Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Authors: Lauren C. Shuffrey, 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?

Previous research has linked gestational diabetes (a type of diabetes mothers develop during pregnancy) to prenatal and postpartum depression in mothers. However, studies have not examined how the combination of gestational diabetes, prenatal depression, and postpartum depression affect early childhood behavior.

What were the study results?

The study found that gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each associated with increased child externalizing (e.g., acting out, aggression, hyperactivity) and internalizing (e.g., anxiety, depression) behavior problems. This study also found that gestational diabetes was associated with increased autism behaviors only among children exposed to above average perinatal maternal depressive symptoms. Finally, the researchers observed gestational diabetes was only associated with child behavioral problems for male children, and not for female children.

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?

These findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy should receive additional monitoring for behavioral problems during early childhood.

Who was involved?

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as mixed race, and 4% as Asian.

What happened during the study?

ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5. They also collected information from the mothers including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

What happens next?

ECHO researchers are currently analyzing blood samples collected during pregnancy to investigate potential inflammatory mechanisms that may influence the associations between gestational diabetes, maternal depression, and early childhood behavior.

Where can I learn more?

Access the full journal article titled, “Gestational Diabetes Mellitus, Perinatal Maternal Depression, and Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” in Child Development.

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

Published May 2, 2023

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Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Children and Adolescents Born Preterm Were More Likely to Use Healthcare Services Related to COVID-19 Symptoms

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Children and Adolescents Born Preterm Were More Likely to Use Healthcare Services Related to COVID-19 Symptoms

Authors: Elisabeth C. McGowan, Monica McGrath, Andrew Law, Barry Lester, 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?

This is one of the first studies to look at healthcare use during the COVID-19 pandemic by a high-risk population—children and adolescents who were born preterm (37 or fewer weeks after gestation). By looking for possible patterns of healthcare utilization, this study can help healthcare providers to improve care for patients in future pandemics or other public health care crises.

What were the study results?

In this study, the researchers found that individuals born at 37 or fewer weeks after gestation were more likely to use healthcare services related to COVID-19 symptoms; those born extremely preterm (28 or fewer weeks) were even more likely to do so. For example, children and adolescents born extremely preterm were twice as likely to ask for an in-person appointment or a telehealth evaluation compared to individuals who were born after 37 weeks. Researchers saw that these differences were probably not caused by known risks for breathing problems such as asthma or chronic lung disease. Additionally, preterm children were no more likely to miss healthcare appointments overall than were individuals born at term.

What was the study's impact?

This study suggests that children and adolescents who were born preterm may be more likely to use healthcare during the COVID-19 pandemic than are children and adolescents who were born at full-term. Understanding the factors associated with both overall healthcare use and symptom-specific use may help healthcare providers identify the best strategies to provide targeted care. Understanding the different needs and patterns of healthcare use among children born preterm and their families during the first year of the pandemic, and why those patterns exist, are important first steps on the path to make healthcare more effective and efficient.

Who was involved?

This study included data from 42 ECHO research sites that together included 1,691 individuals ages 1–18 years. Of these individuals, 270 were born at less than 37 weeks of gestation. The study collected data from participants who were on average between 8 and 9 years of age. Approximately 40% of participants born preterm had reports of asthma-like symptoms within 1 year of healthcare use, compared to 20% of those born at term.

What happened during the study?

In this study, the researchers investigated whether children born preterm used healthcare during the COVID-19 pandemic differently than those born at term. Between April 2020 and August 2021, children’s caregivers and adolescents answered questionnaires regarding COVID-19 and healthcare use. The researchers studied healthcare use related to concerns about COVID-19 symptoms (like trouble breathing, fever, headache, muscle pain, fatigue, itchy eyes, nausea, diarrhea, vomiting, and loss of smell or taste) that resulted in overnight stays in hospitals, visits to urgent care centers or primary care offices, or virtual visits such as telehealth. They also explored changes in overall healthcare use during the pandemic, including missed healthcare appointments caused by parental concerns about going into a medical office or cancellation of an appointment by the provider.

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?

Further studies may evaluate the role socioeconomic factors may play in healthcare utilization.

Where can I learn more?

Access the full journal article, titled “Healthcare Utilization During the COVID-19 Pandemic Among Individuals Born Preterm,” 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 April 28, 2023

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Children and Adolescents Born Preterm Were More Likely to Use Healthcare Services Related to COVID-19 Symptoms

ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

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ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

Authors: Katherine Sauder, 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?

Out of all the prenatal supplements analyzed, the study found one that may potentially give pregnant patients the optimal amounts of the most important nutrients. But, the monthly cost of this supplement can be too high for some people, and it requires pregnant women to take seven pills a day. To ensure that pregnant women have accessible options for prenatal vitamins, the researchers looked for dietary supplements containing close to the needed amounts of nutrients that cost less and required only one to two pills a day.

See the full publication (Appendix A) for a list of the prenatal supplements analyzed during this study and their nutritional contents.

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?

This study can inform pregnant women and their doctors about key nutrients they may be missing in their diet and what prenatal vitamins they can take to get those nutrients. Companies that manufacture prenatal vitamins can also use the results of this study to understand how much of these nutrients should be in the products they make. Importantly, this study highlights the ongoing need for more prenatal vitamin options that are low cost and convenient, while still containing the optimal amounts of key nutrients.

Why was the study needed?

It is important that pregnant women get the right amounts of the nutrients they need for a healthy pregnancy. There are thousands of options for prenatal dietary supplements in the United States, so ECHO researchers conducted this study to help pregnant women and doctors pick the ones that contain optimal doses of key micronutrients to support a healthy pregnancy.

Who was involved?

This study included 2,450 pregnant participants from six ECHO cohorts located across the United States.

What happened during the study?

ECHO researchers first analyzed data about what the participants ate and drank during their pregnancies. Then, they calculated how much vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids the pregnant participants 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 a prenatal vitamin to make up what they were missing in their diet.

The researchers compared over 20,000 prenatal vitamins available in the US, 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.

What happens next?

In addition to the use of prenatal dietary supplements, pregnant women can adjust their diet to include more of the nutrients they need for a healthy pregnancy. Going forward, more research is needed to identify foods that pregnant women could eat to get enough of these nutrients.

Where can I learn more?

Access the full journal article, titled “Selecting a dietary supplement with appropriate dosing for six key nutrients in pregnancy" in The American Journal of Clinical Nutrition.

Read more information about healthy eating during pregnancy on the American College of Obstetricians and Gynecologists website.

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

Published April 2023

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ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

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ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

Authors: Britt Snyder, Tina Hartert, 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?

Few studies have looked at possible links between maternal health characteristics, including environmental stressors, and the metabolism of newborns. Metabolism refers to chemical reactions that take place within the cells to provide the body with the energy needed for growth and maintaining health. Researchers often study metabolism by measuring the blood levels of certain molecules—called metabolites—that are created during those chemical processes.

This study expanded previous findings that showed links between maternal characteristics (such as pre-pregnancy smoking, pre-pregnancy body mass index, education, occupation status, marital status, age at delivery, asthma diagnosis, diabetes during pregnancy, or type of delivery) and amounts of metabolites in newborns. The study also explored the link between these metabolites and child growth patterns. In addition, this study explores the maternal factors and potential series of chemical changes in utero (in the womb) that may contribute to the link between newborn metabolism and childhood BMI*.

*Body Mass Index (BMI) is a common health screening tool that considers both height and weight.

What were the study results?

The researchers identified links between maternal health characteristics and the concentration of various metabolites in newborns. Additionally, this study showed that some metabolites were also linked to childhood BMI at ages 1–3 years.

The study found that factors like higher BMI before pregnancy or maternal age at delivery seemed to increase the levels of key metabolites in newborns. However, other metabolites which were linked with maternal health characteristics were not associated with changes in childhood BMI.

What was the study's impact?

Previous research has shown associations between levels of some newborn metabolites and childhood growth, overweight, and obesity. This study provides additional insights on the maternal factors and potential in utero pathways connecting newborn metabolism and later metabolic dysfunction in children. Such imbalance may increase a person’s lifetime risk of coronary heart disease, diabetes, stroke, and other serious health problems.

Who was involved?

This study included 3,492 infants enrolled in three ECHO research sites with linked newborn screening metabolic data.

What happened during the study?

The researchers used data on maternal health characteristics collected from questionnaires, birth certificates, and medical records. Child BMI was obtained from medical records and study visits. The researchers used statistical tools to evaluate possible links between maternal health characteristics and newborn metabolism.

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?

This study is an early step in assessing biological pathways through which maternal health characteristics may influence prenatal metabolic development. These metabolic changes may then influence health after birth. Future studies are needed to further explore the potential pathways through which maternal health characteristics may impact child health.

Where can I learn more?

Access the full journal article, titled “The Associations of Maternal Health Characteristics, Newborn Metabolite Concentrations, and Child Body Mass Index among US Children in the ECHO Program,” in Metabolites.

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

Published April 1, 2023

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ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

Related Research Summaries

Changes in Body Mass Index among School-aged Children Before and After the Healthy, Hunger-Free Kids Act

Author(s): Aruna Chandran, Emily Knapp, et al.

How Does Neighborhood Social Vulnerability Affect Children’s Weight?

Authors: Izzuddin M. Aris, et al.

Changes in Body Mass Index (BMI) during the COVID-19 Pandemic

Authors: Emily Knapp, Aruna Chandran, et al.

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ECHO Study Links COVID-19 Stress, Slightly Earlier Births

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ECHO Study Links COVID-19 Stress, Slightly Earlier Births

Authors: Kim McKee, Sarah Comstock, 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 effects of depression and stress during pregnancy and their relationship to poor birth outcomes, such as preterm birth, are well documented. This study evaluated how maternal stress during the pandemic may have contributed to newborn health outcomes.

What were the study results?

Babies born to ECHO participants who were pregnant during the pandemic had similar birth weights but were born slightly earlier compared to babies born to ECHO participants who were pregnant between 2016-2019, prior to the pandemic. The study also found levels of stress were similar for ECHO participants who were pregnant between March 2020 and May 2021 compared to those who were pregnant between 2016 and 2019. However, more participants who gave birth from March to September 2020 reported being distressed about changes to their prenatal care and delivery compared with those who delivered after September 2020.

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?

While other studies have noted increased levels of depression and anxiety among pregnant individuals during the COVID-19 pandemic, these trends were not observed in pregnant ECHO participants. These results suggest that many pregnant women in the United States may have already been experiencing stress before the pandemic that didn’t significantly increase following the start of the pandemic.

Who was involved?

This study included a total of 2,983 ECHO participants from 30 U.S. states and territories who delivered a baby between January 1, 2016 and May 31, 2021.

What happened during the study?

In this study, researchers evaluated medical records and maternal reports on birth weight, gestational age at delivery, and birth weight percentiles adjusted for gestational age at delivery among participants. Researchers also used data from pregnant participants across all time periods that measured depression and perceived stress. Participants who were pregnant during the pandemic reported on stress during the pandemic using a questionnaire developed during the pandemic for use with ECHO participants.

What happens next?

The study ended in May 2021 while the pandemic continued to create stressful and confusing conditions for pregnant women and their families. Similar analyses with data from additional pandemic periods could shed light on how the pandemic continues to affect pregnancy and infant health outcomes.

Where can I learn more?

Access the full journal article, titled “Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program,” 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.

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ECHO Study Links COVID-19 Stress, Slightly Earlier Births

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.

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?

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

Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

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Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

Authors: Alison E. Hipwell, Irene Tung, 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.

What were the study results?

This study compared ECHO participants who were pregnant during the COVID-19 pandemic with participants who were pregnant before the pandemic. Participants who were pregnant during the pandemic reported more stress and symptoms of depression. Lower levels of physical activity were associated with more distress, and higher levels of emotional support were associated with less distress during pregnancy for both groups. The results also showed that pregnancies during the pandemic were slightly shorter on average but there was no impact on infant birth weight.

What was the study's impact?

This study highlights the importance of providing access to emotional support and mental health care during pregnancy and identifying ways to promote physical activity to help improve maternal health and well-being, regardless of external conditions like the pandemic.

Why was this study needed?

Previous studies on the effects of the COVID-19 pandemic on pregnancy outcomes have been mixed. This is partly because background information about pregnant participants has been missing and partly because the effects of the pandemic are different for different populations across the country. This study involved pregnant participants from across the United States and collected information about their mental health and well-being along with data on their pregnancy outcomes. The study also focused on positive factors that can be used to improve pregnancy health and birth outcomes, such as physical activity and emotional support.

Who was involved?

This study included 501 pregnant participants who gave birth during the COVID-19 pandemic (between March 12, 2020 and May 30, 2021) and 501 pregnant participants who gave birth before the pandemic (prior to March 11, 2020). Participants were 31 years old on average and enrolled in one of 16 ECHO research sites across the United States.

What happened during the study?

Participants answered questions about their experiences with stress and depression, reported on their physical activity, and described the emotional support they received during pregnancy. The researchers also collected information on participants’ birth outcomes from medical records and maternal reports.

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?

More research is needed to understand how social support and physical activity during pregnancy may protect pregnant women from stress or depression during difficult times. Future research may look for more details about the types of experiences during the COVID-19 pandemic that had the most influence on pregnancy health and well-being.

Where can I learn more?

Access the full journal article, titled “Impact of Sedentary Behavior and Emotional Support on Prenatal Psychological Distress and Birth Outcomes During the COVID-19 Pandemic,” in Psychological Medicine.

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

Published March 8, 2023

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Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

Pregnancy Complications Like Preeclampsia and Gestational Diabetes May Be Linked to Slower Biological Development in Babies

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Pregnancy Complications Like Preeclampsia and Gestational Diabetes May Be Linked to Slower Biological Development in Babies

Authors: Carrie Breton, Christine Ladd-Acosta, 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 babies who were exposed to preeclampsia or gestational diabetes while they were developing in the womb were biologically younger than babies without those exposures, indicating that these exposures may have slowed down babies’ biological development. This difference was more noticeable in female babies compared to male babies.

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?

In this study, researchers found that certain pregnancy complications are related to slower biological development at birth, with girls being more affected than boys. These results provide an important clue about how pregnancy complications can affect underlying biological processes in newborn infants, as preeclampsia and gestational diabetes have been linked to child health outcomes.

Why was the study needed?

Preeclampsia (high blood pressure that can cause kidney or other organ damage during pregnancy) and gestational diabetes (high blood sugar during pregnancy) have been linked to a number of birth complications and children’s health outcomes, including birth weight. More research is needed to identify the biological processes in newborn babies that are affected by these pregnancy complications so doctors can use that information to provide treatments to improve children’s health. This study evaluated how pregnancy complications affect newborn infant’s epigenetic age, a measure of their “biological age” based on molecular markers in their cells.

Who was involved?

The study included 1,801 children from 12 ECHO cohorts across the United States. The participants were born between 1998 and 2008 to mothers who had preeclampsia or gestational diabetes during pregnancy.

What happened during the study?

ECHO researchers calculated each infant’s biological age by analyzing DNA samples collected at birth and compared their biological age (epigenetic age) to their chronological age at birth (measured in pregnancy weeks). Then, the researchers compared the biological ages of newborns exposed to pregnancy complications to the biological ages of babies who were not exposed.

What happens next?

The researchers will continue this research with a larger number of participants. They also plan to see whether the same biological changes detected at birth are related to health outcomes later in childhood.

Where can I learn more?

Access the full journal article, titled “Analysis of Pregnancy Complications and Epigenetic Gestational Age of Newborns,” 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 February 24, 2023

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Pregnancy Complications Like Preeclampsia and Gestational Diabetes May Be Linked to Slower Biological Development in Babies

Child Body Mass Index Dropped After Healthy, Hunger-Free Kids Act in Schools

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Child Body Mass Index Dropped After Healthy, Hunger-Free Kids Act in Schools

Author(s): Aruna Chandran, Emily Knapp, 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 study showed an overall decrease in BMI in the first few years following the implementation of the HHFKA compared to BMI in the decade prior to the program. Among children ages 12-18 years, who may have more autonomy in purchasing their own lunches or snacks during the school day, BMI decreased from year to year following the start of the HHFKA. This was a reversal of the trends seen during the decade before the program, during which adolescent BMI was increasing each year. This study also supported findings from previous studies that found the HHFKA had a positive effect on the health of children from lower-income families by contributing to an annual decrease in their BMI.

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 National School Lunch Program and School Breakfast Program (NSLP) provides free or low cost meals to over 30 million children annually, providing an estimated 50% of students’ caloric intake each school day. This study found that the HHFKA was associated with decreases in child and adolescent BMI. Increasing BMI trends before the HHFKA was implemented were stopped or even reversed in several populations after the law was implemented, which could critically influence their long-term health. The study also found that the implementation of the HHFKA decreased BMI of children from lower-income families, who are more likely to participate in the NSLP and are at higher risk of obesity. Accessibility to school meals and snacks represents a key opportunity for intervention to combat the childhood obesity epidemic.

Why was this study needed?

Childhood obesity is a serious health concern with long-term consequences for health and quality of life. Nearly 1 in 5 children in America is obese. The 2010 Healthy, Hunger-Free Kids Act (HHFKA) was the first legislation passed in nearly 3 decades aimed at improving the nutritional quality of breakfast, lunch, and snacks sold at schools. Studies have shown that the HHFKA has improved the quality of school meals without affecting cost or program participation, but only a few small studies have explored whether the HHFKA reduced body mass index (BMI) in children over time.

Who was involved?

This study included 14,121 children from the ECHO Program between the ages of 5 and 18 who had at least one height and weight measurement recorded between January 2005 to March 2020.

What happened during the study?

Researchers used height and weight measurements from children across 50 ECHO cohorts to calculate each child’s BMI and adjusted each measurement based on age and sex. They used these data to evaluate yearly BMI trends from before and after the implementation of the Healthy, Hunger Free Kids Act in September 2016.

What happens next?

Future studies are needed to further explore and verify the effect of improving the nutritional quality of school meals on childhood obesity. In addition, policymakers could use data from studies like this to evaluate policies related to improving the nutritional quality of meals provided in schools.

Where can I learn more?

Access the full journal article, titled “Changes in Body Mass Index Among School-Aged Children Following Implementation of the Healthy, Hunger-Free Kids Act,” 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: February 13, 2023

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Child Body Mass Index Dropped After Healthy, Hunger-Free Kids Act in Schools

ECHO Study Suggests Link Between Severe Bronchiolitis During Infancy and Asthma During Childhood

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ECHO Study Suggests Link Between Severe Bronchiolitis During Infancy and Asthma During Childhood

Author(s): Kohei Hasegawa, 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.

What were the study results?

Bronchiolitis is a wheezing illness usually caused by a lung infection such as Respiratory Syncytial Virus (RSV). During this study, researchers found that the hospitalized infants with bronchiolitis were more likely to develop asthma by the age of 12 years when compared to hospitalized infant without bronchiolitis. The researchers also saw that this effect was stronger for non-Hispanic White and non-Hispanic Black infants, compared with Hispanic infants.

What was the study's impact?

This is the first nationwide investigation that demonstrates the role of severe bronchiolitis during infancy on influencing long-term childhood asthma risk and identifies subgroups of children who are most at risk for developing asthma following bronchiolitis during infancy. These results could help future investigations to identify what factors may influence the association between severe bronchiolitis and childhood asthma risk across different demographic groups, which could advance the development of targeted prevention strategies for childhood asthma.

Why was this study needed?

Severe bronchiolitis is the most common reason for hospitalization in U.S. infants younger than 2 years old. Many studies have shown that severe bronchiolitis, requiring hospitalization during infancy, is a risk factor for developing childhood asthma. However, these studies have been too narrow to evaluate how severe bronchiolitis during infancy affects childhood asthma risk in various demographic subgroups.

Who was involved?

The researchers analyzed data from 11,762 infants enrolled in 53 ECHO research sites across the United States. All of these infants were hospitalized at age 12 months or younger between 2001-2021. Of these infants, 10% were hospitalized with bronchiolitis. One of the participating ECHO cohorts selectively enrolled children with a parental history of asthma.

What happened during the study?

The researchers collected data from participating infants under 12 months old on caregiver-reported hospitalization for bronchiolitis. The researchers then used data on caregiver-reported asthma diagnosis prior to age 12 to evaluate the relationship between severe bronchiolitis and childhood asthma to determine how this relationship may be affected by major demographic and clinical factors.

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 are needed to investigate the reasons underlying the links among infant bronchiolitis, demographic and clinical factors, and the development of asthma. These findings not only provide an evidence base for early identification of children who are at high risk for asthma but also offer opportunities for early preventive interventions in this large, high-risk population.

Where can I learn more?

Access the full journal article, titled “Association of Severe Bronchiolitis during Infancy with Childhood Asthma Development: An Analysis of the ECHO Consortium,” in Biomedicines.

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

Published: December 22, 2022

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ECHO Study Suggests Link Between Severe Bronchiolitis During Infancy and Asthma During Childhood