?

Researchers collected data on prenatal exposure to substances including alcohol, tobacco, marijuana, and opioids. When the children were between six and 11 years old, their caregivers reported on the presence of problem behaviors such as aggression and anxiety. The researchers also collected data on problem solving skills with words, pictures, and diagrams (verbal and nonverbal reasoning).

What happens next?

Moving forward, the team wants to improve their measures of prenatal substance exposure and expand their sample size to include more ECHO participants. Grouping children that have been exposed to substances prenatally can help identify subgroups of children at risk for problem behaviors and low reasoning skill scores.

Where can I learn more?

The Center for Parenting and Opioids and National Institute on Drug Abuse have additional helpful resources.

The full journal article, titled “Prenatal Substance Exposure: Associations with Neurodevelopment in Middle Childhood” is published in the American Journal of Perinatology.

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

Published May 10, 2023

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ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

“Eat, Sleep, Console” approach shown to be more effective in caring for newborns with neonatal opioid withdrawal syndrome

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“Eat, Sleep, Console” approach shown to be more effective in caring for newborns with neonatal opioid withdrawal syndrome

Author(s): Leslie Young, Lori Devlin, Stephanie Merhar, et al.

Who sponsored this study?

This clinical trial is a collaboration between the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program and the NIH’s Eunice Kennedy Shriver Institute of Child Health and Human Development (NICHD), funded through the NIH Helping to End Addiction Long-term® Initiative (HEAL).

What were the study results?

Researchers found that the “Eat, Sleep, Console” (ESC) care approach is more effective for the treatment of infants with neonatal opioid withdrawal syndrome (NOWS) than usual approaches to care. ESC focuses on care without the use of medications, and includes holding, swaddling, and rocking the baby in a quiet, calm environment.

In this clinical trial, infants cared for with ESC were medically ready for discharge after an average of 8.2 days, whereas infants cared for with usual approaches were medically ready for discharge after 14.9 days. That means that babies were, on average, able to go home 6.7 days sooner. Newborns cared for with ESC were also 63% less likely to receive medication as part of their treatment (19.5% in the ESC group received opioid therapy, compared to 52% in the Finnegan Neonatal Abstinence Scoring Tool [FNAST] group). Safety outcomes at three months of age were similar between both groups.

What was the study's impact?

Newborns exposed to opioids before birth may develop symptoms of NOWS. These symptoms may include tremors, excessive crying and irritability, and problems with sleeping and feeding. In the United States, at least one newborn is diagnosed with NOWS every 24 minutes. There has not previously been strong evidence to support a standard approach to the care of babies with NOWS, and medical care for these babies has varied widely across hospitals.

This study gives hospitals an evidence-based approach to care for babies with NOWS. Compared with usual care using traditional scoring approaches, the ESC care approach substantially shortens the time infants spend in the hospital. The ESC approach has also been shown as safe as usual care approaches after discharge through early infancy.

Why was this study needed?

Hospitals have different approaches for caring for these babies. They often use FNAST to assess newborns with NOWS. The FNAST is an extensive scoring system that assesses signs of withdrawal in more than 20 areas. Concerns have been raised about its subjectivity and overestimation of the need for opioid medication.

The ESC care approach was developed about eight years ago and is growing in popularity in some nurseries, but this method had not previously been rigorously tested. ESC assessments are centered on an infant’s ability to eat, sleep and be consoled without the introduction of medications, and this approach keeps mother and baby together, empowering families to play a larger role in the care of their infants. However, the widespread adoption of ESC without solid evidence of its effectiveness and safety has raised concerns about potentially undertreating infants or discharging them too early. This study tested the extent to which ESC might be a better way to care for babies with NOWS.

Who was involved?

The study examined the hospital outcomes of a diverse group of 1,305 opioid-exposed infants from 26 hospitals across the U.S. The study is part of the Advancing Clinical Trials in Neonatal Opioid Withdrawal (ACT NOW) Collaborative, which brings together two existing pediatric research networks: the NICHD Neonatal Research Network and the ECHO Program’s Institutional Development Award (IDeA) States Pediatric Clinical Trials Network (ISPCTN).

What happened during the study?

The researchers randomized 26 hospitals to transition from FNAST-based care to the ESC care approach at different times. They then evaluated each method based on how soon infants were ready to leave the hospital and whether infants were treated with opioid medication to manage their symptoms.

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 healthcare without first consulting your healthcare professional.

What happens next?

The researchers will continue to follow up with a subset of the participating infants for two more years to see if the ESC approach has any effect on infant and family well-being.

Where can I learn more?

Access the full journal article, titled “Eat, sleep, console approach versus usual care for neonatal opioid withdrawal,” in the New England Journal of Medicine.

Learn more about this clinical trial and the NIH Helping to End Addiction Long-term^® Initiative on the NIH HEAL Initiative^® website.

The content is the responsibility of the authors and does not necessarily represent the official views of the NIH.

Access the associated article.

Published: April 30, 2023

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“Eat, Sleep, Console” approach shown to be more effective in caring for newborns with neonatal opioid withdrawal syndrome

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How does prenatal opioid exposure affect child outcomes?

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Authors: Ruby H.N. Nguyen, Monica McGrath, et al.

Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Author(s): Stephanie Merhar, Songthip Ounpraseuth, Lori Devlin, et al.

Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

Author(s): Leslie Young, Zhuopei Hu, Robert Annett, et al.

The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

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ECHO Study Suggests Exposure to PFAS During Pregnancy May Be Linked to Lower Birthweights

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ECHO Study Suggests Exposure to PFAS During Pregnancy May Be Linked to Lower Birthweights

Authors: Amy Padula, Tracey Woodruff, et al.

Who sponsored this study?

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

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

What were the study results?

PFAS were found in almost all participants in the study. Researchers also found that in this study, participants with higher levels of PFAS exposure were more likely to have babies born with lower birthweight. These results did not find that stress played a role in the relationship between PFAS exposure and birthweight.

What was this study's impact?

The results of this study suggest that PFAS exposure during pregnancy is associated with lower birthweight in infants. However, outside of research studies, pregnant women are not usually tested for PFAS and are often unaware of their potential harms despite PFAS exposure from the environment being common. Therefore, it is important to address efforts to reduce and prevent further exposure to PFAS. Researchers need to better understand where people are most likely to be exposed to these chemicals given the wide range of exposure sources, from PFAS contamination in water to PFAS used in certain consumer products.

Why was this study needed?

It is important to know what the effects of per- and polyfluoroalkyl substances (PFAS) exposures may be on child and maternal health. This study is the largest of its kind and includes participants from across the US to help inform future research related to potential effects of PFAS exposures.

Who was involved?

This study included eleven ECHO pregnancy cohorts with a total of 3,339 participants from several states.

What happened during the study?

The researchers measured the concentration of PFAS, chemicals used in a wide range of consumer products, in the blood of pregnant women. They also surveyed these women about their stress levels throughout pregnancy. These measurements occurred over the past 20 years. The researchers then compared the birthweight for babies resulting from these pregnancies and recorded any instances of preterm birth.

What happens next?

The next step for researchers is to examine potential sources of PFAS exposures, including exposures from drinking water and consumer products. Future studies within ECHO may also examine how body mass index and preexisting conditions, such as diabetes during pregnancy or high blood pressure, may interact with PFAS exposures and contribute to the effects of PFAS on infant birthweight. Future studies may also examine additional chemicals that could contribute to lower birthweight in infants.

Where can I learn more?

The US Environmental Protection Agency (EPA) created a Roadmap to protect people and communities from PFAS contamination.

Access the full journal article, titled “Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental influences on Child Health Outcomes (ECHO) Program” in Environmental Health Perspectives.

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

Published March 15, 2023

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ECHO Study Suggests Exposure to PFAS During Pregnancy May Be Linked to Lower Birthweights

The Influence of Opioid Use Disorder Medications During Pregnancy on the Severity of Neonatal Opioid Withdrawal Syndrome

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The Influence of Mediators on the Relationship Between Antenatal Opioid Agonist Exposure and the Severity of Neonatal Opioid Withdrawal Syndrome

Author(s): Lori A. Devlin, Zhuopei Hu, Songthip Ounpraseuth, Alan E. Simon, Robert D. Annett, Abhik Das, Janell F. Fuller, Rosemary D. Higgins, Stephanie L. Merhar, P. Brian Smith, Margaret M. Crawford, Lesley E. Cottrell, Adam J. Czynski, Sarah Newman, David A. Paul, Pablo J. Sánchez, Erin O. Semmens, M. Cody Smith, Bonny L. Whalen, Jessica N. Snowden, Leslie W. Young

Why was this study conducted?

Opioid use disorder is a treatable disease that can be managed with medicine for opioid use disorder (MOUD). This type of treatment is recommended for pregnant individuals by healthcare professionals to improve pregnancy and newborn outcomes.

Babies who were exposed to opioids during pregnancy may develop signs of neonatal opioid withdrawal syndrome (NOWS), including tremors; excessive crying and irritability; and problems with sleeping and feeding. This study looked at how MOUD use during pregnancy influenced the severity of NOWS symptoms.

What was done?

Data were collected from the medical records’ of 1294 opioid-exposed infants born at or cared for in 30 U.S. hospitals between July 2016 and June 2017. There were 859 infants exposed to MOUD (methadone or buprenorphine) and 435 infants exposed to opioids other than MOUD. We looked to see if infants needed medication to treat NOWS and how long they stayed in the hospital.

What was found?

The results suggest that exposure to MOUD (buprenorphine or methadone) during pregnancy increased the severity of NOWS. Infants exposed to MOUD were two times more likely to need an opioid medication to treat withdrawal. They also remained in the hospital 1.7 days longer than infants not exposed to MOUD. Some factors that reduced the severity of NOWS in infants treated with MOUD were adequate prenatal care, exposure to a single type of opioid, and not being exposed to other mood-changing drugs simultaneously. These factors also decreased the likelihood that infant would need opioid medicine to treat their NOWS symptoms and shortened their hospital stay. Infants exposed to buprenorphine instead of methadone had a shorter length of hospital stay and needed less treatment with opioid medication.

What do the results mean?

Medical experts recommend that pregnant women with an opioid use disorder use MOUD for healthier pregnancies. MOUD can reduce the chances of pregnancy loss, premature birth, infection, and poor growth of the infant. However, using MOUD may be related to increases in the severity of NOWS. Learning more about how MOUD affects the severity of NOWS can help doctors improve the health of mothers using MOUD and their babies. These results also suggest that adequate prenatal care can help improve pregnancy and birth outcomes, and highlight the importance of identifying barriers to receiving sufficient prenatal care as an opportunity to improve infant outcomes.

Who sponsored the study?

This research was supported by the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health.

Appreciation:

We deeply appreciate the doctors, nurses, and hospitals that participated in the study and helped identify and extract information from the required medical records. Their enthusiastic collaboration made this study possible.

You may learn more about this publication here: https://link.springer.com/article/10.1007/s10995-022-03521-3

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

Published: March 11, 2023

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The Influence of Mediators on the Relationship Between Antenatal Opioid Agonist Exposure and the Severity of Neonatal Opioid Withdrawal Syndrome

Read Related Research Summaries

“Eat, Sleep, Console” approach shown to be more effective in caring for newborns with neonatal opioid withdrawal syndrome

Author(s): Leslie Young, Lori Devlin, Stephanie Merhar, et al.

How does prenatal opioid exposure affect child outcomes?

Author(s): Elisabeth Conradt, Sheila Crowell and Barry Lester

Understanding characteristics associated with opioid use during pregnancy

Authors: Ruby H.N. Nguyen, Monica McGrath, et al.

Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Author(s): Stephanie Merhar, Songthip Ounpraseuth, Lori Devlin, et al.

Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

Author(s): Leslie Young, Zhuopei Hu, Robert Annett, et al.

The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

Author(s): Jessica Snowden, Akshatha, Robert Annett, et al.

ECHO Researchers Investigate Whether Prenatal Chemical Exposures Affect the Development of Autism-related Traits in Children

Posted on January 26, 2023October 25, 2024 by Jodi Snare

Collaborative ECHO research led by Jennifer Ames, PhD of the Kaiser Permanente Northern California Division of Research and Ghassan Hamra, PhD of Johns Hopkins Bloomberg School of Public Health, investigates whether exposures to per- and polyfluoroalkyl substances (PFAS) during pregnancy were associated with the development of autism-related traits in children. The researchers looked at data from 1,224 mother-child pairs and found that prenatal exposure to one specific PFAS chemical, perfluorononanoic acid (PFNA), may be associated with an increase in autism-related traits in children. Prenatal exposure to the mixture of all PFAS chemicals combined was not associated with increased autism-related traits in children. This research, titled “Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes,” is published in Epidemiology.

PFAS are widely used, long lasting chemicals, the components of which break down very slowly over time. Previous studies that have investigated the association between prenatal PFAS exposure and childhood autism spectrum disorder (ASD) have been inconsistent and mostly involved small sample sizes. This study leveraged the large, diverse ECHO-wide cohort to evaluate how prenatal PFAS exposure affects the development autism-related traits, even when a child does not receive a clinical ASD diagnosis.

This study included children born between 2011 and 2018 from 10 racially and ethnically diverse ECHO cohorts across the United States, including one cohort that enrolls children from families with an increased likelihood of ASD. The researchers measured the levels of eight different PFAS in blood samples collected from mothers during pregnancy. Later, when their children were aged 2.5 years or older, researchers asked caregivers to report on their child’s autism-related traits using a questionnaire called the Social Responsiveness Scale (SRS). The research team tracked the associations between these data to examine child SRS scores in relation to each individual PFAS as well as the combination of the PFAS.

“In the U.S. population, exposures to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) have dropped substantially since the industry voluntarily phased out these chemicals in the early 2000s,” said Dr. Ames. “However, other PFAS exposures have increased over time, including thousands with unknown toxicity. These so-called ‘forever chemicals’ continue to pose risks to health even after they are phased out because they persist in the environment and inside people’s bodies and don’t break down easily.”

These results underscore the need for more research on whether PFAS chemicals might have more significant effects on child neurodevelopment, and whether factors such as genetics, underlying health conditions, or nutritional status may change the effect of PFAS exposure on brain development.

Read the research summary.

ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children

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ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children

Authors: Jennifer Ames, Ghassan Hamra, et al.

Who sponsored this study?

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

What were the study results?

The researchers found that prenatal exposure to one specific PFAS chemical, perfluorononanoic acid (PFNA) may be associated with an increase in autism-related traits in children. Prenatal exposure to the mixture of all PFAS chemicals combined was not associated with increased autism-related traits in children.

What was the study's impact?

This study draws attention to the potential risks of PFAS chemicals on child neurodevelopment. In the U.S., exposures to some specific PFAS, such as PFOA and PFOS, have dropped substantially since the industry voluntarily phased these chemicals out in the early 2000s. However, other PFAS exposures have increased over time, including thousands of these substances with unknown toxicity. These so-called “forever chemicals” continue to pose risks to health even after they are phased out because they persist in the environment and inside people’s bodies and don’t break down easily. While the estimated effects of PFAS chemicals on child autism-related traits are relatively small in this study, future studies may investigate whether early childhood exposure to PFAS chemicals are associated with effects on other neurodevelopmental outcomes.

Why was this study needed?

Per- and polyfluoroalkyl substances (PFAS) are widely used, long lasting chemicals, the components of which break down very slowly over time. Previous studies looking at associations between prenatal PFAS exposure and childhood autism spectrum disorder (ASD) are inconsistent and mostly conducted in small sample sizes. The objective of this research was to determine whether blood concentrations of PFAS during pregnancy were linked to the development of autism-related traits in children. The researchers in this study were able to examine this question by continuously measuring the development of autism-related traits in a large number of children across the U.S, independently of whether a child received a clinical ASD diagnosis.

Who was involved?

The participants of this study included 1,224 mother-child pairs from ten cohorts across the United States. The participants were geographically, racially, and ethnically diverse, and one of the cohorts included families with an increased genetic likelihood of ASD. Most of the participating children were born between 2011 and 2018.

What happened during the study?

The researchers measured the levels of eight different PFAS in blood samples collected from mothers during pregnancy. Later, when their children were aged 2.5 years or older, researchers asked caregivers to report on the child’s autism-related traits using a questionnaire called the Social Responsiveness Scale (SRS). The research team tracked the relationship between child SRS scores and prenatal exposure to each individual PFAS as well as the combination of the eight PFAS.

What happens next?

Additional research is needed to continue studying the effect of early life exposure to PFAS on child neurodevelopment, including cognition, attention, and other neurobehaviors. Future studies can also investigate whether biological sex and other factors—such as genetics, underlying health conditions, and nutritional status—may change the effect of PFAS exposure on brain development.

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes,” in Epidemiology.

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

Published January 12, 2023

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ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children