News

New ECHO Research Reveals Depression is More Common Among New Mothers of Preterm Babies

Posted on by Jodi Snare

New ECHO research reveals that increasing symptoms of depression may be more common among women who give birth to preterm babies compared to women who have their babies at full term. Mothers of preterm babies were also more likely to experience depression that lasted years after birth, and for many of these women, their symptoms of depression got worse over time. These findings resulted from a collaborative effort between ECHO researchers Danielle Roubinov, PhD of the University of California, San Francisco (UCSF) and Rashelle Musci, PhD of Johns Hopkins University, along with senior author Nicole Bush, PhD, of UCSF and other ECHO researchers.

Their research, titled “Trajectories of Depressive Symptoms Among Mothers of Preterm and Full-Term Infants in a National Sample,“ is published in Archives of Women’s Mental Health. 

The research team collected data from approximately 11,300 women from 35 different ECHO cohorts across the United States that documented self-reported depression measures for women when they were pregnant and after they had their babies. Of these women, 11% had preterm births, and 89% had full-term babies. Follow-up assessments from the two groups of women were collected at least once within the first five years following childbirth to better understand the long-term trajectories of depressive symptoms s and potential opportunities for treatment.

“Having a baby is exciting, but it can also be stressful, and some women feel sad or anxious before and after their baby is born,” said Dr. Roubinov. “This period can be especially difficult for mothers when babies are born prematurely.”

Many mothers can struggle with their mental health after giving birth, and women who give birth prematurely may be particularly at risk of experiencing depressive symptoms related to the birth experience, neonatal care challenges, and ongoing concerns about the infant’s health and development.

“Currently, many doctors only ask women about how they feel when they are pregnant and for six months after birth,” said Dr. Musci. “This study showed us that we should be continuing to ask women about their mental health for years following their pregnancy while helping them to find the support they need.”

Future ECHO studies can add to this research by assessing intervention programs that can help support the mental health of new mothers, as maternal mental health is a critical influence on children’s development.

Learn more about depression during and after pregnancy through the Centers for Disease Control and Prevention and NIH.

Read the Research Summary.

ECHO Researchers Report Higher Levels of Oxidative Stress among Socioeconomically Disadvantaged Pregnant Women

Posted on by Jodi Snare

A collaborative research effort led by Stephanie Eick, PhD, MPH of Emory University’s Rollins School of Public Health and Rachel Morello-Frosch PhD, MPH of the University of California, Berkeley investigated the relationship between various biological, behavioral, and social factors and higher levels of oxidative stress in pregnant women, which is often associated with poor prenatal health outcomes. Pregnant participants who were 30+ years old and had a college degree had lower levels of oxidative stress. In contrast, levels of oxidative stress were higher among pregnant participants who were overweight or obese, or unmarried. Levels of oxidative stress biomarkers were also higher among pregnant participants who were current smokers or had less than a high school education.

This research, titled “Associations between social, biologic, and behavioral factors and biomarkers of oxidative stress during pregnancy: Findings from four ECHO cohorts,” is published in Science of the Total Environment.

To measure oxidative stress, the researchers collected urine samples from approximately 2,000 pregnant participants in the mainland United States and Puerto Rico who were enrolled in one of four ECHO cohorts. They measured the levels of oxidative stress biomarkers at up to three time points during pregnancy and calculated the association between biomarker levels and biological, behavioral, and social factors. Maternal age, pre-pregnancy body mass index, marital/partnered status, parity, and smoking status were included as biological and behavioral factors while race/ethnicity, maternal education, and stressful life events were considered social factors.

“This is the largest study to date to examine the relationship between biologic, social, and behavioral factors and oxidative stress during pregnancy,” said Dr. Eick. “Our results provide important clues into how social and economic inequalities lead to poor health in pregnant women.” This study may also inform future studies looking at risk factors for preterm birth.

As for ongoing research, the team is examining the impact of oxidative stress on adverse pregnancy outcomes, such as preterm birth.

Read the Research Summary.

ECHO PRO Core Publishes Series of Articles on PROMIS® Early Childhood

Posted on by Jodi Snare

ECHO’s Person-Reported Outcomes (PRO) Core published a series of articles on the Patient-Reported Outcome Measurement Information System (PROMIS®) Early Childhood measures in this month’s online edition of the Journal of Pediatric Psychology.

The PROMIS® measures use recent advances in information technology and health survey research to measure person-reported outcomes—such as pain, fatigue, physical functioning, emotional distress, and social role participation—that have a major impact on quality of life.

The PRO Core developed 12 early childhood measures to evaluate common mental, social, and physical health outcomes for children ages 1-5. See below for links to the individual articles. The ECHO Program Office also wrote an introduction to this special series.

The PRO Core, located at Northwestern University in Evanston, Ill., captures the experiences of children and their families who are taking part in ECHO. Led by principal investigators Richard Gershon, PhD, and David Cella, PhD, the PRO Core is responsible for keeping and providing PRO information for researchers, helping researchers use PRO assessments in their study designs, and coordinating plans for updating, approving, and using PRO information in studies.

ECHO-funded Research Finds Higher Asthma Rates Among Black and Hispanic Children Regardless of Neighborhood Income or Density

Posted on by Jodi Snare

A new ECHO study found that although there is a correlation between childhood asthma and being born into a densely populated or lower-income neighborhood, Black and Hispanic children had consistently higher rates of asthma than White children, even in wealthier neighborhoods.

The study, led by ECHO investigators, Dr. Antonella Zanobetti, Harvard T.H Chan School of Public Health, Department of Environmental Health, and Dr. Patrick H. Ryan, Cincinnati Children’s Hospital Medical Center, included data from 5,809 children born over four decades throughout the United States, providing important insight into how racial and ethnic health inequities may cause children to develop wheezing – a symptom involving whistling breathing sounds due to narrowed airways – and asthma.

Of the 5,809 children studied, 46% reported wheezing prior to age 2 and 26% reported persistent wheeze through age 11. Diagnosis of asthma by age 11 varied by cohort, with an overall median prevalence of 25%. Children in neighborhoods with higher population density, and with more families with lower incomes and living below the poverty level, experienced more asthma and early and persistent wheezing. Black and Hispanic children remained at higher risk for asthma than White children, even in neighborhoods with more resources.

Researchers used questionnaires and interviews to collect information such as wheezing and asthma occurrence, medical history, and demographics from participating families over many years. Each child’s home address was matched to U.S. Census tract data for the decade closest to their birth year. Researchers examined the relationship between incidence of wheezing and asthma with children’s race and ethnicity, their mother’s education level and smoking habits, and socioeconomic conditions of the neighborhood in which they were born.

“Neighborhood- and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities,” Dr. Zanobetti said. “Reducing these inequities requires identifying and repairing differences between and within neighborhoods to create equal access to healthy living conditions.”

This research, titled “Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium,” is published in JAMA Pediatrics.

Read the Research Summary.

ECHO Researchers Explore How Study Results Can Help Pregnant Mothers Take Action to Reduce Chemical Exposures

Posted on by Jodi Snare

Collaborative ECHO research led by Amy Padula, PhD, MSc from the University of California, San Francisco and Rachel Morello-Frosch, PhD, MPH from the University of California, Berkeley found that many ECHO participants are motivated to engage in individual and collective action to protect their families and communities from the negative effects of chemical exposures. These findings may be used to improve report-back of chemical results and shift responsibility of chemical exposures from individuals to policymakers.

“When it comes to chemical exposure results, participants were interested in receiving timely, accessible, and straightforward information on how to reduce chemical exposures at the personal and community level,” said Dr. Padula.

This research, titled “Perspectives of peripartum people on opportunities for personal and collective action to reduce exposure to everyday chemicals: Focus groups to inform exposure report-back,” is published in Environmental Research.

In the summer of 2020, the researchers held three online focus groups with a diverse set of 18 mothers from ECHO pregnancy cohorts in Illinois and California. Focus groups, held in both English and Spanish, involved discussions around knowledge of chemical exposures and their sources, chemical exposure report-back preferences, and participants’ interest and willingness to engage in collective action.

Study results demonstrate the usefulness of chemical exposure report-back tools, like the Digital Exposure Report Back Interface (DERBI), for informing and empowering research participants. “Report-back can provide opportunities for participants to learn more about environmental health and how to lower exposure both in their homes and in their communities,” said Dr. Padula.

The next steps for this research include examining surveys from participants who are using DERBI to learn about their chemical exposures. These surveys may reveal more about how chemical exposure reports influence participant engagement with collective action efforts. Drs. Padula and Morello-Frosch encourage other ECHO cohorts to use DERBI to report back individual chemical results to their participants.

More information about the Digital Exposure Report Back Interface (DERBI) or how to use DERBI in your cohort, please visit the Silent Spring Institute website.

Read the Research Summary.

Diverse, Multi-cohort ECHO Program Study Examines Factors Influencing Chemical Exposures in Pregnant Women

Posted on by Jodi Snare

In a collaborative research effort involving participants from nine ECHO cohorts, Jessie P. Buckley, PhD, of Johns Hopkins Bloomberg School of Public Health, and Tracey J. Woodruff, PhD, of the University of California San Francisco led a research team that examined chemical exposures in pregnant women. This is the largest exposure study to measure more than 100 contemporary and emerging chemicals simultaneously in a diverse population of pregnant women in the U.S. The researchers used a new method for measuring multiple chemicals in a small amount of urine.

The research team found that more than 80% of the chemicals were present in at least one of the women in the study, and about a third of the chemicals were found in a majority of the participants. The study found that the women had been exposed to rising levels of certain chemicals, especially replacement chemicals: chemicals meant to replace other chemicals that have been banned or phased out. Many of the women had also been exposed to neonicitinoids, a widely used type of pesticide.

Their research, titled “Exposure to contemporary and emerging chemicals in commerce among pregnant women in the United States: The Environmental influences on Child Health Outcomes (ECHO) Program” is published in Environment Science & Technology.

This multi-cohort ECHO Program study included 171 pregnant women from California, Georgia, Illinois, New Hampshire, New York, and Puerto Rico. Approximately 34% of participants were white, 40% were Hispanic, and 20% were Black. To collect data, the research team used a new method that can identify up to 103 chemicals or chemical metabolites —mainly pesticides, plastics, and BPA/phthalate replacements—simultaneously from a single urine sample. The team determined detection frequencies and concentrations for each chemical in urine samples from women in each of nine ECHO cohorts and assessed how demographic characteristics and the year of sample collection related to measured levels of the chemicals.

The research team identified demographic and sociodemographic trends in chemical exposures, observing higher exposure levels among non-white women, those with lower educational attainment, those who were single, and those exposed to tobacco. Of note, Hispanic women had especially high levels of parabens (preservatives) as well as phthalates and bisphenols (from plastics) compared to National Health and Nutrition Examination Survey data.

“Currently, there is a lack of data on multiple chemical exposures, particularly those that have been identified as potentially hazardous during pregnancy and fetal development,” said Buckley. “This study highlights the importance of including pregnant women in biomonitoring studies and creating policies and practices to decrease overall chemical exposure.”

In the future, the team plans to look at a larger sample of pregnant women. “We aim to increase the number of participants from about 200 to 6,500,” said Woodruff. “We would like to assess whether higher prenatal chemical exposures are related to adverse birth outcomes. This data will be foundational for evaluating contributions to additional adverse pregnancy and child health outcomes.”

Read the research summary.

ECHO Investigators Find Association Between Prenatal Obesity and Child Autism-related Behaviors

Posted on by Jodi Snare

Collaborative ECHO research from Kristen Lyall, ScD of Drexel University and Christine Ladd-Acosta, PhD of Johns Hopkins University found an association between childhood autism-related social behaviors and maternal obesity and gestational diabetes during pregnancy.

The researchers examined the link between child social development and a variety of maternal prenatal conditions—including obesity, gestational diabetes, gestational hypertension, and preeclampsia. Their research, titled “Cardiometabolic pregnancy complications in association with autism-related traits as measured by the Social Responsiveness Scale in ECHO,” is published in the American Journal of Epidemiology and aims to help better understand how a variety of risk factors during pregnancy relate to complex developmental outcomes, such as autism-related traits.

“Just like intelligence scores or height can be plotted on a curve representing everyone’s values ranging from low to high, social functioning and behaviors can also be measured and scored along a similar distribution,” said Dr. Lyall. “Investigating how exposures, health conditions, and risk factors relate across the full range of the outcome distribution may help us learn more about the nature of these relationships and their impact on the population.”

The study involved nearly 7,000 participants from 40 ECHO cohorts, including eight cohorts that had participants with increased likelihood of autism. The researchers collected data on maternal health conditions during pregnancy, maternal age, child autism-related social behaviors, and participant demographics.

Maternal obesity and gestational diabetes are common prenatal conditions, so understanding the impacts of these conditions on children development is an important public health issue. “This work shows that these conditions are not only linked with diagnoses of autism and other developmental conditions, but also subtler changes in related behavioral scores,” said Dr. Ladd-Acosta. “These results highlight the need for better prenatal care and more monitoring of women experiencing conditions like obesity during pregnancy.”

More work is needed in the future to reveal the specific mechanisms linking maternal prenatal health to childhood autism-related social development.

Read the research summary.

ECHO Researchers Identify Effects of Mixed Metal Exposures on Fetal Growth

Posted on by Jodi Snare

In a collaborative research effort led by Caitlin Howe, PhD and Margaret Karagas, PhD of Dartmouth College, researchers observed an inverse association between the metalloid antimony and birth weight for gestational age, suggesting that this understudied metalloid may harm fetal growth. Their study, titled “Prenatal metal(loid) mixtures and birth weight for gestational age: a pooled analysis of three cohorts participating in the ECHO Program” is published in Environment International.

The study included approximately 1,000 mother-newborn pairs in three geographically and demographically diverse ECHO cohorts:

  • The Maternal And Developmental Risks from Environmental and Social Stressors (MADRES) study, a predominantly lower-income Hispanic cohort in Los Angeles, California
  • The New Hampshire Birth Cohort Study (NHBCS), a primarily non-Hispanic white cohort in northern New England
  • The Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) study, a Hispanic cohort in northern Puerto Rico.

The team pooled data from these three cohorts, measured multiple metals in the mothers’ urine samples collected during pregnancy and evaluated the associations with birth weight for gestational age using a multipollutant analysis approach. In addition to the findings for antimony, the team reported that the effects of other metals (cobalt, mercury, nickel, tin) on birth weight for gestational age differed by cohort and/or infant sex. The mixture of metals together did not impact birth weight for gestational age. Cadmium and molybdenum individually were not associated with differences in birth weight for gestational age.

“Previous research on this topic has mainly focused on one metal at a time, but individuals are often exposed to multiple metals simultaneously, which may interact in complex ways to impact health,” said Howe.

This research highlights the need to identify major sources of antimony, which may differ depending on the population, such that interventions can be developed to reduce exposure to this toxic metalloid. In the future, the research team would also like to expand their analysis to additional ECHO cohorts and participants, investigate other biomarkers of metal and metalloid exposures, and identify windows in pregnancy when the developing fetus may be most susceptible to these exposures.

Read the research summary.

ECHO Researchers Investigate Youth Well-being During Covid-19

Posted on by Jodi Snare
Courtney K. Blackwell, PhD
Courtney K. Blackwell, PhD

Between May 2020 and May 2021, ECHO conducted collaborative research led by Person Reported Outcomes (PRO) Core investigator Courtney K. Blackwell, PhD of Northwestern University to investigate COVID-19 pandemic-related family hardships associated with child stress and well-being. This research, titled “Youth well-being during the COVID-19 pandemic,” is published in Pediatrics.

The results of this study demonstrated that families who faced more hardships related to the COVID-19 pandemic had higher levels of both caregiver and child stress and lower child life satisfaction. However, being more socially connected to peers and engaging in family activities led to higher life satisfaction overall. The researchers found that for younger children, family engagement decreased the negative effect of COVID-19 pandemic-related stress on their life satisfaction. For adolescents, pre-existing anxiety and/or depression increased their risk for lower life satisfaction during the COVID-19 pandemic.

During the COVID-19 pandemic, families have faced hardships and interruptions to their daily lives. These disruptions are likely to have a lasting effect on the well-being of children, but the extent of this effect is still unknown. Additionally, little is known about how families can protect their children from COVID-19 pandemic-related stress and promote their positive mental health.

To conduct this research, Dr. Blackwell and her team surveyed more than 1,600 families from 30 US states about their COVID-19 pandemic experience. This study included both parent-reported surveys on children aged 2-12 years and self-reported surveys on adolescents aged 11-17 years. The researchers used survey data from 14 ECHO cohorts across the US to evaluate how COVID-19 pandemic-related family hardships have affected caregiver and child stress, and how stress, social connection, family engagement, and pre-existing mental health conditions have affected children’s life satisfaction.

The study findings demonstrate some of the varied ways that families can cope with adverse events and promote their children’s well-being through family engagement and fostering peer social connectedness. “This study also showed that stress and well-being are not direct opposites,” said Dr. Blackwell, “suggesting the need for future interventions that target both decreasing children’s stress and improving their well-being rather than one or the other.”

The next steps for this research include focusing in on specific COVID-19-related family hardships in order to identify the hardships that contribute the most to child stress and develop targeted strategies for improving child well-being.

Read the research summary.

ECHO Studies Examine Parent-Reported Child Diet Assessments

Posted on by Jodi Snare

Collaborative ECHO research led by Traci Bekelman, PhD, MPH and Dana Dabelea, MD, PhD of the University of Colorado, Anschutz Medical Campus, analyzed parents’ experiences with two parent-reported diet assessments: the Remote Food Photography Method (RFPM)—which involves parents taking pictures of their child’s meals using a smartphone app—and the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24)—which involves parents filling out daily recalls of their child’s meals.

One of their studies, titled “A Qualitative Analysis of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for Assessing Children’s Food Intake Reported by Parent Proxy,” is published in the Journal of the Academy of Nutrition and Dietetics.

This research compared parents’ experience with the RFPM and ASA24. While parents found the RFPM easier to use, they also reported difficulties with missing or forgetting meal photos. Parents appreciated the consolidated workload of the ASA24, but reported that the time commitment was difficult to manage and the food database left out some foods from diverse cuisines.

During the study, researchers collected child diet data from the parents of 40 children aged seven or eight from an ECHO cohort in Colorado and an IDeA States Pediatric Clinical Trials Network site in Louisiana. Parents tracked their child’s diet for three days using either the RFPM or the ASA24 and then for an additional three days using the other method. Afterwards, parents were given surveys on their experience with these tools, and 32 parents participated in focus group discussions.

The insights of parents participating in this study revealed some of the key strengths and weaknesses associated with these tools that may impact participant burden and the accuracy of parent-reported child diet data. “This study has practical implications because researchers have multiple options when selecting a dietary assessment tool,” said Dr. Bekelman, “and must therefore weigh the relative strengths and weaknesses of each method.”

An additional study from this research team compared the accuracy and effectiveness of the RFPM and ASA24 for child dietary assessment by parent-proxy. Caregivers who participated in the study were generally happy with both methods, but each method had drawbacks. The team’s research, titled “A comparison of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for measuring full day dietary intake among school-aged children,” is published in the British Journal of Nutrition.

For this study, the research team recruited participants from the same population in the aforementioned study and asked them to try two ways of measuring what and how much their child ate using the RFPM and ASA24. Participants completed a survey providing information on satisfaction, ease of use, and burdens for each tool.

The team found that most caregivers were happy with both methods. However, some of the main drawbacks that caregivers reported with the ASA24 included challenges using the website and difficulty estimating how much their child ate. On the other hand, the caregivers’ main difficulty with the RFPM was underreporting due to missing photos. These findings will help researchers improve these methods to increase the accuracy of measuring what children eat and reduce participant burden.

Read the research summaries.