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

ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

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ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

Authors: Maxwell Mansolf, Courtney K. Blackwell, 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?

Up to 50% of children and adolescents in the United States might experience sleep problems. Poor sleep can negatively affect brain development, learning, and physical and emotional well-being. Existing studies suggest there could be a link between poor sleep outcomes in children and teens and stress experienced by their caregivers, but these studies have primarily been limited to infants and young children. In this study, researchers used ECHO’s diverse data to study this association in school-age children and teens.

What were the study results?

Children of caregivers who reported feeling stress from their life circumstances were more likely to experience sleep disturbances. This association was consistent across different groups of child and caregiver pairs studied, even after accounting for mental and physical health conditions.

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 research suggests that children whose caregivers report increased perceived stress may be at higher risk for sleep issues. Screening for caregiver stress may help healthcare providers identify and plan interventions for children who may be at risk for sleep issues.

Who was involved?

The study included data from 2,641 children between ages 6 and 18 and their caregivers from 12 ECHO research sites. Most caregivers (78.6%) had at least some college education. About a third of the children (34.7%) had at least one mental health condition, and a quarter of the children (25%) had at least one physical health condition.

What happened during the study?

Researchers analyzed data provided by caregivers who completed the Perceived Stress Scale (PSS) about their own stress as well as the Child Behavior Checklist (CBCL), a common parent-reported child behavior survey, about their children’s emotional and behavioral well-being, including their sleep habits. The PSS is a widely used self-report survey that measures how much a person perceives their life as unpredictable, uncontrollable, and overloading over the previous month. To evaluate how caregiver stress affected child sleep patterns, researchers looked at responses to questions from the CBCL that addressed children’s experience with nightmares, insomnia, excessive sleep, troubled sleep, and ongoing tiredness.

What happens next?

Future sleep interventions may consider a more global approach to improving child and adolescent sleep health. Continued research on the factors that influence family health and well-being may guide interventions that address the entire family and the dynamics of the family relationship.

Where can I learn more?

Access the full journal article, titled “Caregiver Perceived Stress and Child Sleep Health: An Item-Level Individual Participant Data Meta-Analysis,” in the Journal of Child and Family Studies.

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

Published July 15, 2023

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ECHO Study Suggests Caregiver Stress May Be Linked to Child Sleep Issues

ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

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ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

Authors: Matt Kasman, 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?

Health experts agree that sugar-sweetened drink consumption by children in the U.S. should be reduced but finding effective strategies has been a challenge. Large-scale interventions are costly and have shown limited effects. Computer modeling to explore what drives consumption in specific populations could lead to tailored strategies that yield better results.

What were the study results?

Through a computer simulation based on data collected over several years from thousands of real children, researchers found that limiting access to sugary drinks in the home could reduce childhood consumption by as much as 87%. Reducing sugar-sweetened drink availability at school and childcare facilities was also helpful. The amount of the reductions also varied between the groups of children simulated.

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 highlights the importance of tailoring interventions to reduce sugar-sweetened drink consumption for different populations. Using computer models, researchers may gain more information about populations that can help to identify effective targeted interventions.

Who was involved?

This study examined data from children ages 2 to 7 years old in three ECHO research sites across the U.S. These children spent time in different environments as they grew—home, childcare, and school—where they had varying access to sugary beverages.

What happened during the study?

Researchers entered data based on children from three ECHO research sites into a computer model to recreate their sugar-sweetened beverage consumption. Based on the computer model, researchers simulated potential interventions and measured their impact on reducing consumption in different populations. Computer models can be affected by certain factors, including socioeconomic status, BMI, time spent in a specific setting, accessible beverages in the home, and access to a pediatrician.

What happens next?

In future studies, researchers plan to include older children and adjust computer models to explore the consumption of other foods and beverages with health implications.

Where can I learn more?

Access the full journal article, titled “Childhood Sugar-sweetened Beverage Consumption: An Agent-based Model of Context-specific Reduction Efforts,” in the American Journal of Preventive Medicine.

A summary of a previous study that applied computational modeling to a single ECHO research site can be found here.

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

Published July 13, 2023

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ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

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ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

Authors: Sheena Martenies, 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?

There is growing interest in understanding the combined effect of environmental hazards and social stressors on the health and development of children. While there are a number of tools for assessing the impact of environmental and social stressors, these tools can be limiting in the number of indicators they measure, the geographical area they cover, or the period of time they include for their observations. In this study, researchers developed a combined exposure index with national coverage that compiled available data on several environmental and social indicators during prenatal and early-life periods. This index is now being used to facilitate ECHO-wide analyses that consider multiple neighborhood-level exposures at the same time.

What were the study results?

The combined exposure index, which summarized exposures to multiple environmental hazards and social stressors at the neighborhood level, differed by region. The level of combined exposures were highest in the western and northeastern regions of the United States. Researchers also found that pregnant participants who identified as Black and Hispanic had higher exposures compared to White and non-Hispanic participants. Exposure values were also higher for pregnant participants with lower educational attainment.

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 analyzed how the combined exposure to several environmental hazards and social stressors during pregnancy may impact health. Researchers found that pregnant participants from minority groups were more likely to have higher exposures to these hazards. These results support findings from similar studies that suggest that neighborhood quality might influence maternal and child health outcomes, and may contribute to health disparities.

Who was involved?

This study included data from 14,072 pregnancies from 46 different ECHO research sites across the United States.

What happened during the study?

Researchers developed a combined exposure index using publicly available data on environmental hazards and social stressors. The data included variables such as air pollution, features of the built environment, and neighborhood socioeconomic status, and then estimated the likelihood of exposure to these variables for participants in the study, based on where they lived.

What happens next?

Researchers can use this exposure index in future studies to look at how neighborhood features influence child health outcomes. Future studies would benefit from national datasets for key environmental health concerns, such as water contaminants and pesticides, and social stressors that may disproportionally affect certain groups.

Where can I learn more?

Access the full journal article, titled “Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort,” in the International Journal of Environmental Research and 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 July 10, 2023

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ECHO Researchers Develop a National Exposure Index for Combined Environmental Hazards and Social Stressors

Maternal PFAS Exposure During Pregnancy Increases Children’s Risk of Obesity

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Maternal PFAS Exposure During Pregnancy May Increase Children’s Risk of Obesity

Authors: Yun Liu, Joseph Braun, 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?

Per- and polyfluoroalkyl substances (PFAS) are long-lasting chemicals that can be found in many household materials, as well as food and drinking water. Maternal PFAS exposure during pregnancy may be linked to increased weight and a higher risk of obesity among children and adolescents. However, existing studies looking at these associations have had inconsistent findings.

What were the study results?

The study found that higher levels of some PFAS were linked with slightly higher BMIs in children and an increased risk of obesity. This trend was seen across male and female children and wasn’t affected by the presence of other factors linked to childhood obesity.

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?

Recently, there has been growing interest in understanding the effects of PFAS exposure on children’s health and establishing policies to address PFAS pollution. The US Environmental Protection Agency (EPA) has created a Roadmap to address PFAS contamination. Studies like this one can help better understand the risks of PFAS to take effective actions to protect vulnerable populations.

Who was involved?

The researchers used data from 1,391 children between the ages of 2 and 5 years and their mothers who were enrolled in eight ECHO cohorts across United States from 1999 to 2019.

What happened during the study?

The researchers measured levels of seven different PFAS in maternal blood samples collected during pregnancy. The researchers also used data on children’s weight and height to calculate each child’s body mass index (BMI), an approximate measure of body fat.

What happens next?

Future studies are needed to examine potential links between maternal PFAS exposure during pregnancy and obesity-related health concerns in older children.

Where can I learn more?

Access the full journal article, titled “Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI Z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts,” 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 June 7, 2023

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Maternal PFAS Exposure During Pregnancy May Increase Children’s Risk of Obesity

Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

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Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

Authors: Rachel L. Miller; Christine C. Johnson, 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?

While the prevalence of asthma has been reported widely in the United States and elsewhere, studies on childhood asthma incidence rates within specific populations and across various types of asthma and age ranges have been relatively sparse. Describing the incidence rates of ARE across various pediatric populations is a critical first step for identifying potential risk factors and causes.

What were the study results?

In this study, investigators wanted to gather more information about factors that influence the rates of childhood asthma with recurrent exacerbations (ARE)—a subtype of asthma where children experience frequent, severe episodes of asthma.

ARE incidence rates were highest among children ages 2-4 years old, and among non-Hispanic Black and Hispanic Black children. ARE rates were also higher among children living in the Northeast and Midwest compared to those living in the West. Children with a parental history of asthma had ARE rates 2.9 times greater compared to those with no parental history.

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 impact?

Higher incidence rates of ARE among young children, non-Hispanic Black and Hispanic Black children, and children living in the Northeast and Midwest suggest that differential environmental exposures may play a significant role in the onset of recurring asthma issues in children. ARE rates are consistently higher among children with a parental history of asthma, especially for young children, which may be due to a combination of genetic, environmental, and family lifestyle factors.

Who was involved?

The research team leveraged data from 17,246 children born between 1990 and 2017 who were enrolled in 60 ECHO research sites in the U.S. and Puerto Rico. Child participants or their caregivers reported whether and when the child had an asthma diagnosis and any oral corticosteroids prescribed from a health care provider. Incidence rates of ARE were based on reports of systemic (not inhaled) corticosteroid use.

Of the 4,114 children diagnosed with asthma during this study, there were 2,061 children with at least one asthma episode when they used oral steroid medication; 734 of these children had 2 or more asthma episodes with steroid medication use and met the conditions for ARE.

What happened during the study?

The researchers calculated the incidence rates of ARE for the study population as a whole, along with the rates for subsets of the population defined by the year of ARE diagnosis, the decade they were born, their age and sex, their race and ethnicity, their residence at birth, and their parents’ history of asthma. The researchers followed the children from birth until they developed ARE, reached the age of 20 years or the study period ended. The study identified children who developed ARE based on at least two reports of systemic steroid medication use at any time during the entire follow-up period. Children who received asthma diagnoses before age 5 years were required to have confirmation after 5 years, either by a parent or caregiver, adolescent self-report of asthma symptoms, hospitalization, emergency department or urgent care visit for asthma, provider visits due to asthma, or asthma medication use.

What happens next?

ECHO researchers are planning new studies that examine key early environmental exposures that could contribute to ARE, including viral respiratory tract infections, indoor allergens, environmental tobacco smoke, air pollution, stress, socioeconomic status, and where children live.

Where can I learn more?

Access the full journal article, titled “Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program,” in The Journal of Allergy and Clinical Immunology.

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

Published March 25, 2023

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Specific Social, Environmental Factors May Influence Incidence Rates of Childhood Asthma with Recurrent Exacerbations

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

Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

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Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Authors: Lauren C. Shuffrey, 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?

Previous research has linked gestational diabetes (a type of diabetes mothers develop during pregnancy) to prenatal and postpartum depression in mothers. However, studies have not examined how the combination of gestational diabetes, prenatal depression, and postpartum depression affect early childhood behavior.

What were the study results?

The study found that gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each associated with increased child externalizing (e.g., acting out, aggression, hyperactivity) and internalizing (e.g., anxiety, depression) behavior problems. This study also found that gestational diabetes was associated with increased autism behaviors only among children exposed to above average perinatal maternal depressive symptoms. Finally, the researchers observed gestational diabetes was only associated with child behavioral problems for male children, and not for female children.

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 impact?

These findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy should receive additional monitoring for behavioral problems during early childhood.

Who was involved?

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as mixed race, and 4% as Asian.

What happened during the study?

ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5. They also collected information from the mothers including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

What happens next?

ECHO researchers are currently analyzing blood samples collected during pregnancy to investigate potential inflammatory mechanisms that may influence the associations between gestational diabetes, maternal depression, and early childhood behavior.

Where can I learn more?

Access the full journal article titled, “Gestational Diabetes Mellitus, Perinatal Maternal Depression, and Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” in Child Development.

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

Published May 2, 2023

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Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems