ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Authors: Claudia Lugo-Candelas, Tse Hwei, Seonjoo Lee, Cristiane Duarte, 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?

Sleep difficulties are common in pregnancy. Poor prenatal sleep may relate to negative outcomes for both parent and child, including pregnancy complications and certain birth outcomes. The impact of poor prenatal sleep may also extend beyond pregnancy and birth and may increase the risk for neurodevelopment disorders in offspring, particularly attention-deficit/hyperactivity disorder (ADHD).

In this study, ECHO researchers aimed to study potential associations between poor prenatal sleep and an increased risk of ADHD symptoms and sleep problems in offspring.

What were the study results?

Prenatal sleep quality and duration, particularly in the second trimester, appeared related to children’s risk for ADHD, emotional reactivity, and sleep problems at age 4. Longer sleep duration in the second trimester was associated with fewer ADHD symptoms in children. Poorer sleep quality scores in the second trimester were associated with greater offspring ADHD symptomatology. Shorter duration and poorer quality of sleep during the second trimester were also associated with more sleep difficulties in children.

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 the study's impact?

This study extends prior work by examining the associations between self-reported prenatal maternal sleep health and offspring ADHD symptoms in early childhood in a large, socio-demographically diverse sample in the U.S., including Puerto Rico.

Who was involved?

The research team used data from 794 mother-child pairs across five ECHO research sites. All enrolled pairs with available prenatal sleep and offspring ADHD assessments before age seven were included. The pregnant participants were between 27 and 37 years old.

What happened during the study?

Pregnant participants reported on their sleep during pregnancy using self-report questionnaires and reported on children's symptoms and behaviors when children were between 3 and 5 years old. The study assessed the children’s ADHD symptoms and associated characteristics using the Child Behavior Checklist Preschool Version, a widely used parent report that measures behavior problems in children.

What happens next?

Future studies are needed to replicate these findings, as well as investigate the possible mechanisms. Poor sleep may impact inflammation in pregnancy and offspring development, but studies have not examined that association.

Where can I learn more?

Access the full journal article, titled “Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: A prospective analysis of timing and sex differences in the ECHO Cohort,” in The Lancet Regional Health - Americas.

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

Published October 9, 2023

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

ECHO Research Identifies Variety of Low-calorie, Nutrient-rich Foods for Optimal Prenatal Nutrition

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ECHO Research Identifies Variety of Low-calorie, Nutrient-rich Foods for Optimal Prenatal Nutrition

Authors: Katherine Sauder, Catherine Cohen, 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 the study needed?

Most pregnant women in the U.S. are at risk of not getting enough of nutrients like vitamin A, vitamin D, folate, calcium, iron, and omega-3 fatty acids from foods alone. Previous ECHO Cohort research found that only one prenatal supplement available in the U.S. may give pregnant women the optimal amounts of each of these six nutrients. However, that supplement costs $200 per month and requires the patient to take seven pills a day. Researchers in this study turned to diet to explore energy-efficient foods that could provide the right amounts of these nutrients for pregnant patients.

What were the study results?

Researchers in this study identified more than 2,300 low-calorie foods with enough of at least one of the six nutrients important in pregnancy, including many with reasonable serving amounts to avoid excessive intake. For instance, consuming an additional 0.2 cups of raw carrots could provide the optimal amount of vitamin A. An additional 2.6 cups of reduced-fat milk could provide the optimal amount of vitamin D. An additional 0.4 cups of edamame could provide the optimal amount of folic acid. An additional 1 cup of a nutritional drink or shake could provide the optimal amount of calcium. An additional 0.9 cups of multigrain cereal could provide the optimal amount of iron. An additional 0.1 cups of canned chicken could provide the optimal amount of omega-3 fatty acids.

However, no single food evaluated gave enough of all six nutrients. Seaweed (raw or cooked without fat) provided sufficient vitamin A, folate, calcium, iron, and omega-3s but would require consumption of more than 5 cups per day. Twenty-one other foods and beverages (mainly fish, vegetables, and beverages) provided target amounts of four of the six key nutrients. Few foods met targets for vitamin D or iron, suggesting that dietary supplements may be necessary to meet those nutrient needs. Other foods could be added in limited amounts to help meet intake targets without exceeding caloric recommendations or nutrient safety limits.

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 the study's impact?

Results highlight the difficulty in meeting nutritional requirements from diet alone and can inform pregnant women and their doctors about dietary changes and additional supplements that can improve nutrition during pregnancy. Pregnant women can focus on boosting prenatal intake of low-mercury fish, low-fat dairy, green and leafy vegetables, and fortified cereals to meet nutrient recommendations.

Who was involved?

This study included 2,450 pregnant participants from six ECHO Cohort Study Sites located across the U.S.

What happened during the study?

The researchers compared over 2,300 foods and beverages consumed in the U.S., focusing on the nutrients that are most important for maternal and infant health: vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids. ECHO researchers looked at foods and drinks that pregnant participants consumed during their pregnancies and then calculated how much of these six nutrients they were getting from their diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from foods to make up for the gaps in their diet.

What happens next?

Future research may focus on studying exactly how much of these nutrients are needed for pregnant women.

Where can I learn more?

Access the full journal article, titled “Identifying Foods that Optimize Intake of Key Micronutrients During Pregnancy" in The Journal of Nutrition.

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

Published September 27, 2023

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ECHO Research Identifies Variety of Low-calorie, Nutrient-rich Foods for Optimal Prenatal Nutrition

How Much Vitamin D do Children with Asthma and Increased Body Weight Need to Correct Low Vitamin D Levels?

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How much vitamin D do children with asthma and increased body weight need to correct low vitamin D levels?

Study title: Pharmacokinetics of Oral Vitamin D in Children with Obesity and Asthma

Author(s): Jason E. Lang, Rodrigo Gonzalez Ramirez, Stephen Balevic, Brian O’Sullivan, Scott Bickel, Christoph P. Hornik, J. Marc Majure, Saranya Venkatachalam, Jessica Snowden, Laura James

Why was this study conducted?

Among children with asthma, children who also have increased body weight for their height (body mass index (BMI) of ≥85 percentile) tend to have more severe asthma symptoms than their healthy weight peers. Children with asthma and increased body weight also tend to have lower vitamin D levels than other children. Helping children with asthma and increased body weight reach higher vitamin D levels may help their asthma symptoms by lowering inflammation in the lungs. However, there is not enough information on how much vitamin D children with asthma and increased body weight should take to safely raise their vitamin D levels.

What was done?

ECHO ISPCTN research teams in 15 states enrolled children ages 6‑18 years with asthma and increased body weight in a clinical trial. The children took vitamin D capsules for 16 weeks and gave blood samples every month so researchers could check their vitamin D levels. The goal of the study was to find a vitamin D dose that helped children raise their vitamin D levels in their blood to 40 ng/mL, a level that might lower inflammation.

There were two parts of the study. In the first part, children were split into four groups that each took one of four different doses of vitamin D to find a dose that raised children’s vitamin D levels over 16 weeks without causing side effects. All four dosing options were higher than what is usually recommended to raise vitamin D levels. Then, researchers compared the vitamin D dose from part 1 that raised vitamin D levels quickly and safely to the usually recommended daily vitamin D dose to confirm that the higher dose could safely help children reach vitamin D levels that may decrease inflammation. This study was approved by the Institutional Review Board and all participants consented to participate in the study.

What was found?

The first part of the study found that taking a 50,000 international units (IU) vitamin D dose on the first day of treatment and then an 8,000 IU vitamin D dose every day for 16 weeks was most effective at raising vitamin D levels safely. In the second part of the study, researchers confirmed that using this approach raised vitamin D levels in most children to the recommended level while avoiding undesired higher levels. In contrast, no children who followed the current standard-of-care dosing of 600 IU each day achieved the target vitamin D level sufficient to potentially reduce inflammation.

What do the results mean?

Most children with asthma and increased body weight who take vitamin D the vitamin D dose used in this study (50,000 IU vitamin D on day one, then 8,000 IU each day) can safely raise their vitamin D level in a short period of time. The newly determined dose is much greater than the typically recommended dose. This study shows how important it is that children and adolescents with increased body weight get enough vitamin D in their diet or in vitamin supplements every day since the higher the body weight, the faster vitamin D was processed and removed from the body. The results of this study may help children with asthma or other illnesses if having enough Vitamin D lowers inflammation.

Who sponsored the study?

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

Appreciation

All of the families in ECHO ISPCTN trials help study teams across the country learn more every day about how to bring rural and underserved families into research studies. This is critical to ensure that families that are not near large academic centers still get the benefits of research and that the “answers” research studies find are meaningful for children and families across all parts of the country, not just those who live in large cities.

You may learn more about this publication here: https://link.springer.com/article/10.1007/s40262-023-01285-9

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

Published: August 30, 2023

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How much vitamin D do children with asthma and increased body weight need to correct low vitamin D levels?

Read Related Research Summaries

What Are factors That Affect the Incidence Rate of Asthma With Recurrent Exacerbations in Children?

Authors: Rachel L. Miller; Christine C. Johnson, et al.

A Nationwide Study on How Childhood Asthma Relates to Obesity Development

Authors: Nikos Stratakis and Erika Garcia

General health and life satisfaction in children with chronic illness

Author(s): Courtney K. Blackwell, et al

ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Authors: Izzuddin Aris, et al.

Can Neighborhood Conditions Throughout Childhood Shape the Risk of Developing Asthma?

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Authors: Izzuddin Aris, 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?

Neighborhood conditions, such as access to housing, healthy food, transportation, and education centers, can contribute to the development of childhood asthma. Researchers often measure these conditions using the Child Opportunity Index and the Social Vulnerability Index, which link residential addresses at birth, infancy (age 0.5‒1.5 years), and early childhood (age 2.0‒4.8 years) to census-tract data about the opportunities and resources available in the surrounding neighborhood. Previous studies looking into this topic lacked geographic diversity or considered only specific socioeconomic aspects of neighborhood disadvantage, which may not fully capture the role of early-life experiences on health outcomes. This study examines the association of conditions and resources available in neighborhoods during different developmental stages with childhood asthma incidence.

What were the study results?

Living in a neighborhood with higher opportunity at birth, infancy, or early childhood was associated with lower asthma incidence when compared to living in a neighborhood with lower opportunity. Differences in sociodemographic characteristics, parental asthma history, or the number of births a mother had did not explain this effect.

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 impact?

Neighborhood conditions could help researchers identify vulnerable children who are at high risk for developing asthma. Policymakers, researchers, and community groups can use this information to guide decisions and interventions to improve the health of children and promote equitable opportunities across neighborhoods.

Who was involved?

This study used data from 10,516 children at 46 research sites participating in ECHO. The participants have at least one residential address from birth and a parent or caregiver report of a physician’s diagnosis of asthma.

What happened during the study?

Researchers linked participants’ residential addresses to the Child Opportunity Index and Social Vulnerability Index. They estimated asthma incidence rates associated with Child Opportunity Index or Social Vulnerability Index data for a child’s neighborhood at each life stage, adjusting for sociodemographic characteristics, maternal and paternal history of asthma, and the number of births a mother had.

What happens next?

Future studies can explore the impact of investing in early life health and environmental, social, and economic resources on improving health outcomes for children in disadvantaged neighborhoods. Follow-up studies can also focus on how these neighborhood-level factors are affecting asthma rates and how moving may alter asthma development.

Where can I learn more?

Access the full journal article, titled “Associations of Neighborhood Opportunity and Vulnerability with Incident Asthma Among U.S. Children in the ECHO cohorts,” in JAMA Pediatrics.

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

Published August 28, 2023

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Different Viruses that Cause Wheezing Illnesses Provide Limited Protection Against Each Other

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Different Viruses that Cause Wheezing Illnesses Provide Limited Protection Against Each Other

Authors: Yury Bochkov, James Gern, 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?

Rhinovirus (RV) is the most common virus detected in both mild and acute respiratory illnesses, such as the common cold and wheezing. While three species of rhinoviruses (A, B, and C) can cause upper respiratory illnesses, RV-A and RV-C are more likely to cause wheezing illnesses in preschoolers and in children and adults who have asthma. No specific vaccines for these viruses exist yet, in part because the large range of rhinovirus strains makes vaccine development difficult.

After a natural infection, neutralizing antibody responses develop in infected persons that help reduce the risk of illness on a second exposure. The goal of this study was to test whether RV-C infections are more likely than RV-A infections to induce long-lasting antibodies that can protect against other RV-C strains.

What were the study results?

Both RV-A and RV-C infections induced neutralizing antibody responses of similarly long durations but did not provide strong protection against each other. The researcher’s data analysis suggests that RV-C types are less likely than RV-A types to create a strong immune response against different virus strains. 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 the study's impact?

The results showed that while protective antibody responses to RV-C last for several years, they have only modest cross-protection that is limited to genetically similar viruses. These findings suggest that vaccines against RV-C might need to include many of the most common RV-C types to offer broad protection.

Who was involved?

Over 4,000 children were enrolled in 14 independent studies across Australia, Finland, and the United States. Study participants varied in age from 0 to 19 years and had RV-induced illnesses of varying severity. Some studies included participants with asthma, in addition to healthy participants.

What happened during the study?

Researchers tested whether RV-C infections cause protection against multiple RV-C types. Researchers analyzed samples collected between 1998 and 2019. Each of the 14 sites collected nasal samples that were analyzed for RV species and type. Data from 11 studies and 3,199 children included serial sampling for analysis across more than one RV illness. Many children in this study contracted a series of illnesses caused by various RV-A and RV-C types. The investigators examined the sequence of illnesses that children had experienced to understand which kinds of rhinovirus might provide protection against which other kinds of rhinovirus. Researchers also analyzed blood specimens to see whether RV-C infections are more likely to create antibodies to fight other rhinoviruses or produce antibody responses of longer duration than RV-A infections do.

What happens next?

Researchers want to determine why RV-C infections occur so frequently in preschool children, and why they are more likely to cause wheezing illnesses. These studies aim to help researchers design a practical RV-C vaccine that could protect high-risk children.

Where can I learn more?

Access the full journal article, titled “Rhinoviruses A and C Elicit Long-lasting Antibody Responses with Limited Cross-neutralization,” in the Journal of Medical Virology.

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

Published August 28, 2023

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ECHO Researchers Find Different Rhinoviruses Can Provide Limited Protection Against Each Other

ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

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ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

Authors: Maxwell Mansolf, 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?

Up to 50% of children and adolescents in the United States might experience sleep problems. Poor sleep can negatively affect brain development, learning, and physical and emotional well-being. Existing studies suggest there could be a link between poor sleep outcomes in children and teens and stress experienced by their caregivers, but these studies have primarily been limited to infants and young children. In this study, researchers used ECHO’s diverse data to study this association in school-age children and teens.

What were the study results?

Children of caregivers who reported feeling stress from their life circumstances were more likely to experience sleep disturbances. This association was consistent across different groups of child and caregiver pairs studied, even after accounting for mental and physical health conditions.

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 the study's impact?

This research suggests that children whose caregivers report increased perceived stress may be at higher risk for sleep issues. Screening for caregiver stress may help healthcare providers identify and plan interventions for children who may be at risk for sleep issues.

Who was involved?

The study included data from 2,641 children between ages 6 and 18 and their caregivers from 12 ECHO research sites. Most caregivers (78.6%) had at least some college education. About a third of the children (34.7%) had at least one mental health condition, and a quarter of the children (25%) had at least one physical health condition.

What happened during the study?

Researchers analyzed data provided by caregivers who completed the Perceived Stress Scale (PSS) about their own stress as well as the Child Behavior Checklist (CBCL), a common parent-reported child behavior survey, about their children’s emotional and behavioral well-being, including their sleep habits. The PSS is a widely used self-report survey that measures how much a person perceives their life as unpredictable, uncontrollable, and overloading over the previous month. To evaluate how caregiver stress affected child sleep patterns, researchers looked at responses to questions from the CBCL that addressed children’s experience with nightmares, insomnia, excessive sleep, troubled sleep, and ongoing tiredness.

What happens next?

Future sleep interventions may consider a more global approach to improving child and adolescent sleep health. Continued research on the factors that influence family health and well-being may guide interventions that address the entire family and the dynamics of the family relationship.

Where can I learn more?

Access the full journal article, titled “Caregiver Perceived Stress and Child Sleep Health: An Item-Level Individual Participant Data Meta-Analysis,” in the Journal of Child and Family Studies.

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

Published July 15, 2023

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ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

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ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

Authors: Matt Kasman, 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?

Health experts agree that sugar-sweetened drink consumption by children in the U.S. should be reduced but finding effective strategies has been a challenge. Large-scale interventions are costly and have shown limited effects. Computer modeling to explore what drives consumption in specific populations could lead to tailored strategies that yield better results.

What were the study results?

Through a computer simulation based on data collected over several years from thousands of real children, researchers found that limiting access to sugary drinks in the home could reduce childhood consumption by as much as 87%. Reducing sugar-sweetened drink availability at school and childcare facilities was also helpful. The amount of the reductions also varied between the groups of children simulated.

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 the study's impact?

This study highlights the importance of tailoring interventions to reduce sugar-sweetened drink consumption for different populations. Using computer models, researchers may gain more information about populations that can help to identify effective targeted interventions.

Who was involved?

This study examined data from children ages 2 to 7 years old in three ECHO research sites across the U.S. These children spent time in different environments as they grew—home, childcare, and school—where they had varying access to sugary beverages.

What happened during the study?

Researchers entered data based on children from three ECHO research sites into a computer model to recreate their sugar-sweetened beverage consumption. Based on the computer model, researchers simulated potential interventions and measured their impact on reducing consumption in different populations. Computer models can be affected by certain factors, including socioeconomic status, BMI, time spent in a specific setting, accessible beverages in the home, and access to a pediatrician.

What happens next?

In future studies, researchers plan to include older children and adjust computer models to explore the consumption of other foods and beverages with health implications.

Where can I learn more?

Access the full journal article, titled “Childhood Sugar-sweetened Beverage Consumption: An Agent-based Model of Context-specific Reduction Efforts,” in the American Journal of Preventive Medicine.

A summary of a previous study that applied computational modeling to a single ECHO research site can be found here.

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

Published July 13, 2023

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ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

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Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

Authors: Rachel L. Miller; Christine C. Johnson, 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?

While the prevalence of asthma has been reported widely in the United States and elsewhere, studies on childhood asthma incidence rates within specific populations and across various types of asthma and age ranges have been relatively sparse. Describing the incidence rates of ARE across various pediatric populations is a critical first step for identifying potential risk factors and causes.

What were the study results?

In this study, investigators wanted to gather more information about factors that influence the rates of childhood asthma with recurrent exacerbations (ARE)—a subtype of asthma where children experience frequent, severe episodes of asthma.

ARE incidence rates were highest among children ages 2-4 years old, and among non-Hispanic Black and Hispanic Black children. ARE rates were also higher among children living in the Northeast and Midwest compared to those living in the West. Children with a parental history of asthma had ARE rates 2.9 times greater compared to those with no parental history.

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 impact?

Higher incidence rates of ARE among young children, non-Hispanic Black and Hispanic Black children, and children living in the Northeast and Midwest suggest that differential environmental exposures may play a significant role in the onset of recurring asthma issues in children. ARE rates are consistently higher among children with a parental history of asthma, especially for young children, which may be due to a combination of genetic, environmental, and family lifestyle factors.

Who was involved?

The research team leveraged data from 17,246 children born between 1990 and 2017 who were enrolled in 60 ECHO research sites in the U.S. and Puerto Rico. Child participants or their caregivers reported whether and when the child had an asthma diagnosis and any oral corticosteroids prescribed from a health care provider. Incidence rates of ARE were based on reports of systemic (not inhaled) corticosteroid use.

Of the 4,114 children diagnosed with asthma during this study, there were 2,061 children with at least one asthma episode when they used oral steroid medication; 734 of these children had 2 or more asthma episodes with steroid medication use and met the conditions for ARE.

What happened during the study?

The researchers calculated the incidence rates of ARE for the study population as a whole, along with the rates for subsets of the population defined by the year of ARE diagnosis, the decade they were born, their age and sex, their race and ethnicity, their residence at birth, and their parents’ history of asthma. The researchers followed the children from birth until they developed ARE, reached the age of 20 years or the study period ended. The study identified children who developed ARE based on at least two reports of systemic steroid medication use at any time during the entire follow-up period. Children who received asthma diagnoses before age 5 years were required to have confirmation after 5 years, either by a parent or caregiver, adolescent self-report of asthma symptoms, hospitalization, emergency department or urgent care visit for asthma, provider visits due to asthma, or asthma medication use.

What happens next?

ECHO researchers are planning new studies that examine key early environmental exposures that could contribute to ARE, including viral respiratory tract infections, indoor allergens, environmental tobacco smoke, air pollution, stress, socioeconomic status, and where children live.

Where can I learn more?

Access the full journal article, titled “Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program,” in The Journal of Allergy and Clinical Immunology.

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

Published March 25, 2023

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Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

Authors: Jean Frazier, Michael O’Shea, 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?

Inflammation is a normal part of the body’s defense to injury or infection. The investigators in this study wanted to find out whether factors known to be linked with inflammation during pregnancy (such as socioeconomic conditions, environmental exposures, and maternal infections) might be associated with emotional, cognitive, and behavioral dysregulation in children after birth. “Dysregulation” in this context refers to children’s attention, anxiety and depression, and aggression being measurably different from what is typically expected for children of their age.

What were the study results?

In this study, several maternal risk factors correlated with inflammation (lower education attainment, pre-pregnancy obesity, prenatal infections, and prenatal tobacco use) were strongly associated with dysregulation in offspring.

Researchers used a tool called the Child Behavior Checklist (CBCL) to measure aggressive behavior, anxiety/depression, and attention problems in children. Approximately 13.4 % of children and adolescents in the study met the criteria for the CBCL Dysregulation Profile. More youth with dysregulation (35%) were born to mothers with prenatal infections compared with 28% of youth without dysregulation.

Some additional maternal factors, including being overweight before pregnancy, lower education attainment, and smoking during pregnancy, were associated with higher likelihoods of childhood dysregulation. Children and adolescents who had a parent or sibling with a mental health disorder were more likely to experience dysregulation. Having a mother with gestational diabetes had no significant association with child dysregulation.

What was the study's impact?

By providing information about how maternal inflammation and relevant risk factors may be associated with dysregulation in a mother’s offspring, this study can help inform interventions to improve child health outcomes.

Who was involved?

This study included 4,595 children and adolescents (ages 6-18 years) from 18 ECHO research sites across the United States.

What happened during the study?

This study assessed perinatal factors known to be related to maternal and neonatal inflammation.

ECHO researchers collected data on maternal factors before and during pregnancy, including information about infections during pregnancy. They used the CBCL to collect parent-reported information about each child’s behavior. CBCL assessments were collected between 2009 and August 31, 2021, and researchers used these assessments to determine whether a child met criteria for the CBCL Dysregulation Profile based on their scores for aggression, anxiety/depression, and attention.

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 studies could focus on identifying the mechanisms that link maternal factors with childhood dysregulation. These studies could also look at whether certain interventions are able to reverse or partially reverse the mechanisms that contribute to the development of dysregulation.

Where can I learn more?

Access the full journal article, titled “Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence,” in the Journal of the American Academy of Child and Adolescent Psychiatry.

Published May 17, 2023

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

Authors: Sarah Maylott, 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?

Many studies in the past have been interested in how substance exposures during pregnancy affect childhood behavior. Most of these studies, however, have only focused on a single substance or have only assessed children aged 5 years or younger. The purpose of this study was to find out if types of substances affect a child’s behavior during middle childhood.

What were the study results?

Most children in the study were not exposed to any of the substances considered prior to birth, but those who were tended to be exposed to more than one. Children with substance exposures were more likely than their non-exposed peers to have certain behavior problems in middle childhood. Children exposed to tobacco and alcohol were more likely to display rule-breaking or aggressive behaviors, while children exposed to illegal drugs (cocaine, methamphetamine, heroin) were more likely to have higher rates of anxiety, depression, or withdrawn behaviors. However, not all children exposed to substances had behavioral problems, suggesting that some children may be more resilient than others.

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?

Two patterns of substance use during pregnancy were associated with childhood behavior problems. This finding is important because it suggests that researchers can identify children at risk for certain behavioral challenges based on the substances their mothers used during pregnancy. With more research, clinicians may be able to anticipate childhood behavior problems during or shortly after pregnancy based on the kinds of substances the child was exposed to and develop personalized interventions for these children.

Who was involved?

Researchers used data from approximately 2,000 women from 10 ECHO research sites which reported on their substance use during pregnancy. When their children were 6 to 11 years old, a caregiver reported on the child’s behavior. The average age of participating mothers at the time of pregnancy was 28 years old.

What happened during the study?

Using data from 2000 to 2020, the researchers grouped women based on the types of substances they used during pregnancy, including 1) low substance use, 2) mainly tobacco use (with moderate likelihood of using alcohol and marijuana), and 3) illicit use. They then compared children’s behaviors for each of these groups.

What happens next?

Similar large-scale studies are needed that look more closely at how the amount and timing of substance use during pregnancy affect the child’s risk for problem behavior, as well as how the child’s home environment contributes to that risk. Additionally, future studies are needed to identify factors that may increase resiliency in children with prenatal substance exposure.

Where can I learn more?

Access the full journal article, titled “Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes” in the Journal of Pediatrics.

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

Published May 12, 2023

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children