ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

Author(s): Emily Zimmerman, Andréa Aguiar, 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?

The researchers found that higher maternal stress during late pregnancy was associated with fewer but longer sucking bursts when the infants sucked on the special pacifier. It is important to note that the maternal stress levels and infants’ sucking behaviors between the two cohorts were different. This could be due to differences between the two cohorts’ cultures, geographical locations, ethnicities, incomes, and education levels.

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 is the first study investigating the link between maternal stress and infants’ sucking patterns. The results of this study may help promote awareness and earlier detection of stress exposure during pregnancy and, as a result, improve the treatment of stress-exposed infants. This study also researched these outcomes in two groups of participants with different demographics and stress levels, which may allow for earlier detection of high maternal stress exposure in lower SES populations.

Why was this study needed?

Previous studies show that a mother’s stress during pregnancy can affect her baby’s development. But less is known about how a mother’s stress during pregnancy relates to their infant’s brain function early in life. Infants’ sucking patterns have been used to measure brain function soon after birth. This study investigated whether there was any relationship between mothers’ stress in pregnancy and their young infants’ sucking patterns.

Who was involved?

The study included participants from two ECHO cohorts—one from Urbana-Champaign, Illinois and the other from Manati, Puerto Rico.

What happened during the study?

The researchers surveyed mothers regarding their stress during late pregnancy using the Perceived Stress Scale, which has 10 questions. Next, between one and eight weeks after the mothers gave birth, the researchers measured the infants’ sucking behaviors by having them suck on a pacifier connected to a pressure detector for approximately five minutes.

What happens next?

Future studies will look at the question of how early sucking behaviors relate to a child’s growth and development, in particular their brain function and cognitive development.

Where can I learn more?

Access the full journal article, titled “Examining the Association Between Prenatal Maternal Stress and Infant Non-Nutritive Suck” in Pediatric Research.

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

Published December 16, 2021

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

ECHO Study Suggests Higher Risk of Obesity for Children With Asthma

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ECHO Study Suggests Higher Risk of Obesity for Children With Asthma

Author(s): Nikos Stratakis and Erika Garcia

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?

This study found that children with asthma had a 23% higher risk of developing obesity than children without asthma. The risk of obesity was 64% lower among children with asthma who were using asthma medication at a higher proportion compared to children with asthma who were using asthma medication at a lower proportion.

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 supports a link between childhood asthma and obesity later in childhood. Asthma medication may help lower obesity risk in children with asthma. The use of asthma medication for obesity prevention in children with asthma needs to be further researched. Overall, the findings from this study highlight the need for a better understanding of the factors and pathways involved in the link between asthma and obesity risk.

Why was this study needed?

Children who have asthma often have a higher body mass index (BMI) that classifies them as obese. In the last few decades, rates of both asthma and obesity have increased, leading researchers to study the link between the two diseases. The goal of this research was to see if children with asthma had a higher risk of developing obesity compared to children without asthma.

Who was involved?

This study looked at almost 9,000 children and teens across the U.S. between ages 6 to 18.5 who were not obese at the start of the study. On average, children were followed for five years to see if they developed obesity.

What happened during the study?

This study compared the obesity risk among U.S. children with and without asthma. The researchers also studied whether taking medicine for asthma affected the relationship between obesity and asthma in kids. Children with asthma were identified based on a caregiver’s report of a doctor saying the child has asthma. Obesity was defined based on whether the child’s BMI was in the top 5% for their age and sex. Researchers also collected information about whether the child used asthma medication. Over the course of the study 26% of children had an asthma diagnosis and 11% developed obesity.

What happens next?

Researchers may want to study what contributes to increased obesity risk in children with asthma. For example, the effects of asthma on physical activity level or quality of sleep. In addition, there needs to be a better understanding of how the use of asthma medication affects obesity risk among children with asthma. One possibility is that asthma medication leads to higher physical activity in children with asthma, which then lowers the risk of obesity later in childhood.

Where can I learn more?

The full journal article, titled “The Role of Childhood Asthma in Obesity Development: A Nationwide U.S. Multi-cohort Study,” is published 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: September 20, 2021

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ECHO Study Suggests Higher Risk of Obesity for Children With Asthma

ECHO Review Suggests Environmental Exposures Can Affect Health Outcomes Across Multiple Generations

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ECHO Review Suggests Environmental Exposures Can Affect Health Outcomes Across Multiple Generations

Authors: Carrie Breton, Rebecca Fry, Alison Hipwell, Cristiane Duarte, Linda Kahn, and Joseph Braun

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 review found many studies in animals and humans that showed a connection between certain environments, chemicals, and behaviors and health risks across multiple generations. While epigenetics most likely plays a role in these changes, it is often difficult to separate epigenetic effects from other causes. The team also pointed out the need for more studies to tease out the complexity of these effects.

Footnote: Results reported here are for a research project. Other or future research 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 review article brings together results from many studies into one paper, which is usually more powerful than results from a single study. By looking at many results together, scientists can find important patterns and gaps in epigenetics research. This paper will help scientists better understand how the environment can affect the health of a mother, child, and grandchild.

Why was this study needed?

Studies show that the environment may affect the health of many generations in one family. Some of this effect comes from epigenetics, changes in how your genes are read and understood. Your environment and actions can change your epigenetics, and those changes can be passed on to your children and grandchildren. For example, if a pregnant woman is around certain chemicals, her genes may carry a “molecular memory” of those chemicals that can be passed on through her children. The purpose of this study was to put together what is known about epigenetics to understand how environments, chemicals, and behaviors may affect the health of children for generations to come.

Who was involved?

This research looked at previous studies on humans and animals and summarized the information.

What happened during the study?

The team of experts read a lot of studies on this topic and worked together to write a summary of current knowledge.

What happens next?

The ECHO Program will keep collecting data on the health effects of environmental exposures on children. The scale of the ECHO Program makes it ideal for the study of the ongoing, generational effects of these exposures.

Where can I learn more?

Access the full journal article, titled “Exploring the evidence for epigenetic regulation of environmental influences on child health across generations” published in Communications Biology.

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

Published: June 22, 2021

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ECHO Review Suggests Environmental Exposures Can Affect Health Outcomes Across Multiple Generations

More Environmental Exposures Research

Do chemicals that break down slowly in the environment affect how long it takes to become pregnant?

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

A review of studies that look at whether exposure to common non-persistent chemicals in consumer products delays the time it takes to become pregnant

Author(s): Alison E. Hipwell, Linda G. Kahn, Pam Factor-Litvak, et al

Review of Prenatal Air Pollution Exposure and Brain Development

Author(s): Heather E. Volk, Frederica Perera, Joseph M. Braun, Samantha L. Kingsley, Kim Gray, Jessie Buckley, Jane E. Clougherty, Lisa A. Croen, Brenda Eskenazi, Megan Herting, Allan C. Just, Itai Kloog, Amy Margolis, Leslie A. McClure, Rachel Miller, Sarah Levine, Rosalind Wright

ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

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ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

Author(s): Brian Hallmark, 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 under Award Number 5UH3 OD023282.

What were the study results?

Four wheezing patterns were seen among the children: (1) infrequent—few wheezing episodes in the first three years then none after that; (2) transient—some wheezing in first few years then fewer and gone by around age six; (3) late onset—little wheezing in the first few years then slowly happens more often; (4) persistent—many wheezing episodes over the first 11 years.

About half of children experience wheezing before three years old, and 62% wheezed in the first 10 years of life. The wheezing may start because of a viral infection (like the common cold). Many children only wheeze as preschoolers. AA children were more likely than European American (EA) children to have persistent wheezing.

Several small gene changes were connected to transient, late onset, and persistent wheezing in EA children, but for both AA and EA children, only two specific small gene changes were connected with a greater likelihood of the child wheezing after the first three years.

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?

For the first time, it is reported that genetic changes associated with childhood asthma are also associated with all wheezing patterns in young children. These wheezing patterns were found consistently in children located in different cities and born in different decades.

Wheezing in young children is often a result of common respiratory viruses that affect breathing. These findings, together with what we know about the genes associated with asthma, suggest that some of these small gene changes may be connected to a higher risk of colds and other viral airway infections that trigger wheezing in small children.

This study also highlights the importance of including multiple race/ancestry groups in genetic studies to understand how small changes in genes are connected to different health outcomes in diverse groups.

Why was this study needed?

Previous studies have shown that many children wheeze during the first few years of life—some later stop, while others can develop ongoing asthma. Other children do not wheeze during early life but still develop asthma later during childhood. Understanding where these patterns come from may shed light on how asthma begins and help doctors identify children who might need help earlier. Other studies identified small changes in specific genes that could be responsible for some cases of childhood asthma. This study tried to find possible connections between those small gene changes and different wheezing patterns in children. This is also the first study that looks at how small genetic changes may relate to specific patterns of wheezing in African American (AA) children.

Who was involved?

Data came from children enrolled at birth in seven different studies across the US. Nearly 3,700 children who experienced at least three wheezing events were included, and researchers analyzed the genes of 1,928 of these children. About 32% of these children were AA. Each study site used questionnaires and interviews to collect information from children and their parents over many years.

What happened during the study?

The team collected patient characteristics and data on wheezing and asthma and pulled those data together to group each child based on when and how often they wheezed from birth to age 11. Each site also collected DNA samples from the children and sent them to be analyzed for small changes in genes associated with asthma. The researchers used statistics to identify four different wheezing patterns and connect them with specific genetic changes.

What happens next?

The team is looking at possible associations between children’s insulin levels, genetic variations, and the development of asthma in childhood.

Where can I learn more?

Access the full journal article, titled “Chromosome 17q12-21 Variants Are Associated with Multiple Wheezing Phenotypes in Childhood,” in the American Journal of Respiratory and Critical Care Medicine.

Additional Details

This project would not have been possible without ECHO CREW support, as the data came from seven separate birth cohorts brought together by that program. In particular, combining those datasets was essential to getting a large enough sample size to include AA children.

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

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Published: April 1, 2021

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ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

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ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

Author(s): Timothy Choi, James E. Gern and Yury A. Bochkov

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. Additional support came from contributing studies by the NIH, the Sigrid Juselius Foundation (Helsinki, Finland) and the National Health Medical Research Council (Australia).

What were the study results?

As children age, they are less likely to be infected with the rhinovirus C species. This may be because the immune system gets stronger against infection with rhinovirus C species compared to other species. Other personal factors related to more frequent infections are wheezing respiratory illnesses and a genetic difference in a protein used by the viruses to enter cells.

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 care without first consulting your healthcare professional.

What was the study's impact?

Infections with rhinoviruses, generally known as common colds, are the most common cause of wheezing illnesses in preschoolers and children with asthma. Unfortunately, there are no treatments for these respiratory viruses. The results of the study identify children most likely to develop more severe illnesses with rhinovirus C based on young age and genetics. This new information on at-risk populations and the viruses most likely to cause illnesses can help scientists create a vaccine specifically for the rhinovirus C species.

Why was this study needed?

Rhinovirus is a leading cause of the common cold and wheezing illnesses in young children and in children with asthma. There are three species of rhinoviruses (A, B, and C), and C viruses are often more likely to cause wheezing illnesses, especially in young children. The main objectives of this study were to identify age and other personal risk factors for rhinovirus illnesses, and to determine whether certain rhinoviruses are more frequent and more likely to cause wheezing illnesses.

Who was involved?

More than 4,000 children were enrolled in 14 independent studies across the United States, Finland, and Australia from 2000 to 2019. Study participants had illnesses of varying severity and varied in age from zero to 19 years.

What happened during the study?

Each of the 14 sites collected nasal samples and studied them for rhinovirus species and type. The investigators then tested whether characteristics such as age, gender, and race influenced which viruses were seen. Investigators also identified which viruses are most common and which are most likely to cause illnesses.

What happens next?

Future research will focus on studying the strength and length of time people can be immune to rhinovirus C. This will help determine why these viruses are able to produce such a strong immune response, and why rhinovirus C infections decrease with age. This information may help researchers design a practical vaccine against rhinovirus C that could be used to protect high-risk children.

Where can I learn more?

View the full journal article, titled "Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection," in American Journal of Respiratory and Critical Care Medicine.

Additional details

The authors thank the many investigators, children and families who conducted and participated in this multinational collaborative study.

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

Published: April 1, 2021

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ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

ECHO Discovery

Co-author James Gern presented An Integrated Approach to Identifying Early Life Causes of Childhood Asthma at a past ECHO Discovery webinar. You can view his presentation here.

Better Sleep Quality Is Linked to Lower Levels of Stress and Better General Health in Children

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Better Sleep Quality Is Linked to Lower Levels of Stress and Better General Health in Children

Author: Courtney K. Blackwell

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?

Results suggested better sleep quality was connected with lower levels of stress and better general health. This, in turn, predicted higher levels of life satisfaction. Findings remained stable for a subsample of children with the poorest sleep quality.

*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?

Children who sleep well have happier lives than those who do not sleep as well. Given the varying nature of children’s sleep quality, this study offers findings to inform future studies that want to test specific ways to improve children’s well-being. Ways to improve sleep may include education programs for parents that teach parents how to prevent things that keep children from sleeping well (e.g., ways to lower screen time in the hour before bed). Other ideas may include looking at how elementary school start times affect children’s sleep quality.

Why was this study needed?

Sleep quality is important to children’s health and well-being. Until now, research has focused on how poor sleep may cause health problems. The current study explored if and how better sleep quality may lead to positive health in children.

Who was involved?

More than 1000 caregivers of 5- to 9-year-old children from 3 ECHO Program cohorts participated in this study. Participants were from different places in the United States, had different financial backgrounds and 10% were of Hispanic origin.

What happened during the study?

Between March and December 2017, caregivers completed surveys about their children’s sleep quality, general health, stress, and life satisfaction.

What happens next?

This study provides early evidence on the ways better sleep can improve the lives of children. Future research with more diverse samples can make these findings apply to more people. Additionally, measures to try with younger children are available so that we can see how this affects children younger than 5.

Where can I learn more?

Access the full journal article, titled “Better sleep, better life? How sleep quality influences children's life satisfaction.”

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

Published: September 29, 2020

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Better Sleep Quality Is Linked to Lower Levels of Stress and Better General Health in Children

ECHO Study Suggests Chronically Ill Children Can Still Have High Life Satisfaction

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ECHO Study Suggests Chronically Ill Children Can Still Have High Life Satisfaction

Author(s): Courtney K. Blackwell, Amy J. Elliott, Jody Ganiban, 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?

Results suggested that children with at least one chronic illness had worse general health, but similar levels of life satisfaction as other children their age who do not have a chronic illness. Children (those with and without illness) who were less stressed and came from higher income families had higher life satisfaction. Overall, this study shows that chronic illnesses do not necessarily keep children from leading happy, satisfying lives.*

*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 is the first ECHO project to collect and combine new data from multiple cohorts to examine the topic of positive health. Findings highlight opportunities for healthcare professionals to broaden views of health from meaning the “absence of disease” to one where all children, regardless of illness, have well-being. This idea aligns with the Institute of Medicine’s definition of child health, and this study provides innovative measures to understand such outcomes. Results from this study may lead to future research on the relationship between certain chronic illnesses and child well-being. It may be particularly interesting for large research programs, such as ECHO, that have access to larger groups of children with different illnesses. Study findings also give researchers a way to address recent national initiatives, such as the Health Resources and Services Administration’s focus on creating programs that address children’s life satisfaction.

Why was this study needed?

The relationship between chronic illness and negative health outcomes is well-known. However, less is known about the relationship between chronic illness and positive health outcomes, such as life satisfaction, especially in children.

Who was involved?

Participants came from three ECHO Program cohorts. Participants were 1,113 caregivers who reported information for 1,253 children 5-9 years old.

Of these children:

About half were male (53%)
The majority were white (79%)
A tenth were Hispanic (10%)
A fifth had at least one chronic illness (20%)

What happened during the study?

Three ECHO cohorts surveyed caregivers on their children’s general health, life satisfaction, and stress between March 2017 and December 2017. Cohorts shared results from these surveys and data related to children’s medical conditions and family demographic information with the ECHO research team.

What happens next?

This study provides a start for more research on the relationship between certain chronic illnesses and children’s well-being as well as how chronic illness relates to the change in well-being over time.

Where can I learn more?

Access the full journal article, titled “General Health and Life Satisfaction in Children With Chronic Illness.”

For an overview of the research and findings, see the American Academy of Pediatrics press release.

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

Published: June 2019

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ECHO Study Suggests Chronically Ill Children Can Still Have High Life Satisfaction

ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia

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ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia

Author(s): Cosby Stone, Cynthia McEvoy, Judy Aschner, et al

Who sponsored this research?

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 learned:

There was not enough information in existing studies to recommend using vitamin E to prevent BPD.
A specific type of vitamin E called α-tocopherol isoform may be helpful in preventing or treating BPD.

*Results reported here are for a single research review. Other or future reviews or 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 researchers think that studying the vitamin E α-tocopherol isoform would help provide more information on the benefits and risks of using it to prevent and treat BPD. This type of vitamin E is already associated with better health outcomes for conditions such as asthma, allergic airway swelling, and improved lung growth than other forms of vitamin E. However, without further studies, there is not enough information to recommend it now.

Why was this study needed?

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mostly affects newborns and infants. It occurs when a newborn or infants’ lungs are damaged from being on a ventilator (a machine that provides oxygen). We already know that there is a connection between low levels of vitamin E and the risk of BPD. Some doctors use vitamin E to help prevent BPD in newborns and infants. However, the last time researchers studied how vitamin E may affect BPD was 1991. Since then, we have learned more about how to reduce the risk of oxygen and ventilator-related lung injuries in newborns. We also know more about how vitamin E affects overall lung health. People only get vitamin E through their diet or supplements, like vitamins, so it’s important to understand if people need more of it.

What was the purpose of the study?

To update our knowledge and understanding of vitamin E and BPD.

Who was involved?

No study participants were involved in this research. The researchers involved are experts in neonatology (the study of newborns), epidemiology (understanding health in certain populations of people), pulmonary medicine (medicine related to the lungs) and environmental interventions (how changing something in a person’s environment affects health.

What happened during the study?

Researchers gathered and analyzed existing research on vitamin E. From this analysis, they suggest ideas for future research that could help us learn more about vitamin E and its role in preventing or treating BPD.

What happens next?

Researchers are interested in studying individual types of vitamin E as dietary supplements to improve lung health and as a potential way to treat or prevent BPD. We will need more and better data from research studies to understand if taking certain vitamin E isoforms can help reduce the risk of:

BPD for newborns when taken by a pregnant women at risk of preterm birth.
BPD for premature newborn when given to the newborn right after birth.
Having long-term lung problems that may continue later into life.

Where can I learn more?

Access the full journal article titled, “Update on Vitamin E and Its Potential Role in Preventing or Treating Bronchopulmonary Dysplasia.”

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

ePublished: March 7, 2018

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ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia