ECHO Research Suggests Airborne Lead Exposure Affects Children’s Cognitive Development, Impacting Males More Than Females

Authors: Amii Kress, Lisa Gatzke-Kopp, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Chemicals used in manufacturing, such as lead, are often released into the air and water. The government sets limits on the amount of pollution that is allowed based on what scientists believe are safe levels for humans. Studies suggest that there is no safe level of lead exposure for children. Despite a substantial decrease in children’s blood lead levels in recent decades, significant disparities in lead exposure still exist. Houses with old lead paint and areas with older and poorly kept housing or corroded pipes pose a higher risk of lead exposure. However, there is limited research on how airborne lead from industrial emissions affects children. This study tested whether lead pollution in the air, even at very low levels, is related to children’s intelligence and executive functioning.

What were the study results?

Children who lived in areas with relatively more lead pollution in the air in the early years of their lives exhibited less impulse control and had slightly lower IQ scores when they reached preschool and school age. Each increase in the level of airborne lead exposure was linked to an average decrease of 0.74 points in children’s IQ scores. The association between lead exposure and executive function was less straightforward in this study, with the influence changing noticeably only at higher levels. This was especially true for boys, who were more sensitive to the effects of airborne lead. Cognitive flexibility, or the ability to adapt to changing situations, and memory did not appear to be affected.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was this study's impact?

These results suggest that the amount of lead in the air during early childhood may affect children’s brain development. These findings could contribute to a broader approach to children’s health by considering all of the ways that a child’s environment could pose invisible risks. This study suggests that, in addition to efforts to reduce environmental pollution in general, attention to factors like nutrition that may mitigate the impact of exposure on children’s development could reduce health disparities of lead exposure for vulnerable individuals.

Who was involved?

This study looked at over 3,000 children from across the United States who were part of a research study that contributed to the ECHO Cohort.

What happened during the study?

Researchers used children’s home addresses to create a timeline of all the places that they lived from the time they were born until they were 5 years old. They then matched those locations to a database provided by the Environmental Protection Agency (EPA) that estimates the relative amount of lead pollution in the air for every half-square mile yearly. Researchers determined the average amount of exposure over the course of five years for each individual child and then examined whether the level of exposure was related to how the children performed on cognitive and IQ tests when they were between 3 and 8 years old.

What happens next?

Future studies are needed to examine whether other factors in the child’s environment make the effects of lead pollution better or worse. For instance, children with a healthy diet may be less likely to suffer from the effects of air pollution. Furthermore, previous work has suggested that males are more vulnerable to the effects of adverse conditions during neurodevelopment generally. These findings, along with evidence that lead exposure may affect male and female children differently, warrant additional research.

Where can I learn more?

Learn more about the additional data supporting this study through the EPA’s Toxic Release Inventory program. The program offers a Toxics Tracker website that people can use to learn more about the sources of air pollution in their communities.

Access the full journal article titled “Airborne Lead Exposure and Childhood Cognition: The Environmental Influence on Child Health Outcomes (ECHO) Cohort (2003-2022)” in the American Journal of Public Health.

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

Published March, 2024

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ECHO Research Suggests Airborne Lead Exposure Affects Children’s Cognitive Development, Impacting Males More Than Females

ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

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ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

Author: Santiago Morales

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Previous research has found a relationship between maternal education and children’s neurocognitive functions, but many of these studies have focused on early childhood. In addition, many previous studies have treated maternal education as something that doesn’t change over time. Few studies have explored whether a mother’s education level over the course of their child’s development might associate with neurocognitive function. ECHO researchers wanted to examine the relationship between changes in a mother’s education over time and their children’s later neurocognitive functioning, such as executive function and language skills.

What were the study results?

A mother’s education level during pregnancy and infancy was associated with children’s language and executive function. Increases in maternal education were related to improved language performance but were not associated with executive functioning performance.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The study suggests that early maternal education is strongly associated with later child neurocognitive outcomes. In the study, changes in maternal education were also associated with some of these outcomes. These results suggest that further examining these associations can provide important insights that can help inform policies and interventions designed to foster neurocognitive development.

Who was involved?

The study included 2,688 children, adolescents, and young adults from 3 to 20 years of age at ECHO research sites in 42 states across the U.S.

What happened during the study?

Mothers reported their own education levels during pregnancy and their child’s infancy, and again, years later when their children’s neurocognitive functions were also assessed. For both periods, the study categorized the mother’s education level into one of five groups—less than high school; high school or GED equivalent degree; some college, associate degree or trade school; bachelor’s degree; and graduate degree. The same categories were used to measure maternal education during childhood. Maternal education and income are two commonly used indicators of socioeconomic status. However, missing income data in this study prevented investigators from fully assessing the impact of socioeconomic status and income on neurocognitive skills.

Researchers also measured child participants' cognitive abilities during childhood, adolescence, or young adulthood using the NIH Toolbox Cognition Battery. These tests assess aspects of cognition including language, memory, and problem solving. Test results created scores that reflected language skills, executive function, and overall brain function. The analysis included child participants who contributed at least one score.

What happens next?

While this study suggests an association between maternal education and a child’s neurocognitive function, this research doesn’t necessarily explain the factors or mechanisms involved in that association. Future studies might further explore these factors to provide additional insights.

Where can I learn more?

Access the full journal article, “Maternal Education Prospectively Predicts Child Neurocognitive Function: An ECHO Study,” in Developmental Psychology.

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

Published February 26, 2024

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ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Authors: Claudia Lugo-Candelas, Tse Hwei, Seonjoo Lee, Cristiane Duarte, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Sleep difficulties are common in pregnancy. Poor prenatal sleep may relate to negative outcomes for both parent and child, including pregnancy complications and certain birth outcomes. The impact of poor prenatal sleep may also extend beyond pregnancy and birth and may increase the risk for neurodevelopment disorders in offspring, particularly attention-deficit/hyperactivity disorder (ADHD).

In this study, ECHO researchers aimed to study potential associations between poor prenatal sleep and an increased risk of ADHD symptoms and sleep problems in offspring.

What were the study results?

Prenatal sleep quality and duration, particularly in the second trimester, appeared related to children’s risk for ADHD, emotional reactivity, and sleep problems at age 4. Longer sleep duration in the second trimester was associated with fewer ADHD symptoms in children. Poorer sleep quality scores in the second trimester were associated with greater offspring ADHD symptomatology. Shorter duration and poorer quality of sleep during the second trimester were also associated with more sleep difficulties in children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study extends prior work by examining the associations between self-reported prenatal maternal sleep health and offspring ADHD symptoms in early childhood in a large, socio-demographically diverse sample in the U.S., including Puerto Rico.

Who was involved?

The research team used data from 794 mother-child pairs across five ECHO research sites. All enrolled pairs with available prenatal sleep and offspring ADHD assessments before age seven were included. The pregnant participants were between 27 and 37 years old.

What happened during the study?

Pregnant participants reported on their sleep during pregnancy using self-report questionnaires and reported on children's symptoms and behaviors when children were between 3 and 5 years old. The study assessed the children’s ADHD symptoms and associated characteristics using the Child Behavior Checklist Preschool Version, a widely used parent report that measures behavior problems in children.

What happens next?

Future studies are needed to replicate these findings, as well as investigate the possible mechanisms. Poor sleep may impact inflammation in pregnancy and offspring development, but studies have not examined that association.

Where can I learn more?

Access the full journal article, titled “Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: A prospective analysis of timing and sex differences in the ECHO Cohort,” in The Lancet Regional Health - Americas.

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

Published October 9, 2023

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles

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ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles

Authors: Marie Camerota, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was the study needed?

Birth outcomes for infants born very preterm have steadily improved over the past several decades. More children born at earlier gestational ages are surviving into childhood, however, it is unclear how being born very preterm may influence neurodevelopmental or behavioral problems.

Outcomes of children born at a gestational age of less than 33 weeks (“very pre-term”) vary significantly, with some children showing few neurodevelopmental concerns and others showing significant impairment. Most prior research has looked at single outcomes—for example, whether a child born preterm had a lower neurodevelopmental score or higher levels of behavior problems. Understanding how these different outcomes may group together can help researchers and healthcare providers provide more comprehensive treatment plans for children born very preterm.

What were the study results?

Researchers found evidence for four different neurobehavioral profiles based on different combinations of cognitive, motor, and behavioral outcomes of children at the age of two. These profiles range from few or no developmental concerns to severe impairment in one or more domains. The study placed most children (about 85%) into one of two groups with no/mild developmental delay and a low prevalence of behavioral problems. The remaining 15% fell into one of two profiles with more serious neurodevelopmental problems with (5%) or without (10%) co-occurring behavior problems.

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 helps researchers better understand outcomes for children following a very pre-term birth. The different groups of children this study described might require different types of follow-up services or interventions.

Who was involved?

This study included more than 2,000 babies who were born at less than 33 weeks gestational age and were evaluated at the age of two years. Pre-term children from three ECHO research sites in the U.S. were included in this analysis.

What happened during the study?

Researchers recruited children born less than 33 weeks gestational age into the ECHO Program shortly after they were born. When these children reached age two years, researchers conducted a neurodevelopmental assessment and a motor exam; parents completed questionnaires about their children’s behavior. ECHO researchers looked for patterns in these data to understand whether there were groups of children with similar strengths and weaknesses.

What happens next?

More research is needed to understand why some preterm children develop neurodevelopmental and/or behavioral problems and others do not. To do this, future studies may study risk factors in pregnancy, the perinatal period, and in early infancy.

Where can I learn more?

Access the full journal article, titled “Neurodevelopmental and behavioral outcomes of very preterm infants: latent profile analysis in the Environmental influences on Child Health Outcomes (ECHO) Program,” 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 September 12, 2023

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ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles

“Accelerated” Biological Age at Birth Not Linked to Behavioral and Emotional Health Outcomes in Early Childhood

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“Accelerated” Biological Age at Birth Not Linked to Behavioral and Emotional Health Outcomes in Early Childhood

Authors: Christine Ladd-Acosta, Heather Volk, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was the study needed?

Previous studies have shown that early identification and intervention in the development of emotional and behavioral health challenges in children seems connected to better long-term health outcomes. Recently, researchers have begun looking at how epigenetic factors affect children’s biological age and health outcomes.

A molecular process known as DNA methylation, or DNAm, adds a tag to DNA to control gene expression. Researchers measure DNAm to estimate a person’s biological age and compare it with their chronological age to better understand the factors that may influence their long-term health outcomes. In this study, ECHO researchers looked at the link between biological age at birth, the time between conception and birth (chronological gestational age), and emotional and behavioral health outcomes in children.

What were the study results?

Differences between biological age at birth and chronological gestational age did not appear linked to emotional and behavioral problems in childhood. This study did not find any difference between boys and girls in terms of the effect of “accelerated” biological age on behavioral and emotional outcomes.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

These results highlight that because biological age at birth does not seem to predict emotional or behavioral health challenges in early childhood, research should investigate how other biological factors at birth may influence neurodevelopmental health outcomes in early childhood.

Who was involved?

The study included four ECHO research sites in the United States and a total of 592 children.

What happened during the study?

Researchers calculated each child’s “biological age” by analyzing DNA samples collected at birth, and they compared this age to the child’s chronological gestational age. They then tested whether newborns who showed increased biological age relative to their chronological age (“accelerated aging”) were more likely to have emotional and behavioral problems in early childhood.

What happens next?

Future research in a larger sample might confirm these findings. The relatively small sample size of this study may have made it difficult to observe differences in behavioral or emotional outcomes based on child sex. Future research with larger samples could help investigate potential differences in the results between boys and girls.

Where can I learn more?

Access the full journal article, titled “Accelerated epigenetic age at birth and child emotional and behavioral development in early childhood: a meta-analysis of four prospective cohort studies in ECHO,” in Epigenetics.

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

Published September 10, 2023

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“Accelerated” Biological Age at Birth Not Linked to Behavioral and Emotional Health Outcomes in Early Childhood

Prenatal Depression May Be Linked to Autism-Related Traits in Children

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Authors: Lyndsay A. Avalos, Lisa A. Croen, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was this study needed?

Previous research suggests an association between prenatal depression or a history of depression prior to pregnancy and autism spectrum disorder (ASD) in children, but most studies have focused on a formal ASD diagnosis, rather than autism-related traits. Studying social communication and other autism-related traits can help researchers and clinicians understand how prenatal depression may be associated with these traits present in children at varying levels without a formal diagnosis. This is critical because autism‑related traits can impact children’s physical, social, and psychological development, regardless of whether they receive a clinical diagnosis.

What were the study results?

Children of mothers with prenatal depression had slightly more autism-related traits compared to those without. The association was similar among boys and girls. Prenatal depression also increased the likelihood of moderate to severe autism-related traits, indicating a higher likelihood of ASD diagnosis.

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 adds to the understanding of how prenatal depression may be associated with neurodevelopment in children, such as social communication and behavioral characteristics that may not reach a clinical threshold but can still impact a child’s social and behavioral functioning. These findings highlight the need for early ASD screening for children whose parents had prenatal depression to promote early intervention and support their healthy development. Mental health screening and prevention efforts for depression in pregnant individuals could also be beneficial.

Who was involved?

The study involved 33 prenatal and pediatric research sites with information on depression in birth parents and autism-related traits in children. The primary analysis included 3,994 parent-child pairs with prenatal depression diagnosis data; a secondary analysis included 1,730 parent-child pairs with depression severity data.

What happened during the study?

Researchers measured the incidence and severity of prenatal depression and assessed autism-related traits using the Social Responsiveness Scale (SRS) for children up to 12 years of age.

What happens next?

While this study didn’t explore the reason for the association between autism-related traits in children and prenatal depression in mothers, future research may analyze parent and child genetic data to clarify whether certain genes increase the likelihood of depression and autism-related traits, or what other factors affect the findings.

Where can I learn more?

Access the full journal article, titled “Prenatal Depression and Risk of Child Autism-Related Traits Among Participants in the Environmental influences On Child Health Outcomes Program,” in Autism Research.

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

Published August 1, 2023

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

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Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

Authors: Marisa Patti, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

The Social Responsiveness Scale (SRS) is a questionnaire used to measure social communication and autism spectrum disorder (ASD)-related traits. Researchers have developed a shortened version of the SRS, which included only 16 questions out of the original 65. This shortened version is intended to provide a very similar summary of behaviors and traits as the longer version but takes less time to complete.

As a new tool, the short SRS has been previously tested to ensure that it measures autism spectrum-related traits. However, it was not clear prior to this study if the short SRS can measure associations in epidemiologic analyses of autism spectrum risk factors in the same way as the full SRS so that research findings can be comparable across studies using both versions. In other words, do scores from both the short and long versions suggest the same associations? Or does shortening the SRS reduce our ability to detect risk factors due to differences in measurement? In this study, the authors tested associations with an established risk factor for autism diagnosis, preterm birth, or gestational age, to see if patterns were consistent across versions.

What were the study results?

Younger gestational age and preterm birth were associated with higher full SRS scores. The same associations were seen with short SRS scores. These associations are also consistent with associations seen for autism diagnosis, suggesting the ability of both the full and short SRS to detect risk factor associations.

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?

Gathering meaningful information for research studies can be a lengthy and time-consuming process for participants. This study shows that in some studies information collected using shorter assessments can be as useful as that captured using longer assessments, helping to reduce the time participants spend answering questionnaires.

Who was involved?

The study included 2,760 child-parent pairs from 11 different research sites within the ECHO Program. Participating children were between 2.5 and 18 years in age. The study sample included participants from research sites drawn from the general population, pre-term birth research sites, and familial-autism research sites, the last consisting of participants with a child diagnosed with autism.

What happened during the study?

Researchers collected caregiver-reported responses from both the full and shortened SRS. Information on gestational age and pre-term birth were collected from maternal reports on standardized questionnaires and from medical records.

What happens next?

Future studies are needed to investigate how comparable estimates are between the full and short SRS using other types of risk factors, such as genetic factors, and in other study populations. Researchers may also consider using the short SRS in future studies as an efficient measure of social behaviors.

Where can I learn more?

Access the full journal article, titled “A Comparative Analysis of the Full and Short Versions of the Social Responsiveness Scale in Estimating an Established Autism Risk Factor Association in ECHO: Do we Get the Same Estimates?” in the Journal of Autism and Developmental Disorders.

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

Published July 22, 2023

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Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

Authors: Jean Frazier, Michael O’Shea, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Inflammation is a normal part of the body’s defense to injury or infection. The investigators in this study wanted to find out whether factors known to be linked with inflammation during pregnancy (such as socioeconomic conditions, environmental exposures, and maternal infections) might be associated with emotional, cognitive, and behavioral dysregulation in children after birth. “Dysregulation” in this context refers to children’s attention, anxiety and depression, and aggression being measurably different from what is typically expected for children of their age.

What were the study results?

In this study, several maternal risk factors correlated with inflammation (lower education attainment, pre-pregnancy obesity, prenatal infections, and prenatal tobacco use) were strongly associated with dysregulation in offspring.

Researchers used a tool called the Child Behavior Checklist (CBCL) to measure aggressive behavior, anxiety/depression, and attention problems in children. Approximately 13.4 % of children and adolescents in the study met the criteria for the CBCL Dysregulation Profile. More youth with dysregulation (35%) were born to mothers with prenatal infections compared with 28% of youth without dysregulation.

Some additional maternal factors, including being overweight before pregnancy, lower education attainment, and smoking during pregnancy, were associated with higher likelihoods of childhood dysregulation. Children and adolescents who had a parent or sibling with a mental health disorder were more likely to experience dysregulation. Having a mother with gestational diabetes had no significant association with child dysregulation.

What was the study's impact?

By providing information about how maternal inflammation and relevant risk factors may be associated with dysregulation in a mother’s offspring, this study can help inform interventions to improve child health outcomes.

Who was involved?

This study included 4,595 children and adolescents (ages 6-18 years) from 18 ECHO research sites across the United States.

What happened during the study?

This study assessed perinatal factors known to be related to maternal and neonatal inflammation.

ECHO researchers collected data on maternal factors before and during pregnancy, including information about infections during pregnancy. They used the CBCL to collect parent-reported information about each child’s behavior. CBCL assessments were collected between 2009 and August 31, 2021, and researchers used these assessments to determine whether a child met criteria for the CBCL Dysregulation Profile based on their scores for aggression, anxiety/depression, and attention.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future studies could focus on identifying the mechanisms that link maternal factors with childhood dysregulation. These studies could also look at whether certain interventions are able to reverse or partially reverse the mechanisms that contribute to the development of dysregulation.

Where can I learn more?

Access the full journal article, titled “Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence,” in the Journal of the American Academy of Child and Adolescent Psychiatry.

Published May 17, 2023

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

Authors: Sarah Maylott, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

Why was this study needed?

Many studies in the past have been interested in how substance exposures during pregnancy affect childhood behavior. Most of these studies, however, have only focused on a single substance or have only assessed children aged 5 years or younger. The purpose of this study was to find out if types of substances affect a child’s behavior during middle childhood.

What were the study results?

Most children in the study were not exposed to any of the substances considered prior to birth, but those who were tended to be exposed to more than one. Children with substance exposures were more likely than their non-exposed peers to have certain behavior problems in middle childhood. Children exposed to tobacco and alcohol were more likely to display rule-breaking or aggressive behaviors, while children exposed to illegal drugs (cocaine, methamphetamine, heroin) were more likely to have higher rates of anxiety, depression, or withdrawn behaviors. However, not all children exposed to substances had behavioral problems, suggesting that some children may be more resilient than others.

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?

Two patterns of substance use during pregnancy were associated with childhood behavior problems. This finding is important because it suggests that researchers can identify children at risk for certain behavioral challenges based on the substances their mothers used during pregnancy. With more research, clinicians may be able to anticipate childhood behavior problems during or shortly after pregnancy based on the kinds of substances the child was exposed to and develop personalized interventions for these children.

Who was involved?

Researchers used data from approximately 2,000 women from 10 ECHO research sites which reported on their substance use during pregnancy. When their children were 6 to 11 years old, a caregiver reported on the child’s behavior. The average age of participating mothers at the time of pregnancy was 28 years old.

What happened during the study?

Using data from 2000 to 2020, the researchers grouped women based on the types of substances they used during pregnancy, including 1) low substance use, 2) mainly tobacco use (with moderate likelihood of using alcohol and marijuana), and 3) illicit use. They then compared children’s behaviors for each of these groups.

What happens next?

Similar large-scale studies are needed that look more closely at how the amount and timing of substance use during pregnancy affect the child’s risk for problem behavior, as well as how the child’s home environment contributes to that risk. Additionally, future studies are needed to identify factors that may increase resiliency in children with prenatal substance exposure.

Where can I learn more?

Access the full journal article, titled “Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes” in the Journal of Pediatrics.

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

Published May 12, 2023

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

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ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

Authors: Liz Conradt, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

Why was this study needed?

Little is known about how a pregnant mother’s exposure to multiple substances, like tobacco, alcohol, or opioids, during pregnancy may be associated with outcomes for their children when they reach middle childhood. Most research looks at the effects of single-substance exposures or focuses on the effects of prenatal exposures on the child’s health exclusively during birth or early childhood. In this study, the research team evaluated the effects of prenatal exposure to multiple substances (alcohol, tobacco, marijuana, and opioids) on children’s reasoning skills and behavior during middle childhood.

What were the study results?

The team identified two groups of children based on their reasoning skills and problem behavior scores. Group 1 had average verbal reasoning skills, average spatial reasoning skills, and normal levels of problem behavior. Children in this group were exposed to fewer substances before birth. Group 2 included children with multiple substance exposures before birth. This group had below average verbal reasoning skills, but average spatial reasoning skills, and higher levels of problem behavior. Children in Group 2 were significantly more likely to be exposed to tobacco before birth. The effects of tobacco exposure on problem behavior and reasoning skills were stronger than expected.

What was the study's impact?

This study suggests that children exposed to tobacco and other substances before birth may be at increased risk for problem behaviors and lower verbal reasoning skill scores during middle childhood. These findings will help pediatricians identify children who are at risk for behavior problems and poorer reasoning skill scores. If replicated, this information might help pregnant women and their doctors to recognize how prenatal tobacco, especially in the context of other substance exposure, might affect their child’s verbal reasoning and behavior in middle childhood.

Who was involved?

This study involved pairs of mothers and their biological children. There were 256 mother-child pairs from two ECHO research sites with locations in Rhode Island, Minnesota, Washington, California, and New York. Children were ages six to 11 at the time of the behavioral and reasoning skills assessments.

What happened during the study?

Researchers collected data on prenatal exposure to substances including alcohol, tobacco, marijuana, and opioids. When the children were between six and 11 years old, their caregivers reported on the presence of problem behaviors such as aggression and anxiety. The researchers also collected data on problem solving skills with words, pictures, and diagrams (verbal and nonverbal reasoning).

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Moving forward, the team wants to improve their measures of prenatal substance exposure and expand their sample size to include more ECHO participants. Grouping children that have been exposed to substances prenatally can help identify subgroups of children at risk for problem behaviors and low reasoning skill scores.

Where can I learn more?

The Center for Parenting and Opioids and National Institute on Drug Abuse have additional helpful resources.

The full journal article, titled “Prenatal Substance Exposure: Associations with Neurodevelopment in Middle Childhood” is published in the American Journal of Perinatology.

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

Published May 10, 2023

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ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning