ECHO Study Links Phthalate Exposure During Pregnancy With Genetic Changes in the Placenta

Authors: Alison Paquette, Sheela Sathyanarayana, 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.

What were the study results?

Researchers found that several phthalates were associated with changes in the expression of 38 genes within the placenta. Some of these changes in gene expression were only significant in male or female infants. This shows that phthalates may change how the placenta works in different ways for the two sexes. The team also studied which biological pathways were connected to these changes in gene expression. They found 27 specific pathways that may have been affected by phthalate exposure. These pathways involved important building blocks for the developing infant.

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?

Exposure to phthalate chemicals is related to changes in gene expression in placentas. This is important because these changes in gene expression may affect the growing baby.

Why was this study needed?

There is a lot we still don’t know about how phthalates affect the placenta. Phthalates are a group of chemicals used in plastics and household products. The placenta is an organ in pregnant women that provides their growing baby with oxygen and nutrients. It also helps mothers and babies share information. Exposure to phthalates during pregnancy may harm the placenta and affect how the baby develops. Looking at changes in how genes are expressed when exposed to phthalates during pregnancy can help researchers measure the effect on how the placenta works. Genes are expressed when DNA is converted into proteins, which perform a variety of important functions and play critical roles in development.

Who was involved?

The study involved pregnant women from Memphis, Tennessee who enrolled in the CANDLE study during their pregnancy. Researchers collected urine and placentas from mothers just after their babies were born. These participants were between 16-40 years old, mostly Black, and had relatively healthy pregnancies.

What happened during the study?

Researchers measured the amount of 16 phthalates in urine collected from the participants during the 2nd and 3rd trimester of pregnancy.

Researchers collected the placenta from the mother after having the baby and measured the expression of each gene in the placenta. For each gene, the researchers tried to figure out if higher phthalate concentrations were related to more or less gene expression in the placenta. This information was used to understand how phthalates may have affected how the placenta worked.

What happens next?

This research team will study how changes in the placenta are related to pregnancy complications like preterm birth within this same group of pregnant women. They will also use new tools and technologies to study how phthalates may cause these changes in gene expression.

It is also important to look at the effect of phthalates on other groups of women and see how these changes in placental function impact infant and childhood health.

Where can I learn more?

Read more information about how people are exposed to phthalates and how to decrease exposures.

Access the full journal article, titled “A Comprehensive Assessment of Associations between Prenatal Phthalate Exposure and The Placental Transcriptomic Landscape” in Environmental Health Perspectives.

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

Published September 3, 2021

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ECHO Study Links Phthalate Exposure During Pregnancy With Genetic Changes in the Placenta

ECHO Review Suggests Environmental Exposures Can Affect Health Outcomes Across Multiple Generations

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ECHO Review Suggests Environmental Exposures Can Affect Health Outcomes Across Multiple Generations

Authors: Carrie Breton, Rebecca Fry, Alison Hipwell, Cristiane Duarte, Linda Kahn, and Joseph Braun

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.

What were the study results?

The review found many studies in animals and humans that showed a connection between certain environments, chemicals, and behaviors and health risks across multiple generations. While epigenetics most likely plays a role in these changes, it is often difficult to separate epigenetic effects from other causes. The team also pointed out the need for more studies to tease out the complexity of these effects.

Footnote: Results reported here are for a research project. Other or future research 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 review article brings together results from many studies into one paper, which is usually more powerful than results from a single study. By looking at many results together, scientists can find important patterns and gaps in epigenetics research. This paper will help scientists better understand how the environment can affect the health of a mother, child, and grandchild.

Why was this study needed?

Studies show that the environment may affect the health of many generations in one family. Some of this effect comes from epigenetics, changes in how your genes are read and understood. Your environment and actions can change your epigenetics, and those changes can be passed on to your children and grandchildren. For example, if a pregnant woman is around certain chemicals, her genes may carry a “molecular memory” of those chemicals that can be passed on through her children. The purpose of this study was to put together what is known about epigenetics to understand how environments, chemicals, and behaviors may affect the health of children for generations to come.

Who was involved?

This research looked at previous studies on humans and animals and summarized the information.

What happened during the study?

The team of experts read a lot of studies on this topic and worked together to write a summary of current knowledge.

What happens next?

The ECHO Program will keep collecting data on the health effects of environmental exposures on children. The scale of the ECHO Program makes it ideal for the study of the ongoing, generational effects of these exposures.

Where can I learn more?

Access the full journal article, titled “Exploring the evidence for epigenetic regulation of environmental influences on child health across generations” published in Communications Biology.

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

Published: June 22, 2021

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ECHO Review Suggests Environmental Exposures Can Affect Health Outcomes Across Multiple Generations

More Environmental Exposures Research

Do chemicals that break down slowly in the environment affect how long it takes to become pregnant?

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

A review of studies that look at whether exposure to common non-persistent chemicals in consumer products delays the time it takes to become pregnant

Author(s): Alison E. Hipwell, Linda G. Kahn, Pam Factor-Litvak, et al

Review of Prenatal Air Pollution Exposure and Brain Development

Author(s): Heather E. Volk, Frederica Perera, Joseph M. Braun, Samantha L. Kingsley, Kim Gray, Jessie Buckley, Jane E. Clougherty, Lisa A. Croen, Brenda Eskenazi, Megan Herting, Allan C. Just, Itai Kloog, Amy Margolis, Leslie A. McClure, Rachel Miller, Sarah Levine, Rosalind Wright

ECHO Study Finds Pregnant Women Exposed to Variety of Chemicals—Some May Affect Birth Weights

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ECHO Study Finds Pregnant Women Exposed to Variety of Chemicals—Some May Affect Birth Weights

Author(s): John L. Pearce, Brian Neelon, Michael S. Bloom, Jessie P. Buckley, Cande V. Ananth, Frederica Perera, John Vena, and Kelly Hunt

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

Findings from the study revealed that moms experienced a broad range of chemical exposure profiles with marked variability in exposure magnitudes across chemical classes and exposure frequencies. Evaluation of health effects found that maternal exposure profiles dominated by higher levels of flame-retardants (i.e., polybrominated diphenyl ethers, PBDEs) were associated to lower birth weights. Exposure profiles with higher levels of polychlorinated biphenyls (PCBs) and perfluoroakyl (PFAS) substances were associated with increased birth weights. PCBs are man-made chemicals that are often found in industrial and commercial products, such as electrical and hydraulic equipment and plasticizers in paints, plastics, and rubber products. PFAS substances can often be found in food packaging, commercial household products, drinking water, and living organisms.

What was the study's impact?

ECM provides a promising framework for supporting studies of other exposure mixtures as the resulting mapping benefits visualization and assessment of relationships in complex data.

Why was this study needed?

Pregnant women often encounter numerous chemicals that may pose a risk to them and their baby. Studies seeking to identify health effects in populations that experience such complex exposure scenarios remains difficult. With this study, the researchers tried to improve research of multiple exposures by presenting a mixtures methodology, defined as exposure continuum mapping (ECM), that allows investigators to identify complex exposure patterns (i.e., mixtures) within their study population and evaluate complex health effects.

Who was involved?

The team involved a diverse mother-child cohort over 600 women participating in ECHO that also enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's (NICHD) Fetal Growth Studies from 2009-2012.

What happened during the study?

To begin, the team obtained data previously collected from the study population during their participation in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's (NICHD) Fetal Growth Studies. These data included concentrations of endocrine disrupting chemicals (EDCs) measured in blood samples collected from mothers 8-12 weeks into their pregnancy and their infant’s weight at birth. Then, the team analyzed these data with ECM in order to identify the range of EDC exposure profiles experienced by moms during their pregnancy and to examine the relationship to the birth weight of their children.

What happens next?

The team will apply ECM to assist investigations of exposure mixtures and other child health outcomes, with particular interest on obesity.

Where can I learn more?

For access to software tools see: https://github.com/johnlpearce/

Access the full journal article, titled “Exploring associations between prenatal exposure to multiple endocrine disruptors and birth weight with exposure continuum mapping.”

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

Published June 2, 2021

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ECHO Study Finds Pregnant Women Exposed to Variety of Chemicals—Some May Affect Birth Weights

Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

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Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Author(s): Stephanie Merhar, Songthip Ounpraseuth, Lori Devlin, et al.

What was done?

We reviewed medical records from 30 U.S. hospitals. There were 180 babies with NOWS treated with morphine (M) and a secondary drug [phenobarbital (P) or clonidine (C)]. We compared the two groups (M + P and M + C) and calculated the number of days spent in the hospital and the number of days they received morphine.

What was found?

Babies in the M + P group had fewer days of morphine treatment compared to babies in the M + C group. They also spent fewer days in the hospital than the M + C group. However, babies in the M + P group were more likely to continue taking phenobarbital at home.

What do the results mean?

In this study, babies treated with M + P had shorter hospital stays, and in some cases, fewer days of morphine treatment. But, some studies show that long-term use of phenobarbital could cause problems with the development of the nervous system. More research is needed on the benefits and risks of using this drug to treat NOWS symptoms.

Why was this study conducted?

Babies exposed to opioids (e.g., morphine, methadone, etc.) in the womb may have drug withdrawal symptoms called neonatal opioid withdrawal syndrome (NOWS) after birth. Some are given medicine for their symptoms. If the medicine doesn’t work, doctors may add other (secondary) medicine to the treatment. This study looked at two secondary drugs used most often to see if one was better than the other in NOWS treatment.

Appreciation:

We deeply appreciate the doctors, nurses, and hospitals that participated in the study and helped identify and extract information from the required medical records. Their enthusiastic collaboration made this study possible. The authors thank the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health for supporting this research.

Access the full journal article, titled "Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome," published in Pediatrics.

Published March, 2021

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

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Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Resources

Centers for Disease Control and Prevention (CDC)

About Opioid Use During Pregnancy

Related Research Summaries

Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

Author(s): Leslie Young, Zhuopei Hu, Robert Annett, et al.

The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

Author(s): Jessica Snowden, Akshatha, Robert Annett, et al

How does prenatal opioid exposure affect child outcomes?

Author(s): Elisabeth Conradt, Sheila Crowell, Barry Lester

ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

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ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

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. Individual authors were additionally supported by the National Institutes of Environmental Health Sciences, Diabetes and Digestive and Kidney Diseases, and Alcohol Abuse and Alcoholism.

What were the study results?

The strongest evidence points to a connection between human-made chemicals called polychlorinated biphenyls and a longer time to get pregnant. These chemicals used to be used in electrical and hydraulic equipment. Even though production of these chemicals stopped in the late 1970s, we are still exposed to them through soil, water, and building materials. Another group of chemicals called organochlorine pesticides do not seem to affect the time it takes to get pregnant. We still need more research on brominated flame retardants, found in furniture, clothing, and other household products, and per- and polyfluoroalkyl substances, found in non-stick cookware and stain-resistant fabrics. Many of the newer chemicals in these categories have not yet been studied.

What was the study's impact?

This review shows that some long-lasting chemicals may increase the time it takes for couples to get pregnant. This can be stressful and lead couples to seek expensive fertility treatment. Although many of the chemicals covered in our review are no longer made or used in the US, they can last for years—even decades—in the environment and in our bodies. Therefore, they can still affect our health. We need more research on newer chemicals that have been invented to replace dangerous ones. We also need to figure out exactly how these chemicals interfere with healthy reproduction. For example, there may be times in life, such as puberty, when being exposed to them may be especially damaging. The ECHO Program is an important resource for answering these questions.

Why was this study needed?

Some human-made chemicals can cause problems with the reproductive system. Many studies have looked at whether these chemicals affect how long it takes to get pregnant. How long it takes to become pregnant is a sign of a couple’s reproductive health and can be a sign that they need to seek fertility treatment. Our review compares the results of past studies to see if there are consistent patterns for particular types of chemicals. It also identifies chemicals that need further research.

Who was involved?

This review includes all papers published in English on this topic from January 1, 2007 to August 6, 2019. Our search looked at 28 articles. These articles used data from 19 different studies. The studies took place in North America, Europe, and East Asia.

What happened during the study?

We searched five science libraries and found more than 4500 articles that could possibly fit our topic and narrowed them down to the 28 articles discussed in our paper. We read each article carefully, gave it a score based on its quality, and pulled out the most important information. This included whether the chemicals the paper looked at affected how long it took to get pregnant, and if so, by how much. We then put that information into tables. Finally, we looked at whether or not results were consistent, especially among high-quality studies. We then drew our conclusions.

What happens next?

This is the second review that this team of authors has written on chemicals and time to pregnancy. Our next paper will look at whether different types of air pollution affect how long it takes to get pregnant.

Where can I learn more?

Access the full journal article titled "Persistent organic pollutants and couple fecundability: a systematic review" published in Human Reproduction Update.

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

Published: February 19, 2021

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ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

Author(s): Anne L. Dunlop, Alicynne Glazier-Essalmi, 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.

What were the study results?

There were differences in how early the baby was born based on the mother’s race and ethnicity. Compared to non-Hispanic white women, women of all other races had a higher chance of PTB. For women overall, a bachelor’s degree or above was linked to less chances of PTB, and a high school education or less led to higher chances of PTB. This link between education level and PTB was mostly seen in non-Hispanic white women and those who lived in the South and Midwest regions of the US. This study also collected data on neighborhood factors; non-Hispanic white women living in a rural area had a higher chance of PTB delivery compared to women living in an urban area.

What was the study's impact?

This study explored an important gap in the field of children’s health. It gathered information on how factors such as the mother’s race/ethnicity, location, education level, and SES affect if a baby is born early. The results show that higher education among women could help decrease the chances of PTB in the US, especially in the South and Midwest regions.

Why was this study needed?

There are high rates of preterm birth (PTB) in the US. Previous studies show that the rates of PTB are different based on race and location, but there is not much information available on what causes these differences. This study also explored the link between the mother’s SES, race, and location and how they affect the baby’s age at birth. Socioeconomic status (SES) is a combination of factors such as education, income, and occupation.

Who was involved?

Women enrolled in the ECHO Program who delivered a baby were included in this study. They provided all of the required information about themselves and their infant. More than 20,000 mother-infant pairs participated.

What happened during the study?

Researchers studied a variety of information including the mother’s age at delivery, education, physical address or region, alcohol use, prenatal care, and the child’s birth sex and how many weeks they were at birth. They took this information and looked for patterns and connections between factors that affect PTB.

What happens next?

Non-Hispanic Black women, Native American, and Alaskan Native women have the highest rates of PTB. Future studies in these populations will help explore the causes for these differences and figure out ways to prevent PTB.

Where can I learn more?

View the full journal article, titled “Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts” in PLOS One.

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

Published: January 8, 2021

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

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Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

Author(s): Leslie Young, Zhuopei Hu, Robert Annett, et al.

What was done?

The medical records of babies born between July 1, 2016 and June 30, 2017 and their mothers were reviewed at 30 U.S. hospitals. From these records, 1377 babies were selected for the study.

For the babies, we looked at how many were given medicines for their NOWS symptoms and what they ate. We also looked at how long they were in the hospital, and who they went home with. For the mothers, we looked at what types of care they had during their pregnancy.

What was found?

The hospitals in this study varied in how they took care of pregnant women with opioid use and their babies.

In the babies:

6% to 100% received medicine for NOWS symptoms,
22% to 83% were fed breast milk,
length of hospital stay was 2 to 28 days, and
33% to 91% went home with their parents.

In the mothers:

6% to 100% were given medicine for their opioid use disorder,
31% to 100% received adequate medical care during their pregnancy, and
2% to 75% received prenatal counseling.

What do the results mean?

This study suggests that the care for pregnant women who use opioids and their babies differs widely in the U.S. This means that some mothers and babies may not be getting the best care.

More research into the care we provide will help doctors find a standardized way to care for babies with NOWS. Standardized care will help all babies with NOWS get the best care possible.

Why was this study conducted?

Babies exposed to opioids in the womb may show signs of withdrawal after birth. This is called neonatal opioid withdrawal syndrome (NOWS). Babies with NOWS may tremble, have increased crying, or be more difficult to calm. They also may not sleep or eat well.

In the U.S., there is not a standard way to care for babies with NOWS after they are born. That means U.S. doctors may be treating babies with NOWS in different ways. This study looked at the variation in the care provided to babies with NOWS in the U.S.

Appreciation:

We deeply appreciate the doctors, nurses, and hospitals that participated in the study and helped identify and extract information from the required medical records. Their enthusiastic collaboration made this study possible. The authors thank the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health for supporting this research.

Access the full journal article, titled "Site-Level Variation in the Characteristics and Care of Infants With Neonatal Opioid Withdrawal," published in Pediatrics.

Published January 2021

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

Download this summary

Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

Resources

Centers for Disease Control and Prevention (CDC)

About Opioid Use During Pregnancy

Related Research Summaries

Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Author(s): Stephanie Merhar, Songthip Ounpraseuth, Lori Devlin, et al.

The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

Author(s): Jessica Snowden, Akshatha, Robert Annett, et al

How does prenatal opioid exposure affect child outcomes?

Author(s): Elisabeth Conradt, Sheila Crowell, Barry Lester

Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

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Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

Author(s): Brett Doherty and Megan Romano

Who sponsored this study?

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, and grant funding.*

What were the study results?

Researchers found 199 unique chemicals in the wristbands worn by women in the study. There were 16 chemicals, including chemicals in personal care products and consumer goods, which were found most often. Most women had comparatively low amounts of exposures to these chemicals but others had more unique combinations of chemical exposures. Education and behaviors, such as nail polish use, helped predict the level of chemical exposures.

What was the study's impact?

This work helps identify opportunities and challenges for using tools like silicone wristbands to understand chemical exposures during pregnancy. The research team also identified common exposures and exposure patterns within the study population, which may be studied in future research.

Why was this study needed?

Pregnant women are exposed to chemicals that may be bad for their health or their babies’ health. At the same time, the types of chemicals and their co-occurrence are not well understood. The researchers used silicone wristbands that capture chemicals in the environment to learn more about these exposures in a group of pregnant women in northern New England.

Who was involved?

This study included 255 women enrolled in the New Hampshire Birth Cohort Study (NHBCS) between 2017 and 2019. The NHBCS began in 2009 and includes more than 2,000 mother and child pairs.

What happened during the study?

During early pregnancy, the women wore the wristbands and went about their normal activities while chemicals in their environment became trapped in their wristbands. The women then returned the wristbands after one week and researchers measured the captured chemicals. This provided information about the chemicals in the women’s environments.

What happens next?

The team will connect the chemical exposure information collected from the silicone wristbands to maternal and infant health outcomes. This connection may show how chemicals influence human health and provide clues to prevent health problems. The team will also compare these wristband measurements to traditional measurements of chemical exposures. This will help scientists better understand the strengths and weaknesses of this new technology.

Where can I learn more?

Access the full journal article , titled “Assessment of Multipollutant Exposures During Pregnancy Using Silicone Wristbands” published in Frontiers in Public Health.

Additional details

This work included collaboration with Dr. John Pearce, who, like Dr. Romano, is an OIF Cycle 1 Awardee. Dr. Pearce provided expertise related to the statistical methods used in this research, which he developed through his project entitled “Developing exposure characterization tools to address complex exposures within ECHO” (EC0155).

*Award Numbers include U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3 OD023275, and the National Institute of Environmental Health Sciences under Award Number P42ES007373. Brett T. Doherty was supported by National Cancer Institute grant R25CA134286.

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

Published: September 29, 2020

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Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

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The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

Author(s): Jessica Snowden, Akshatha, Robert Annett, et al

What was done?

In the fall of 2017, 54 sites within two research networks were surveyed. The sites were asked about the protocols and practices they used to treat NOWS infants. They were also asked how NOWS infants were diagnosed, what drugs they were given, what non-drug methods were used, and what areas of the hospital cared for NOWS infants.

What was found?

Sites could be divided into those that were NICUs (neonatal intensive care units) and those that were not ICUs (non-ICUs). NICUs were more likely to have protocols for screening mothers and diagnosing NOWs. They were also more likely to have protocols for how to give drugs for NOWS symptoms and encouraging breastfeeding. NICUs were more likely to use non-drug methods to treat NOWS infants.

Non-drug methods included swaddling, cuddling, massage, and low-stimulation environments. Morphine was the first drug of choice for NOWS symptoms at a majority of sites, regardless of their type.

What do the results mean?

Non-ICU sites need targeted training and standardized care plans for NOWS infants. However, it is not clear which practices are the most beneficial. Some variations in care may be best for some NOWS infants. The long-term effects of drug therapy and non-drug methods in these infants are unknown. The variations seen in this study show the need for multisite clinical trials in infants with NOWS. These studies will help define the best policies and practices to use with NOWS infants.

Why was this study conducted?

Neonatal opioid withdrawal syndrome (NOWS) often occurs when the mothers of unborn babies use opioids. The number of babies with NOWS has dramatically increased in the last 10 years due to the opioid crisis in the US. Doctors and hospitals have developed standard protocols on how best to care for these babies. The goal of this study was to collect information on how hospitals care for NOWS infants and to use this information for future clinical studies on the best methods to care for them.

Appreciation:

The authors especially thank the sites of the Institutional Development Award States Pediatric Clinical Trials Network and the Neonatal Research Network for contributing participating in the survey. The authors would also like to thank the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health for supporting this research.

You may learn more about this publication here: https://www.ncbi.nlm.nih.gov/pubmed/31324654

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

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The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

ECHO Review Finds No Strong Link Between Non-Persistent Chemical Exposures Found in Consumer Products and the Time It Takes Couples to Get Pregnant

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ECHO Review Finds No Strong Link Between Non-Persistent Chemical Exposures Found in Consumer Products and the Time It Takes Couples to Get Pregnant

Author(s): Alison E. Hipwell, Linda G. Kahn, Pam Factor-Litvak, 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. This work was also supported by NIH grants P30 ES009089, R01ES013543, R01ES014393, R01ES08977, and T32ES023772.

What were the study results?

There were some signs that when either men, women, or both were exposed to certain chemicals, it took a longer for the couple to get pregnant. But more research needs to be done to truly understand those effects. There were also signs that certain chemicals did not have any effects.

*Results reported here are for a single review of specific studies during a 10-year period. 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 papers we reviewed did not show a strong link between non-persistent chemicals and how long it takes to get pregnant. But, because there are not many studies like this, we concluded that more research is needed. While we wait for more research, it does not hurt to try to avoid certain chemicals in case they could affect the chances of becoming pregnant. We suggest common-sense lifestyle changes for men and women who would like to have a child. These include trying to avoid contact with certain non-persistent chemicals. Some ways to do this would be to use fewer plastic food containers and look at ingredient lists on personal care and cleaning products in order to avoid phthalates, parabens, TCS, benzophenones, and glycol ethers.

Why was this study needed?

Many products that people use contain non-persistent chemicals that can disrupt hormones. Non-persistent chemicals are chemicals that are broken down fairly quickly in the environment and in the human body. Therefore, non-persistent chemicals are often used in everyday household products. Some studies show these chemicals may affect people’s chance to get pregnant or may cause problems in pregnancy. These chemicals may also affect how long it takes for a couple to become pregnant, but not many studies have tried to answer this question. The goals of this study were to:

Review and summarize what is known about possible links between non-persistent chemicals and the time it takes to get pregnant.
To identify what information is missing in existing studies about this topic.
To present our results in a way that might change health policies and future research about chemicals in products that people use.

Who was involved?

This review looked at existing studies of healthy men and women who were in the age range to get pregnant. The studies were done in several different countries and ranged in size from 137 to 10,512 participants.

What happened during the study?

We used several sets of data to do a large search of research papers published from 2007 to 2017. We searched for articles about both common non-persistent chemicals and time to get pregnant. Our search found 3,456 articles. Two authors reviewed each of the articles we found to make sure they included information we needed. We found that 15 papers from 12 different studies, and then we pulled information from those for our review.

What happens next?

We are doing another review that will study whether there is a connection between chemicals that stay in the body for a long time and the time it takes to become pregnant.

Where can I learn more?

Access the full journal article titled, “Exposure to non-persistent chemicals in consumer products and fecundability: a systematic review” in Human Reproduction Update.

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

Published: January 1, 2019

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ECHO Review Finds No Strong Link Between Non-Persistent Chemical Exposures Found in Consumer Products and the Time It Takes Couples to Get Pregnant