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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.

For Teens’ Mental Health, Strong Friendships Matter More Than Social Media Use, NIH Study Finds

Posted on by Jodi Snare

Teens who report strong, high-quality friendships tend to have better mental health—an influence that appears nearly three times stronger than the link between social media use and mental health challenges, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Today’s teens spend a lot of time online. This has raised concerns about how digital interactions affect teens’ well-being. As social media use has grown, some wonder if it’s playing a role in the rise of teen mental health challenges. Such concerns prompted the U.S. Surgeon General to issue a warning in 2023 about the potential impact of social media on youth mental health.

“Social media use does not occur in a vacuum—it’s one piece of a much larger picture,” said Courtney K. Blackwell, PhD, of Northwestern University’s Feinberg School of Medicine. “Our study found that peer relationships seem to matter a lot more than social media when it comes to teen mental health outcomes.”

In the study, researchers found that a teen with strong, supportive friendships is likely to experience positive mental health, regardless of how much time they spend on social media. By contrast, teens who report poor-quality friendships and nearly the same level of social media use are more likely to report poor mental health. In comparison, the amount of time spent using social media had a much smaller influence on teen mental health outcomes.

Teens ages 13 to 18 reported how much time they spend on social media and whether they use it actively (like posting and commenting) or passively (like scrolling and browsing). Researchers used the PROMIS® assessment tools and the Strengths and Difficulties Questionnaire to measure their mental well-being, including life satisfaction, sense of purpose, symptoms of depression, and the quality of their friendships.

A 2021 national survey of 8th and 10th graders, cited in the U.S. Surgeon General’s report on social media and youth mental health, found that teens spent an average of 3.5 hours daily on social media. More recently, a 2023 Gallup survey of 13- to 19-year-olds reported that the average had increased to 4.8 hours per day.

The study included 963 teens aged 13 to 18 from across the United States. Teens completed surveys on social media habits, peer relationship quality, and mental health outcomes. The results provide insight into how social media use and mental health influence each other during the teenage years, extending beyond negative outcomes like anxiety and depression to also include positive mental health indicators.

“Instead of just focusing on limiting adolescents’ social media use, perhaps emphasizing ways to bolster the quality of their social relationships would help address the current youth mental health crisis in the U.S.,” said Dr. Blackwell.

Looking ahead, the research team plans to use data collected over time to understand better how social media use and mental health influence each other during this sensitive development period. Future studies could focus on improving peer relationship quality as a pathway to better teen mental health outcomes.

This collaborative research was published in the Journal of Adolescent Health.

 

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

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Follow @ECHOChildHealth for the latest ECHO Program updates on X.

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.

Prenatal Exposure to Phenols and Parabens Appear to Be Higher Among Minority Populations, ECHO Study Finds

Posted on by Jodi Snare

Pregnant women in Hispanic and Black communities may experience greater prenatal exposure to endocrine-disrupting chemicals (EDCs), including environmental phenols (EPs) and parabens, according to a study funded by the Environmental influences on Child Health Outcomes (ECHO) Cohort at the National Institutes of Health (NIH).

EDCs are commonly encountered during pregnancy through everyday items such as plastics, food packaging, and personal care products. Although these products break down quickly in the body, EDCs can cross the placenta and accumulate in fetal tissue. Prenatal exposure has been linked to pregnancy complications, developmental challenges, and long-term health risks.

The findings revealed significant differences in chemical exposure levels based on race and ethnicity. Non-Hispanic Black and Hispanic participants had higher levels of certain EPs compared to non-Hispanic White participants. For example, non-Hispanic Black and Hispanic participants showed elevated levels of paradichlorobenzene—a chemical found in mothballs, fumigants, and air fresheners. Non-Hispanic Black participants also had higher levels of parabens, commonly used as preservatives in processed foods and personal care items.

“These findings indicate that pregnant individuals from different racial and ethnic backgrounds experience varying levels of exposure to potentially harmful chemicals,” said Michael S. Bloom, PhD, of George Mason University. “Understanding these differences is crucial for evaluating their effects on maternal and fetal health and identifying the underlying causes can inform effective interventions.”

Researchers analyzed urine samples from 4,006 pregnant participants across 11 ECHO Cohort Study Sites, representing Hispanic, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White individuals.

Low-income and minority communities may face heightened exposure due to factors like proximity to industrial facilities and limited access to a broad range of consumer products and fresh foods, researchers noted in the study.

This collaborative research was published in the Journal of Exposure Science and Environmental Epidemiology.

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Bloom, M.S., Upadhyaya, S., Nzegwu, A.W. et al. Racial and ethnic differences in prenatal exposure to environmental phenols and parabens in the ECHO Cohort. J Expo Sci Environ Epidemiol (2025). https://doi.org/10.1038/s41370-025-00750-w

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X.

NIH Study Suggests Behavioral and Emotional Challenges More Common in Children with Autism Spectrum Disorder (ASD)

Posted on by Jodi Snare

Children with autism spectrum disorder (ASD) showed higher levels of emotional and behavioral problems, including depression, anxiety, and ADHD, compared to their peers without ASD, according to a new study funded by the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program.

Key Takeaways:

  • Children with ASD had higher scores on the Child Behavior Checklist (CBCL)—a questionnaire that helps identify emotional and behavioral challenges in children and adolescents—showing they may experience more emotional and behavioral challenges overall.
  • Higher CBCL scores were linked to the likelihood of receiving an ASD diagnosis, particularly for children scoring in the top 30%.
  • Among children with ASD, girls experienced significantly higher levels of anxiety and depression compared to boys, with age-related differences in symptom severity.
  • Autism-related traits measured by the Social Responsiveness Scale (SRS) were associated with higher CBCL scores, suggesting that children with more autism traits may face additional emotional and behavioral challenges.

These findings highlight the importance of monitoring and addressing emotional and behavioral health in children with ASD to better inform early interventions. To learn more, access the study online.

Read the research summary.

NIH Study Finds No Significant Link Between Time Spent in Childcare and Young Children’s Mental Health, Even Amid Early Adversity

Posted on by Jodi Snare

Sending children to childcare outside the home may not significantly affect children’s mental health, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health. This finding holds true even for children who face challenges, such as a parent’s mental illness or financial struggles at home.

Many children in the U.S. under the age of 5 years spend some time in childcare outside the home. Researchers wanted to learn whether attending childcare influenced the mental health of children, particularly those who had experienced early adversity.

“Despite the extensive use of childcare in the U.S. and documented benefits, there are still some concerns that childcare attendance (vs. staying at home with a parent) increases the risk for poor child outcomes,” said Michelle Bosquet Enlow, PhD, of Boston Children’s Hospital and Harvard Medical School. “This can lead to considerable feelings of guilt and worry for parents who use childcare.”

The study looked at various forms of childcare, including center-based care, home-based non-relative care, and care by a relative. However, previous findings on the role of childcare in child mental health have produced mixed results. While many studies highlight positive associations with attending childcare, some raise concerns that childcare may increase the risk for poor child developmental outcomes. “Understanding how childcare can influence children's development, especially for those facing extra challenges, can help shape public policies that promote healthy outcomes for kids,” said Dr. Bosquet Enlow.

Key Findings

  • Children facing early life adversity were more likely to have higher levels of anxiety, depression, aggression, or hyperactivity symptoms.
  • Childcare attendance did not seem to be associated with increased or decreased levels of mental health symptoms, including among children facing adversity.
  • The study did not find any evidence that the number of hours in childcare corresponded to worse mental health outcomes for children, even those at elevated psychosocial and socioeconomic risk.

The findings suggest that while children facing higher levels of stress, mental illness in the family, and economic hardship were more likely to have higher levels of internalizing symptoms (such as anxiety and depression) and externalizing symptoms (such as aggression and hyperactivity), number of hours in childcare did not appear to play a significant role in altering these outcomes.

About the study

The study followed 2,024 parent-child pairs from three diverse U.S. research groups within the ECHO Cohort. Participants were recruited from hospitals in North Carolina, Pennsylvania, and Tennessee, as well as from adoption agencies across the United States.

Researchers measured children’s childcare experiences from birth to age 3 years and examined parental factors like childhood adversity, depression, and education level. Between ages 3 and 5.5 years, the children’s mental health was assessed for symptoms like anxiety, depression, and aggression.

This collaborative research was published in Development and Psychopathology.

Bosquet Enlow, M., et al. (2024) The Influence of Early Childhood Education and Care on the Relation between Early Life Social Adversity and Children’s Mental Health in the Environmental influences for Child Health Outcomes Program. Development and Psychopathology. DOI: 10.1017/S0954579424001822

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

 

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X.

Year in Review 2024

Posted on by Jodi Snare

A newly published feature, Year in Review 2024, reflects how the ECHO Cohort Consortium has continued to enhance child health for generations to come.

Through the ECHO Cohort, a collaborative approach to gathering information from study participants across dozens of research awards, many of the nation’s leading researchers are working together to examine a broad range of early environmental influences—including socioeconomic status, family support, biological factors, nutrition, and physical and chemical exposures.

Currently, the NIH is funding 45 ECHO Cohort awards at academic medical centers across the country where investigators and their teams completed activation of 77 study sites where researchers enroll participants and collect data. These sites are located across 30 states, Puerto Rico, and the District of Columbia. ECHO Cohort study sites are identified in blue on the map.

In the past year, these research teams have enrolled nearly 6,000 pregnancies on the way to the program’s goal of 30,000 new pregnant participants. When those babies are born, they join the 30,000 existing child participants in the ECHO Cohort.

In 2024, ECHO research teams completed numerous analyses of the data collected in the ECHO Cohort, drawing important conclusions about how environmental influences impact child health outcomes. These insights were shared in 48 research articles published by peer-reviewed science and public health journals over the year.

The consortium’s work in 2024—from activating study sites to enrolling participants to publishing research analyses—represents another year of growth, collaboration, and learning.

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.

NIH Study Highlights Potential Disparities in Birthweight Outcomes Linked to Environmental Exposures in Vulnerable Populations

Posted on by Jodi Snare

A new study from the Environmental influences on Child Health Outcomes (ECHO) Program sheds light on how environmental exposures may have a larger impact on birth outcomes in vulnerable populations, particularly those defined by race, ethnicity, and maternal education. Researchers wanted to understand when the effect of these exposures becomes clinically significant and how different levels of exposure impact various groups differently.

To explore this, researchers used statistical models to simulate four potential scenarios in which average birthweights in a population could be reduced by varying amounts: 50g, 125g, 167g, and 250g. The study found that the percentage of children with low birthweight (LBW) (birthweight<2500g) varied by socioeconomic categories with the greatest percentage LBW seen in the most vulnerable socioeconomic groups. After analyzing the four scenarios, a clear trend was seen such that the greatest impact of an exposure was seen in the most vulnerable sub-populations. This trend was observed for all scenarios including the impact of a small environmental exposure. The most striking disparity among all scenarios was found in racial sub-populations.

This study showed how vulnerable groups, who already face higher risks of poor health, are more affected by small environmental exposures compared to the general population. Read a research summary here.

Nutrition That Aligns With Guidelines During Pregnancy May Be Associated With Better Infant Growth Outcomes, NIH Study Finds

Posted on by Jodi Snare

Expectant mothers who maintain a diet that meets USDA dietary guidelines during pregnancy may be more likely to have infants with healthy birthweights, steadier growth patterns, and potentially a reduced risk of obesity later in childhood, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

The research, involving more than 2,800 mother-child pairs across eight ECHO Cohort Study Sites, suggests that following a healthy prenatal diet in line with the USDA Dietary Guidelines for Americans could have long-term positive effects on infant growth up to 24 months.

“This study found that eating a healthy diet during pregnancy was linked with a lower chance of extremely rapid infant growth,” said Assiamira Ferrara, MD, PhD, of Kaiser Permanente Northern California Division of Research. Dr. Ferrara noted that rapid growth from birth to 24 months is a strong predictor of obesity later in life.

The study used two dietary measures—the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP)—to look at maternal eating patterns. The HEI measures overall diet quality. The EDIP score measures how likely a diet is to cause inflammation in the body. Diets with high EDIP scores have been linked to increased levels of inflammation.

Key findings from the research showed that:

  • Higher HEI scores, reflecting healthier diets, were associated with a 12% reduced chance of infants being born large for gestational age (LGA), alongside lower rates of rapid growth up to 6 and 24 months.
  • Lower EDIP scores, indicating diets with reduced inflammatory potential, were associated with a 24% higher chance of LGA and had mixed effects on growth: slower from birth to 6 months but faster growth between birth and 12 months. This association was less clear and warrants further study.

To assess rapid growth, the study relied on a measurement called the weight-for-length z-score (WLZ) a tool used to track an infant's growth. It compares a baby’s weight to its length and tells you how far a baby's weight is from the average weight of babies of the same length. Rapid growth was defined as a significant increase in WLZ scores from birth to 6, 12, or 24 months. Babies whose WLZ scores jumped more than expected moved to a higher percentile on the growth chart, meaning they weighed more relative to their peers of the same length.

“The findings support a role for a balanced prenatal diet that aligns with the USDA Dietary Guidelines in promoting healthy birthweights and balanced growth through early childhood,” said Monique Hedderson, PhD, of Kaiser Permanente Northern California Division of Research. “This suggests the need for programs to help improve pregnant womens' access to healthy food and interventions to support healthy eating during pregnancy.”

Researchers said that the findings represent an opportunity for an early obesity prevention strategy. More research is needed to learn how low-inflammatory diets during pregnancy might benefit fetal and infant growth.

About the Study

The study analyzed data collected between 2007 and 2021 from the ECHO Program about 2,854 mother-child pairs. Among the children studied, 48.7% were girls. Children came from diverse racial and ethnic backgrounds: 23.3% White, 22.4% Black, 35.8% Hispanic, 7.8% Asian, and 7.8% other racial backgrounds. Researchers collected information on diet, birth size, and infant growth at 6, 12, and 24 months through medical records and other measurement tools.

This collaborative research was published in JAMA Network Open.         

Ferrara, A. & Hedderson, M. (2024) Prenatal Diet and Infant Growth from Birth to Age 24 months. JAMA Network Open. DOI:: 10.1001/jamanetworkopen.2024.45771

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

 

Media Contacts

For information or to request an interview, contact Rebekah Yeager,  rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact  NIHKidsandEnvironment@od.nih.gov.

Connect With Us

echo connectorCheck out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X.