Exposure to Flame-retardant Chemicals During Pregnancy Associated with Differences in Child Growth Patterns

Authors: Anne P. Starling, Jessie P. Buckley, Deborah Bennett, 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?

Organophosphate esters (OPEs) are chemicals widely used as flame retardants and plastic softeners in a variety of household and industrial products. Pregnant women are commonly exposed to these chemicals. While prior studies have examined the effects of OPE exposure during pregnancy on birth outcomes, less is known about how prenatal exposure to these chemicals affects children’s growth patterns beyond infancy. Understanding how early-life environmental exposures are associated with child growth trajectories is important because childhood growth rates can be linked to later risk of obesity and heart disease. This study specifically examined the relationship between OPE exposure during pregnancy and child height, weight, and body mass index (BMI).

What were the study results?

The study found that exposure to specific OPEs during pregnancy was associated with differences in child growth rates between ages 2 and 10 years. Higher prenatal exposure to bis (1,3-dichloro-2-propyl) phosphate (BDCPP) was associated with faster increases in weight and height during early childhood (ages 2–5). In mid-childhood (ages 6–10), higher prenatal exposure to diphenyl phosphate (DPHP) was associated with faster increases in body mass index and weight. In contrast, prenatal exposure to bis(1-chloro-2-propyl) phosphate (BCPP) was associated with slower growth across multiple periods. Some associations differed by child sex and by maternal pre-pregnancy body mass index.

What was this study's impact?

These findings suggest that exposure to certain flame-retardant chemicals during pregnancy may be associated with children’s growth patterns. Because growth trajectories are linked to future obesity and metabolic health, these results underscore the importance of understanding and potentially reducing exposure to these widely used chemicals during pregnancy.

Who was involved?

The study included 4,566 mother-child pairs from 14 ECHO Cohort Study Sites across the United States. Researchers collected exposure data during pregnancy and collected growth data from ages 2 to 10 years.

What happened during the study?

Researchers measured nine chemical markers of OPE exposure in urine samples collected from pregnant participants. They later collected child weight and height measurements between ages 2 and 10 years, which were used to calculate each child’s BMI. The researchers then used statistical models to examine how prenatal OPE exposure was associated with rates of change in weight, height, and BMI.

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 help researchers better understand the biological mechanisms linking prenatal OPE exposure to child growth and examine whether reducing exposure during pregnancy could improve long-term child health outcomes. Additional studies may also explore the combined effects of multiple environmental chemical exposures during pregnancy and early childhood on the patterns of child growth patterns.

Where can I learn more?

Access the full journal article, titled “Gestational exposure to organophosphate ester flame retardants and child growth in weight, height, and body mass index at age 2-10 years: the Environmental influences on Child Health Outcomes Program” in Environmental Research.

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

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Exposure to Flame-retardant Chemicals During Pregnancy Associated with Differences in Child Growth Patterns

Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

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Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

Authors: Chang Liu, Jody Ganiban, 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?

Childhood obesity is defined as having a body mass index (BMI) 0at or above the 95^th percentile for age and sex. Without early support or intervention, children who show patterns of high BMI during childhood are more likely to become overweight or obese as teenagers and adults. This increases their risk for long-term health issues, including diabetes and heart disease. To prevent these outcomes, it's important to understand how children's BMI changes over time and identify early-life factors—especially those that can be changed—that influence childhood growth patterns. This study aimed to identify unusual BMI patterns (sometimes called atypical BMI trajectories) in early childhood and understand which early-life factors may contribute to them.

What were the study results?

In this study, researchers found two common patterns in how children’s BMI changes over time. Most children (89.4%) had a typical pattern where their BMI went down from ages 1 to 6, then slowly increased. A smaller group (10.6%) had an atypical pattern where their BMI stayed the same from ages 1 to 3.5, then showed rapid increases from ages 3.5 to 9. By age 9, these children were more likely to develop obesity, with an average BMI higher than the 99th percentile. Some factors that associated with the risk of a child developing obesity included high birthweight, maternal smoking during pregnancy, high maternal BMI before pregnancy, and greater maternal weight gain during pregnancy.

What was this study's impact?

The study highlights key prenatal risk factors and early childhood growth trajectories related to childhood obesity, offering opportunities for early prevention and intervention to help children stay on a healthy growth path and reduce their chances of becoming obese.

Who was involved?

The study included 9,483 children from diverse racial, geographical, and socioeconomic backgrounds from the ECHO Cohort.

What happened during the study?

Researchers looked at data collected over time about children’s weight and height from medical records, measurements taken by staff, reports from caregivers, or measurements taken at home. They tracked how children's BMI changed as they grew and looked for patterns.

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 help researchers understand the biological mechanisms and social/environmental factors linked to childhood obesity, helping to develop targeted intervention programs that can redirect unhealthy BMI trajectories.

Where can I learn more?

Access the full journal article, titled “Early-Life Factors and Body Mass Index Trajectories Among U.S. Children in the ECHO Cohort,” in JAMA Network Open.

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

Published May 22, 2025

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Unusual Early Childhood Weight Patterns Associated with Higher Risk of Future Obesity

ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

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ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

Authors: Monique Hedderson, Assiamira Ferrara, 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?

Nearly one-third of children in the U.S. have overweight or obesity, putting them at risk of adverse health outcomes later in life. More research is needed to inform prevention strategies during critical periods of growth, including pregnancy. This study aimed to understand the association between diet quality during pregnancy and infant growth. Rapid growth from birth to 24 months has been identified as a strong predictor of obesity later in life. ECHO researchers looked at how a mother’s nutrition during this crucial period of development might influence the baby’s size at birth and their growth over time.

What were the study results?

Researchers used two indexes to measure healthy eating patterns: the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP). These scales measure how well foods in a person’s diet align with the U.S. Dietary Guidelines and the diet’s inflammatory potential, respectively. Expectant mothers with higher HEI scores were more likely to have babies with a healthy birthweight and fewer growth issues. Specifically, higher HEI scores were associated with a 12% lower chance of having a baby born large for gestational age (LGA) and a lower chance of rapid growth from birth to 6 months and birth to 24 months. By contrast, a lower score on the EDIP, indicating a less inflammatory diet, was associated with a 24% higher chance of LGA and slower growth to 6 months but faster growth from birth to 12 months. This association was less clear and warrants further study.

What was this study's impact?

The study's findings support the idea that a prenatal diet aligning with U.S. Dietary Guidelines, measured by the HEI, may promote healthy birthweight and infant growth through 24 months. The findings suggest that following USDA dietary guidelines during pregnancy may improve long-term infant growth. This highlights the need for programs or interventions to help pregnant individuals adopt healthy diets.

Who was involved?

The study included 2,854 mother-child pairs from eight ECHO Cohort Study Sites. Among the children, 48.7% were girls, 23.3% were White, 22.4% were Black, 35.8% were Hispanic, 7.8% were Asian, and 7.8% came from other racial backgrounds.

What happened during the study?

The study examined data from mothers and their children in eight different groups that were part of the ECHO Program between 2007 and 2021. Researchers used medical records and study weight and height measurements to track the babies' sizes and growth over time. The mothers' diets during pregnancy were evaluated to calculate HEI and EDIP scores. The study then explored how these diet patterns were associated with babies' size at birth and their growth up to 6, 12, and 24 months old.

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 their 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.

Note: 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?

More research is needed to understand the potential benefits of low-inflammatory prenatal dietary patterns in fetal and infant growth. Future studies could investigate how an infant's appetite and feeding habits might influence the connection between a mother's diet during pregnancy and the baby's long-term growth.

Where can I learn more?

Access the full journal article, titled “Prenatal Diet and Infant Growth from Birth to Age 24 months,” in JAMA Network Open.

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

Published November 21, 2024

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ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

ECHO Study Investigates Exposure to Flame-Retardants During Pregnancy and Childhood Obesity Risk

Authors: Alicia K. Peterson, Assiamira Ferrara, 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?

Organophosphate esters (OPE) replaced polybrominated diphenyl ethers (PBDEs) as flame retardants and plastic softeners in the mid-2000s. They are now present in various household and industrial products, including polyurethane foam, furniture, electronics, construction materials, infant products, textiles, and fabrics. Health officials have raised concerns about their impact on hormone systems and potential links to obesity. This study looked at whether the levels of OPEs found in a mother's urine during pregnancy were associated with a higher risk of obesity in her child.

What were the study results?

The study found varying associations between gestational OPE exposure and childhood obesity. The study found that children aged 5 to 10 years who were exposed to higher levels of dibutyl phosphate and di-isobutyl phosphate (DBUP/DIBP) during their mother’s pregnancy had a 14% greater risk of developing obesity compared to those with the lowest exposure levels. In contrast, children whose mothers had higher exposure levels of bis (1,3-dichloro-2-propyl) phosphate (BDCPP) during their mother’s pregnancy had a 15% lower risk of developing obesity than those with the lowest levels of exposure. Researchers measured for evidence of nine different OPEs in pregnant participants’ urine. Evidence of exposure to DBUP/DIBP and BDCPP was present in more than 80% of the samples. No association with obesity risk was observed for the rest of the OPEs measured.

What was this study's impact?

The study highlights the potential public health issue of gestational OPE exposure and its association with childhood obesity. It suggests the need for further investigation across a broad range of OPE exposures and could inform potential regulations on the manufacture and use of OPEs.

Who was involved?

The study involved 5,087 individuals from 14 ECHO Cohort Study Sites. The study population was geographically, racially, and ethnically diverse.

What happened during the study?

Researchers measured OPE exposure in the urine samples of pregnant participants between 2006 and 2020 and collected BMI measurements for the children from infancy to age 10 years.

Note: 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?

Further studies could help researchers better understand the associations between gestational exposure across a broad range of OPE exposures and childhood obesity.

Where can I learn more?

Access the full journal article, “Gestational Exposure to Organophosphate Ester Flame Retardants and Risk of Childhood Obesity in the Environmental influences on Child Health Outcomes Consortium,” in Environment International.

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

Published October 17, 2024

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ECHO Study Investigates Exposure to Flame-Retardants During Pregnancy and Childhood Obesity Risk

Food Insecurity in Pregnancy & Early Life May Be Linked to Higher Chance of Obesity in Children & Adolescents

Authors: Izzuddin M. Aris, 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 studies have linked food insecurity with obesity in adults, but evidence around the impact in children isn’t as clear. Many of these studies have looked at food insecurity and obesity at a single point in time rather than following the children over time. Because of this, it’s difficult to understand whether childhood obesity is directly influenced by food insecurity. Additionally, the few long-term studies that have addressed food insecurity and childhood obesity have primarily focused on late childhood or adolescence. ECHO Cohort researchers aimed to explore how food insecurity during pregnancy and early life—stages that may be particularly important to influencing long-term health outcomes—could be related to obesity in childhood and adolescence.

What were the study results?

Children who lived in low-income, low-food-access (LILA) neighborhoods during early childhood or whose mothers lived there during pregnancy were found to have higher body mass index (BMI) at ages 5 and 15. Living in those conditions was also associated with a 50% greater chance of developing obesity or severe obesity at ages 5, 10, and 15 years—regardless of individual sociodemographic factors. The association was strongest for those living in LILA neighborhoods during early childhood and their mother’s pregnancy. A LILA neighborhood is defined as a low-income neighborhood where a third or more residents live more than one half mile from a grocery store in urban areas or more than 10 miles in rural areas.

What was this study's impact?

These findings suggest that pregnancy and early childhood may be life stages when neighborhood food access can play the biggest role in long-term health outcomes. Living in neighborhoods with access to healthy foods during these stages may be important in preventing the development of obesity later in childhood and adolescence.

Who was involved?

The study included 28,359 participants from 55 ECHO Cohort Study Sites, including racially, ethnically, and geographically diverse mother-child pairs. Approximately 23% of the participants lived in a LILA neighborhood during pregnancy, and around 24% lived in these areas during early childhood.

What happened during the study?

Researchers mapped out where participants lived during pregnancy (from 1994 to 2023) or early childhood (from 1999 to 2023), matching each address to a specific neighborhood based on census data. They then linked these neighborhoods to food access data from the USDA Food Access Research Atlas for the years closest to when the participants lived there. The database offers information on household income, vehicle availability, and food access in neighborhoods.

Child weight and height data were collected from birth to adolescence through in-person research visits, medical records, and parent or caregiver reports. Researchers compared this data with information on where the children lived to determine if there was a link between neighborhood food access and child BMI or obesity.

Note: 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 are needed to learn whether improving access to healthy food early in life helps prevent childhood obesity. Improvements could include encouraging new supermarkets in existing food deserts, offering healthy food options at food pantries, or making healthier choices available in small retail and convenience stores.

Where can I learn more?

Access the full journal article, titled “Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity,” in JAMA Pediatrics.

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

Published September 16, 2024

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Food Insecurity in Pregnancy & Early Life May Be Linked to Higher Chance of Obesity in Children & Adolescents

Weight Gain During Infancy in Children Born Preterm Associated with Higher Risk of Obesity, According to New ECHO Research

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Weight Gain During Infancy in Children Born Preterm Associated with Higher Risk of Obesity, According to New ECHO Research

Authors: 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?

Infants born preterm typically have a period of poor growth in their first few months. After this stretch, they typically exhibit “catch-up” growth defined by an increase in weight z-score—a measure to classify a child’s nutritional status—during childhood and adolescence.

Prior research suggested that a “trade-off” may be associated with catch-up growth, such that individuals with more rapid weight gain during infancy have better neurodevelopmental outcomes than individuals with less weight gain. However, rapid catch-up growth during infancy has also been associated with a higher risk of becoming overweight or obese.

This study can help inform evidence-based guidelines for managing infant nutrition and growth monitoring after infants born very preterm (prior to 32 weeks of gestation) are discharged from a neonatal intensive care unit (NICU), to support rates of growth less likely to contribute to childhood overweight and obesity.

What were the study results?

In comparison to infants with low weight gain after birth, infants with very high weight gain after NICU discharge, which was experienced by 13.6% of participants, had higher body mass index (BMI) scores and a higher risk of obesity at 12-48 months.

The study team found no evidence that very high weight gain after NICU discharge was associated with better neurodevelopmental outcomes at 12 to 48 months of age. However, infants with very low weight gain after NICU discharge had lower scores on cognitive and language assessments. No significant differences were found between girls and boys.

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 this study's impact?

The study’s findings suggest possible benefits of close monitoring of post-NICU growth and healthier feeding practices to prevent obesity, which is associated with multiple adverse health outcomes. However, as single studies rarely provide sufficient evidence to change clinical practice, the authors note that the current study should not be the sole basis for such changes.

Who was involved?

This study involved 1,400 children born before 32 weeks of gestation in hospitals in multiple states in the U.S. between 2002 and 2020. A majority of these children experienced neonatal complications—issues faced during the first 28 days of life—the most common of which was neonatal chronic lung disease.

What happened during the study?

After birth, the participants were followed for 1 to 4 years, at which point their BMI and neurodevelopmental outcomes were assessed. Data about each of the participants were shared, with appropriate informed consent from a parent or guardian, with the ECHO Cohort Consortium. This allowed for analyses of relationships between weight gain following NICU discharge and neurodevelopmental outcomes and BMI at 1 to 4 years of age.

What happens next?

Future studies are needed to evaluate the relationship between the pace of weight gain during early childhood, long-term developmental outcomes, and changes in children’s BMI. This study focused on weight gain among infants born very preterm after discharge from the NICU. Additional studies are needed to observe the effects of different rates of catch-up growth on infants born closer to term.

Where can I learn more?

Access the full journal article, titled “Association of Growth During Infancy with Neurodevelopment and Obesity in Children Born Very Preterm: The Environmental influences on Child Health Outcomes Cohort,” in the Journal of Pediatrics.

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

Published August 2024

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Weight Gain During Infancy in Children Born Preterm Associated with Higher Risk of Obesity, According to New ECHO Research

ECHO Study Analyzes Relationship Between Molecules During Pregnancy and Childhood BMI

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ECHO Study Analyzes Relationship Between Molecules During Pregnancy and Childhood BMI

Authors: Rachel Kelly, Nicole Prince, Donghai Liang, 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?

A child’s body mass index (BMI) can be associated with their future health. Some researchers seek to understand how factors during pregnancy may influence childhood BMI. Increasingly, researchers use molecular data to analyze the relationship between pregnancy and childhood health outcomes. Researchers sometimes combine molecular data from multiple study sites to increase the statistical power of these analyses. This study aimed to evaluate molecular data during pregnancy across multiple study sites while also using these data to test a framework for analyzing molecular data across multiple studies.

What were the study results?

ECHO researchers combined the results from multiple ECHO Cohort Study Sites including mothers and their children to determine whether a relationship existed between small molecules present in the mother’s blood during pregnancy and later childhood BMI. Altogether, 20 molecules showed up in all study sites, and 127 molecules showed up in at least two. The study found that the levels of only six small molecules, primarily related to maternal diet, were associated with BMI across all sites. However, statistical analysis across these study sites did not identify significant associations between these molecules and child BMI.

What was this study's impact?

This study demonstrates some of the challenges that arise when harmonizing molecular data across diverse study sites and highlights important considerations for researchers trying to conduct similar analyses. Ensuring that all of the studies used in an analysis have the same standardized procedures for collecting samples, measuring molecules present in those samples, and collecting related data (e.g., BMI, diet) can improve the reliability and reproducibility of results.

Who was involved?

This study involved mothers and their children from multiple study sites: the Atlanta ECHO Cohort, the New Hampshire Birth Cohort, and the Vitamin D Antenatal Asthma Reduction Trial. The researchers included mothers in the second and third trimesters of pregnancy and measured their children’s BMI at the age of two years.

What happened during the study?

For this study, the authors combined existing results from multiple study sites. Pregnant participants provided blood samples, and researchers used those samples to measure a range of small molecules. These molecules provide information on each participant’s health, environment, and biological/genetic factors that could affect their pregnancy. The researchers continued to follow these participants and their children across pregnancy and early life to assess their ongoing health, height, and weight. Ultimately, in this analysis, the authors used data from these studies to evaluate the relationship between molecules measured during pregnancy and BMI at age two years, aiming to identify relationships that were consistent across all three studies.

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?

Differences in how molecular data were collected and measured between the sites in this study made it difficult to draw strong conclusions on the relationship between small molecules during pregnancy and childhood BMI. Future analyses could involve larger, more standardized studies that all use the same methods for sample collection and measurement. Many ECHO Cohort Study Sites are now measuring small molecules in both mothers and children with a standardized approach under the ECHO Cohort Data Collection Protocol. ECHO researchers have an opportunity to use these data to power analyses that can explore the relationship between pregnancy health and child health outcomes.

Where can I learn more?

Access the full journal article, titled “Metabolomic Data Presents Challenges for Epidemiological Meta-Analysis: A Case Study of Childhood Body Mass Index from the ECHO Consortium,” in Metabolomics.

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

Published January 24, 2024

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ECHO Study Analyzes Relationship Between Molecules During Pregnancy and Childhood BMI

ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

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ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

Authors: Gayle Shipp, Adaeze Wosu, 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?

Obesity in kids is becoming more common around the world. When children have obesity, they often carry it into adulthood, affecting their long-term health outcomes. While previous studies have shown that breastfeeding may protect children against obesity and other chronic conditions, this relationship has not been studied much in women with obesity. ECHO Cohort researchers wanted to explore the possible link between breastfeeding practices in women with obesity and overweight prior to pregnancy and a child’s BMIz score. Researchers use BMIz scores to compare children’s height and weight to those of their peers while the more familiar BMI assesses body weight in relation to height.

What were the study results?

This study found that consistently breastfeeding infants in any amount during their first three months was associated with lower BMIz scores during early childhood (between the ages of 2 and 6) and a lower risk of childhood obesity, regardless of the mother’s pre-pregnancy BMI. This protective association appeared stronger for children with mothers who had obesity before pregnancy (BMI of 30 or higher) compared to those categorized as overweight (BMI between 25 and 29.9) during the same time.

Exclusive breastfeeding at three months was associated with a lower child BMIz score only among women with a pre-pregnancy BMI in the normal range. Each additional month of any or exclusive breastfeeding correlated with a significantly lower child BMIz, particularly for mothers categorized as overweight (in the case of any breastfeeding) or as having obesity (for any or exclusive breastfeeding) prior to pregnancy.

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 this study's impact?

The results of this study highlight that each additional month of breastfeeding, whether a consistent amount or exclusive, may contribute to a lower weight later in childhood, especially for mothers who had obesity before pregnancy. Health professionals can use this study’s findings as an opportunity to encourage and promote breastfeeding among all women, especially those who have obesity.

Who was involved?

The study looked at BMI measurements from 8,134 pairs of mothers and kids at 21 study sites in 16 states and Puerto Rico.

What happened during the study?

The researchers calculated BMI and BMIz scores from measurements taken at study visits, medical records, or self-reported data for the mother and child. Additionally, the study examined two breastfeeding situations: whether the mother ever breastfed or whether the mother was exclusively breastfeeding the infant at 3 months old. This continuous breastfeeding measure included the duration of any breastfeeding allowing for formula or other food and the duration of exclusive breastfeeding with no formula feeding or other food.

What happens next?

Future research and public health prevention efforts could continue to focus on addressing disparities in breastfeeding duration and obesity among mothers that can affect child health outcomes.

Where can I learn more?

Access the full journal article titled “Maternal Pre-pregnancy BMI, Breastfeeding, and Child BMI” in Pediatrics.

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

Published December 19, 2023

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ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

How Much Vitamin D do Children with Asthma and Increased Body Weight Need to Correct Low Vitamin D Levels?

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How much vitamin D do children with asthma and increased body weight need to correct low vitamin D levels?

Study title: Pharmacokinetics of Oral Vitamin D in Children with Obesity and Asthma

Author(s): Jason E. Lang, Rodrigo Gonzalez Ramirez, Stephen Balevic, Brian O’Sullivan, Scott Bickel, Christoph P. Hornik, J. Marc Majure, Saranya Venkatachalam, Jessica Snowden, Laura James

Why was this study conducted?

Among children with asthma, children who also have increased body weight for their height (body mass index (BMI) of ≥85 percentile) tend to have more severe asthma symptoms than their healthy weight peers. Children with asthma and increased body weight also tend to have lower vitamin D levels than other children. Helping children with asthma and increased body weight reach higher vitamin D levels may help their asthma symptoms by lowering inflammation in the lungs. However, there is not enough information on how much vitamin D children with asthma and increased body weight should take to safely raise their vitamin D levels.

What was done?

ECHO ISPCTN research teams in 15 states enrolled children ages 6‑18 years with asthma and increased body weight in a clinical trial. The children took vitamin D capsules for 16 weeks and gave blood samples every month so researchers could check their vitamin D levels. The goal of the study was to find a vitamin D dose that helped children raise their vitamin D levels in their blood to 40 ng/mL, a level that might lower inflammation.

There were two parts of the study. In the first part, children were split into four groups that each took one of four different doses of vitamin D to find a dose that raised children’s vitamin D levels over 16 weeks without causing side effects. All four dosing options were higher than what is usually recommended to raise vitamin D levels. Then, researchers compared the vitamin D dose from part 1 that raised vitamin D levels quickly and safely to the usually recommended daily vitamin D dose to confirm that the higher dose could safely help children reach vitamin D levels that may decrease inflammation. This study was approved by the Institutional Review Board and all participants consented to participate in the study.

What was found?

The first part of the study found that taking a 50,000 international units (IU) vitamin D dose on the first day of treatment and then an 8,000 IU vitamin D dose every day for 16 weeks was most effective at raising vitamin D levels safely. In the second part of the study, researchers confirmed that using this approach raised vitamin D levels in most children to the recommended level while avoiding undesired higher levels. In contrast, no children who followed the current standard-of-care dosing of 600 IU each day achieved the target vitamin D level sufficient to potentially reduce inflammation.

What do the results mean?

Most children with asthma and increased body weight who take vitamin D the vitamin D dose used in this study (50,000 IU vitamin D on day one, then 8,000 IU each day) can safely raise their vitamin D level in a short period of time. The newly determined dose is much greater than the typically recommended dose. This study shows how important it is that children and adolescents with increased body weight get enough vitamin D in their diet or in vitamin supplements every day since the higher the body weight, the faster vitamin D was processed and removed from the body. The results of this study may help children with asthma or other illnesses if having enough Vitamin D lowers inflammation.

Who sponsored the study?

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

Appreciation

All of the families in ECHO ISPCTN trials help study teams across the country learn more every day about how to bring rural and underserved families into research studies. This is critical to ensure that families that are not near large academic centers still get the benefits of research and that the “answers” research studies find are meaningful for children and families across all parts of the country, not just those who live in large cities.

You may learn more about this publication here: https://link.springer.com/article/10.1007/s40262-023-01285-9

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

Published: August 30, 2023

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How much vitamin D do children with asthma and increased body weight need to correct low vitamin D levels?

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ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

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ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

Authors: Callie Brown, Charles Wood, 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?

Obesity affects millions of adults, adolescents, and children in the United States. Many children in the United States enter their school years with obesity, and children with obesity at 3 years of age have a 90% probability of having overweight or obesity as an adolescent.

While existing literature suggests a relationship between parental stress and childhood body mass index (BMI), the exact way in which parental stress might affect BMI in children isn’t fully understood. There has been some disagreement in what types of stress and at what time points during childhood stress is related to child BMI. This study allowed researchers to look at a large, diverse sample of mothers and children over time to evaluate how maternal stress might be associated with the child’s BMI.

What were the study results?

This study suggests that there is no association between stress of mothers during the first year after birth and the risk of their child having obesity between ages 2 and 4.

While the study did not find an association between maternal stress levels and childhood obesity, it did reveal other information about both maternal stress and childhood BMI. In this study, the researchers found that higher stress levels were more likely among Hispanic and Black mothers, and less likely among mothers with private health insurance. Higher child BMI was more likely among Hispanic mothers, when the mothers’ BMI before birth was higher, and when the child’s birth weight was higher.

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 this study's impact?

Doctors and researchers are working to identify opportunities to prevent childhood obesity. There are many factors in the first year of life that are related to higher weight gain and earlier obesity in children, but this study’s results suggest that the level of a mother’s stress in the first year of life does not appear to be a risk factor for higher obesity risk in very young children. This may be because other factors are stronger predictors of differences in childhood BMI.

Who was involved?

The study included 1,694 mothers and their children from across the United States.

What happened during the study?

ECHO researchers analyzed data from single pregnancies where maternal stress was measured in the child’s first year of life and a child’s weight and height were measured between 2 and 4 years of age.

In addition to examining maternal stress levels and childhood BMI, researchers analyzed information including a mother’s BMI before pregnancy, the baby’s birthweight, a mother’s race, ethnicity, and age at the time of the child’s birth, and the type of health insurance they had. They also looked at the number of children a mother had and her education level.

What happens next?

Future studies may look into additional factors that can influence children’s risk for increased BMI such as BMI later in childhood, other periods or types of stress, and parent- or caregiver-measured stress.

Where can I learn more?

Access the full journal article, titled “Maternal stress and early childhood BMI among US children from 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 July 21, 2023

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ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI