News

Vitamin D During Pregnancy May Play a Role in Children’s Cognitive Development, ECHO Study Suggests

Posted on by Jodi Snare

Higher vitamin D levels during pregnancy may be linked to better scores on cognitive tests, according to a new study by the Environmental influences on Child Health Outcomes (ECHO) Cohort.

Researchers found that children whose mothers had higher vitamin D levels while pregnant tended to perform better on cognitive tests assessing skills like problem-solving and processing new information at ages 7 to 12. However, vitamin D levels were not linked to skills based on learned knowledge, such as vocabulary. The association appeared strongest among children of Black mothers, and vitamin D levels measured earlier in pregnancy seemed most important for children’s brain development. Black people often have lower vitamin D levels because their skin has more pigment, which makes it harder for the skin to produce vitamin D from sunlight.

“Our study provides important new evidence that early pregnancy may be a critical period when vitamin D has the greatest potential to support cognitive development, said Melissa M. Melough, PhD, RD of the University of Delaware, Newark. “This highlights a key opportunity for clinicians to enhance screening and support for vitamin D supplementation before and during pregnancy. “

Vitamin D deficiency is common during pregnancy and has been linked to early brain development, but few studies have examined whether these effects continue into later childhood or differ by racial group. The researchers emphasize that while these findings add to growing evidence on the role of vitamin D in pregnancy, further studies are needed to determine the optimal dose and timing of supplementation to support cognitive development.

This collaborative research was published in The American Journal of Clinical Nutrition.

Living in Low-income-low-food-access Neighborhoods Linked to Higher Risk of Childhood Asthma

Posted on by Jodi Snare

Living in a low-income neighborhood with low food access was associated with higher risks of developing asthma, according to a recent ECHO Cohort study led by Veronica A. Wang, PhD, Antonella Zanobetti, PhD, and Diane Gold, MD of Harvard T. H. Chan School of Public Health and Rima Habre, ScD of the University of Southern California.

Asthma is characterized by chronic inflammation in the lungs, and prior research shows that a nutritious diet can reduce airway inflammation. However, access to affordable and healthy foods is often difficult for many communities that have limited access to supermarkets or grocery stores. In this study, the researchers wanted to learn whether living in a low-income-low-food access neighborhood was associated with childhood asthma and whether this association was modified by sociodemographic factors.

The study included 16,012 children from 35 ECHO Cohort study sites across the U.S., and the investigators used low-income-low-food-access (LILA) neighborhood metrics from the U.S. Department of Agriculture’s Food Access Research Atlas to evaluate each child’s neighborhood food access.

Key Takeaways include:

  • Living in a low-income neighborhood with low food access was associated with higher risks of developing asthma for both cumulative early (age 0-5 years) and cumulative middle (age 0-11 years) childhood, which stronger associations observed for cumulative early childhood.
  • The increased risk of asthma was more noticeable among girls, Hispanic children, and children whose mothers had less than a high school education.
  • The findings suggest that food access in the immediate vicinity of residence and that vehicle access may be important and may contribute to disparities in childhood asthma development.

This collaborative research, titled “Residing in a low-income-low-food-access neighbourhood and asthma in early and middle childhood in the Environmental influences on Child Health Outcomes (ECHO) program: a multisite cohort study,” is published in BMJ Open.

Exposure to Air Pollution During Pregnancy Associated with Higher Risk for Autism-related Outcomes

Posted on by Jodi Snare

Exposure to certain air pollutants during pregnancy was associated with autism-related traits and increased odds of autism spectrum disorder (ASD) diagnosis in children, according to a recent ECHO Cohort study led by Akhgar Ghassabian, MD, PhD of NYU Grossman School of Medicine and Heather Volk, PhD of Johns Hopkins Bloomberg School of Public Health.

Air pollution is a significant environmental health concern and contributes to many illnesses and early deaths worldwide. Ambient air pollution can have detectable effects on the brain. Recent studies show that being exposed to air pollution during pregnancy and early life can affect how a child’s brain develops. This can happen through several pathways, such as causing inflammation in the brain, disrupting hormones, or changing how genes work. Previous research has suggested potential links between air pollution and neurodevelopmental disorders, but the relationship between exposure to air pollution, even at low levels, during pregnancy and ASD has been unclear.

This study included 8,035 mother-child pairs from 44 ECHO Cohort study sites, including over 1,000 children who were potentially at higher risk for ASD based on being born preterm or having siblings with autism.

Key takeaways include:

  • Prenatal exposure to ozone was associated with autism-related traits and increased risk of ASD diagnosis.
  • Exposure to fine particulate matter (PM5) and nitrogen dioxide was also associated with a higher risk of autism, but associations varied by geographical regions.
  • There was little evidence for differences between boys and girls in the association between prenatal air pollution exposure and autism outcomes.

These findings suggest that even low levels of air pollution exposure during pregnancy can be associated with autism-related outcomes. This highlights the importance of understanding the risks associated with air pollution exposure during pregnancy and its effects on neurodevelopment.

This collaborative research, titled “Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium,” is published in Environmental Health Perspectives.

Young Children Show Widespread Exposure to Environmental Chemicals, ECHO Study Finds

Posted on by Jodi Snare

Children had higher levels of certain replacement chemicals compared to their mothers during pregnancy.

Young children are exposed to a wide range of environmental chemicals, including some emerging and replacement chemicals, according to ECHO Cohort research measuring early childhood exposures. This study found that children aged 2 to 4 years often had higher levels of certain chemicals compared to their mothers during pregnancy, highlighting potential risks for future health.

Researchers measured 111 different chemicals in urine samples from 201 children and their mothers from six ECHO Cohort study sites across the United States. More than half of the children’s samples contained multiple chemicals, such as environmental phenols, pesticides, phthalates, and markers of exposure to polycyclic aromatic hydrocarbons (PAHs). Approximately 34 chemicals were found in over 90% of the samples, including nine of which have not been included in U.S. national biomonitoring.

Compared to their mothers, children showed higher levels of chemicals like bisphenol S (BPS), used in hard plastics and synthetic fibers, and compounds related to pesticides. By contrast, mothers had higher levels of chemicals such as triclosan and monoethyl phthalate (MEP), which are found in some soaps and cosmetics.

“Finding so many chemicals detected in over 90% of young children reinforces the concern that our children are being exposed to a sea of potentially harmful compounds from their earliest years, with little parents can do to protect them”, said Deborah Bennett, PhD of the University of California, Davis.

Over time, exposures to chemicals like triclosan, parabens, phthalates, and PAHs have become less common, likely due to regulations and bans. However, replacement chemicals such as DINCH—a phthalate substitute in some plastics—and certain pesticides have been increasingly detected.

This collaborative research, titled “Early Childhood Exposures to Environmental Chemicals in the Environmental influences on Child Health Outcomes Consortium,” is published in Environmental Science & Technology.

Prenatal Exposure to Certain Flame Retardants Associated with Autism-Related Traits, ECHO Study Finds

Posted on by Jodi Snare

High exposure to some organophosphate esters (OPEs) during pregnancy was associated with higher scores for increased autism-related traits and greater odds of an autism diagnosis in children, according to research from the Environmental influences on Child Health Outcomes (ECHO) Program led by Jennifer Ames, PhD, and Lisa Croen, PhD of Kaiser Permanente Northern California. Overall, the study found generally small associations between three OPEs and child autism-related outcomes.

OPEs, often called “regrettable replacements,” replaced polybrominated diphenyl ethers (PBDEs) in the mid-2000s as flame retardants and plastic softeners, and are now found in furniture, electronics, construction materials, textiles, and infant products. Despite their widespread use, little is known about their effects on child development.

In this study, ECHO researchers analyzed urine samples from 4,159 pregnant mothers for nine OPE biomarkers and assessed children’s autism-related traits using the Social Responsiveness Scale (SRS), along with autism diagnoses.

Key findings include:

  • High exposure to bis(butoxyethyl) phosphate (BBOEP) was associated with higher autism-related trait scores and greater odds of an autism diagnosis, particularly among boys.
  • Bis(1-chloro-2-propyl) phosphate (BCPP) exposure was linked to higher autism-related trait scores.
  • High exposure to bis(2-chloroethyl) phosphate (BCETP) was associated with lower odds of an autism diagnosis.

“Organophosphate esters are widely used, but their potential effects on neurodevelopment are understudied. Our findings highlight the need for further research to understand their long-term effects on child neurodevelopment,” said Dr. Ames.

The study included children born from 2006 to 2020 at 15 ECHO Cohort sites across the United States.

This collaborative research, titled “Exposure to organophosphate ester flame retardants and plasticizers during pregnancy and autism-related outcomes in the ECHO Cohort,” is published in Environmental Health Perspectives.

Register Now for the NIH ECHO Symposium “Translating Science to Action”

Posted on by Jodi Snare

Please join the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program for the inaugural ECHO Symposium: Translating Science to Action on Sept. 15, 2025, at the NIH campus in Bethesda, Maryland, and online. This free, one-day event will bring together researchers, clinicians, policymakers, advocates, community leaders, and more to explore how early environmental factors influence child health—and how we can translate science into meaningful action.

Agenda highlights include:

  • Keynote Address by Dr. Susan Kressly, President of the American Academy of Pediatrics
  • Opening remarks by Dr. Matt Gillman, Director of the NIH ECHO Program and by former ECHO Cohort Participant, Jadine Benjamin
  • Closing address by Dr. Michael Warren, Chief Medical and Health Officer of the March of Dimes
  • Three dynamic sessions featuring expert presentations, panel discussions, and opportunities for audience Q&A.

Whether you join us in person or online, you’ll have the opportunity to participate in Q&As, connect with thought leaders, and help advance solutions to improve the health of children for generations to come!

If you haven’t yet, register now to reserve your spot!

Here’s a closer look at what’s planned:

Session 1: Chemical Exposures
Session Chair
Kristie Trousdale, Children’s Environmental Health NetworkSafer Alternatives? Investigating Replacement Chemicals and Child Health
Dr. Jessie Buckley, University of North Carolina

Exposure to Phthalates in Pregnancy and Childhood: Evidence, Knowledge Gaps, and Opportunities
Dr. Leo Trasande, NYU Grossman School of Medicine

From Clinic to Community: Translating Environmental Health Research into Pregnancy Care
Dr. Blair Wylie, Beth Israel Deaconess Medical Center

Session 2: Social and Neighborhood Factors
Session Chair
Dr. Nicole Bush, University of California, San FranciscoUnderstanding Childhood Trauma and Toxic Stress to Enhance Child Health
Dr. Nadine Burke Harris, Former California Surgeon General

Associations of Neighborhood Opportunity and Vulnerability with Child Health Outcomes
Dr. Izzuddin Aris, Harvard Pilgrim Health Care Institute and Harvard Medical School

Influences of Media Use on Child Health and Development
Dr. Jenny Radesky, University of Michigan

Session 3: Community Experiences
Session Chair
Dr. Lee Beers, Children’s National HospitalBehind the Data: A Parent’s Voice in Pediatric Research
Cassondra Perez, ECHO Cohort Parent Participant

Indigenous Community Health
Dr. Johnnye Lewis, University of New Mexico

Rural Health Research in the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN)
Dr. Leslie Young, University of Vermont

From Flint to Rx Kids: Translating Crisis into a Bold Prescription for Healthier Futures
Dr. Mona Hanna, Michigan State University

ECHO Research Finds No Significant Association Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

Posted on by Jodi Snare

Wheezing symptoms occur in 20-40% of infants, contributing to a substantial impact on children’s quality of life and their use of healthcare. Multiple early exposures, such as prenatal exposure to cigarette smoking, have been associated with these wheezing symptoms. Previous studies have suggested a possible link between antibiotic exposure during pregnancy and an increased risk of wheezing and cough in children, caused by an imbalance in the birthing parent’s microbiome due to antibiotic use.

“It is unlikely that a randomized controlled trial could be done to try to answer this question, because antibiotics are necessary treatments for bacterial infections during pregnancy,” said ECHO Cohort investigator Rachel Greenberg, MD, MB, MHS of Duke University. “In the absence of trial data, large studies that observe individuals over time, like the ECHO Cohort, are essential to understand the impact of common interventions during pregnancy.”

This study included 4,721 pregnant participants and their 4,779 infants from 12 study sites in the ECHO Cohort Consortium. Overall, 36% of pregnant participants used at least one antibiotic while pregnant, and about 26% of infants had a report of wheezing.

Key takeaways include:

  • Exposure to antibiotics during pregnancy was not associated with infant wheezing during the first 18 months after birth.
  • Prenatal antibiotic exposure was also not associated with an increase in emergency room visits or hospitalizations for wheeze during infancy.
  • However, prenatal antibiotic use was associated with higher odds of medication use for wheeze or dry cough during infancy, which could imply more severe symptoms and a medical provider’s diagnosis.
  • An association between prenatal antibiotic exposure and medication use for wheeze or cough during infancy was only observed among children born via vaginal delivery and thus exposed to the birthing parent’s microbiota.
  • The researchers also observed an association between prenatal antibiotic exposure and wheeze in research sites that recruited participants who had a family history of asthma, suggesting that a genetic or environmental risk within these families may increase the likelihood of wheeze.

This collaborative research, titled “Association Between Prenatal Antibiotic Exposure and Infant Wheeze Outcomes” is published in Acta Paediatrica.

 

NIH Study Finds No Association Between Prenatal Dietary Patterns and Autism Diagnoses, But Potential Links with Broader Traits

Posted on by Jodi Snare

Three validated dietary patterns were not associated with diagnosis, but healthy eating during pregnancy showed a modest link with lower scores for traits related to autism

Expectant mothers with higher diet quality—measured by the Healthy Eating Index (HEI) and the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P)—had children with modestly lower scores for traits related to autism spectrum disorder (ASD), according to ECHO Cohort research led by Kristen Lyall, ScD, and Rachel Vecchione, MPH, of Drexel University. However, the study did not find a significant association between these prenatal dietary patterns and a formal ASD diagnosis.

Previous research has suggested potential links between prenatal diet and neurodevelopmental conditions, but most studies focused on individual foods or nutrients rather than overall dietary patterns. In this study, ECHO researchers examined overall dietary patterns to better understand effects of usual dietary intake across foods.

“This study broadly supports the importance of a healthy diet during pregnancy. Autism is a complex condition with many contributing factors. Here, we found some evidence to suggest a healthy diet during pregnancy may be linked with reduced likelihood of broader traits related to autism, but effect sizes were small,” said Dr. Lyall.

The study included up to 6,084 mother-child pairs from 14 ECHO Cohort Study Sites, which included general population sites and sites with a higher chance of ASD occurring in families.

This collaborative research, titled “Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental influences on Child Health Outcomes Consortium,” is published in Nutrients.

Stronger Executive Functioning Skills in Children May Support Healthier Behaviors and Lower Chronic Disease Risk, Study Finds

Posted on by Jodi Snare

Children with stronger executive functioning skills may be better equipped to develop health-promoting behaviors that reduce their risk of chronic disease, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Key takeaways include:

  • Across all pediatric life stages, children with higher working memory consumed fewer sugary drinks and saturated fats.
  • In middle childhood, greater cognitive flexibility and behavioral inhibition were linked to eating more fruits and vegetables. These skills were also associated with increased physical activity.
  • In adolescence, higher scores in all executive functioning domains were linked to greater physical activity.

“The results of this study allow us to get more specific in how and when we intervene,” said ECHO Cohort investigator Nichole Kelly, PhD of the University of Oregon. “For example, targeting working memory as a specific domain of executive functions may be most fruitful in improving children’s dietary behaviors, particularly through early intervention, as the link between working memory and diet was evident in early childhood.”

The findings suggest that early interventions targeting executive functioning, particularly working memory, could improve dietary habits throughout childhood. However, the effects of executive functioning on health behaviors were small, indicating that additional strategies may be necessary to support families in fostering healthier lifestyles. Additionally, because this study looked at this association at only one point in time for each child, it isn’t clear whether executive functioning influences health behaviors or vice versa.

This collaborative research, titled “Children’s executive functioning and health behaviors across pediatric life stages and ecological contexts,” was published in the Journal of Behavioral Medicine.

New ECHO Research Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

Posted on by Jodi Snare

Maternal stress during pregnancy showed a small but significant association with child sleep problems and sleep disturbance, according to recent ECHO Cohort research led by Sarah Dee Geiger, PhD and Susan Schantz, PhD of the University of Illinois at Urbana-Champaign and Aruna Chandran, MD, MPH and Marie L. Churchill, MS of Johns Hopkins University Bloomberg School of Public Health. This effect was seen even when the researchers accounted for the influence of maternal stress after pregnancy.

“Sleep is crucial for child vitality, and poor sleep quality is common among kids in the U.S., so any modifiable factor that affects it is worth paying attention to,” said Dr. Geiger. “In this case, getting moms’ stress down during pregnancy and beyond will have positive effects on their children’s sleep quality, setting them up for a healthier childhood and beyond.”

“Poor quality sleep has all kinds of health implications in childhood and beyond,” added Dr. Schantz. “Yet we don’t have a good understanding of the environmental factors that contribute to poor sleep quality in children. This study of children from several cohorts across the U.S. sheds new light on the impact maternal stress, both prenatal and postnatal may have on child sleep.”

Additional studies can help researchers understand the biological mechanisms and social determinants underlying the relationship between maternal stress and child sleep. Read the research summary here.