Children and Adolescents Born Preterm Were More Likely to Use Healthcare Services Related to COVID-19 Symptoms

Authors: Elisabeth C. McGowan, Monica McGrath, Andrew Law, Barry Lester, 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?

This is one of the first studies to look at healthcare use during the COVID-19 pandemic by a high-risk population—children and adolescents who were born preterm (37 or fewer weeks after gestation). By looking for possible patterns of healthcare utilization, this study can help healthcare providers to improve care for patients in future pandemics or other public health care crises.

What were the study results?

In this study, the researchers found that individuals born at 37 or fewer weeks after gestation were more likely to use healthcare services related to COVID-19 symptoms; those born extremely preterm (28 or fewer weeks) were even more likely to do so. For example, children and adolescents born extremely preterm were twice as likely to ask for an in-person appointment or a telehealth evaluation compared to individuals who were born after 37 weeks. Researchers saw that these differences were probably not caused by known risks for breathing problems such as asthma or chronic lung disease. Additionally, preterm children were no more likely to miss healthcare appointments overall than were individuals born at term.

What was the study's impact?

This study suggests that children and adolescents who were born preterm may be more likely to use healthcare during the COVID-19 pandemic than are children and adolescents who were born at full-term. Understanding the factors associated with both overall healthcare use and symptom-specific use may help healthcare providers identify the best strategies to provide targeted care. Understanding the different needs and patterns of healthcare use among children born preterm and their families during the first year of the pandemic, and why those patterns exist, are important first steps on the path to make healthcare more effective and efficient.

Who was involved?

This study included data from 42 ECHO research sites that together included 1,691 individuals ages 1–18 years. Of these individuals, 270 were born at less than 37 weeks of gestation. The study collected data from participants who were on average between 8 and 9 years of age. Approximately 40% of participants born preterm had reports of asthma-like symptoms within 1 year of healthcare use, compared to 20% of those born at term.

What happened during the study?

In this study, the researchers investigated whether children born preterm used healthcare during the COVID-19 pandemic differently than those born at term. Between April 2020 and August 2021, children’s caregivers and adolescents answered questionnaires regarding COVID-19 and healthcare use. The researchers studied healthcare use related to concerns about COVID-19 symptoms (like trouble breathing, fever, headache, muscle pain, fatigue, itchy eyes, nausea, diarrhea, vomiting, and loss of smell or taste) that resulted in overnight stays in hospitals, visits to urgent care centers or primary care offices, or virtual visits such as telehealth. They also explored changes in overall healthcare use during the pandemic, including missed healthcare appointments caused by parental concerns about going into a medical office or cancellation of an appointment by the provider.

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?

Further studies may evaluate the role socioeconomic factors may play in healthcare utilization.

Where can I learn more?

Access the full journal article, titled “Healthcare Utilization During the COVID-19 Pandemic Among Individuals Born Preterm,” 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 April 28, 2023

Access the associated article.

Download this summary

Children and Adolescents Born Preterm Were More Likely to Use Healthcare Services Related to COVID-19 Symptoms

Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

<< Back to Research Summaries

Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

Authors: Julie A. Hofheimer, Monica McGrath, Rashelle Musci, 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?

Emotional and behavioral difficulties during early childhood can predict later problems such as anxiety, depression, attention deficits, and aggression. This study aims to describe children’s behavioral development from 18 to 72 months of age, examining risk factors for continuing behavioral problems that can inform early interventions to improve behavioral and emotional regulation.

What were the study results?

Children born preterm, males, and those exposed to more family hardships had more behavioral difficulties that persisted over time, including anxiety/depression, attention deficits, and aggression. Other factors that increased the risk for behavioral difficulties in children were prenatal substance exposure and higher maternal psychosocial and economic difficulties during pregnancy. Some children who experienced fewer family hardships showed improved behavior over time when receiving early support. The researchers were able to identify early life factors that may increase a child’s risk for experiencing behavioral and emotional difficulties later in childhood.

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

What was the study's impact?

This study suggested that support and services for families to help them cope with newborn health challenges and other family hardships may help improve young children’s behavioral and emotional difficulties. Specifically, preterm births and prenatal substance exposures may be used to identify children who may benefit from early support. Individualized support to meet the specific needs of children may prevent later behavioral problems and improve future outcomes for vulnerable children and their families.

Who was involved?

The study included 3,934 children born between 1990 and 2019 and their mothers from 20 ECHO cohorts across the United States. About 80% of the children were born at term (at or beyond 37 weeks of gestation), and about 20% were born preterm (before 37 weeks of gestation).

What happened during the study?

The researchers collected caregiver self-reports, demographics, and medical and social environment information about the mothers and children before and during pregnancy and from infancy through age 6. Caregivers also completed the Child Behavior Checklist at multiple study visits to describe their child’s behavior at different ages. Researchers compared the trajectory of children’s scores for dysregulation behaviors (anxiety, depression, attention, and aggression) across the first six years of life. Researchers described three patterns of behavioral trajectories observed in these children 1) high and increased dysregulation (2.3%); 2) borderline and stable dysregulation (12.3%); and 3) low and decreasing dysregulation (85.6%).

What happens next?

Future ECHO studies may examine how the behavior of children continues to develop after six years of age. These new studies could focus on identifying additional risk and protective factors for emotional and behavioral well-being and patterns across middle childhood and adolescence.

Where can I learn more?

Access the full journal article, titled “Psychosocial and Neonatal Risk Factors Associated with Behavioral Dysregulation Trajectories Among Young Children from 18 through 72 Months of Age,” 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 April 26, 2023

Access the associated article.

Download this summary

Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

<< Back to Research Summaries

ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

Authors: Katherine Sauder, 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?

Out of all the prenatal supplements analyzed, the study found one that may potentially give pregnant patients the optimal amounts of the most important nutrients. But, the monthly cost of this supplement can be too high for some people, and it requires pregnant women to take seven pills a day. To ensure that pregnant women have accessible options for prenatal vitamins, the researchers looked for dietary supplements containing close to the needed amounts of nutrients that cost less and required only one to two pills a day.

See the full publication (Appendix A) for a list of the prenatal supplements analyzed during this study and their nutritional contents.

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

What was the study's impact?

This study can inform pregnant women and their doctors about key nutrients they may be missing in their diet and what prenatal vitamins they can take to get those nutrients. Companies that manufacture prenatal vitamins can also use the results of this study to understand how much of these nutrients should be in the products they make. Importantly, this study highlights the ongoing need for more prenatal vitamin options that are low cost and convenient, while still containing the optimal amounts of key nutrients.

Why was the study needed?

It is important that pregnant women get the right amounts of the nutrients they need for a healthy pregnancy. There are thousands of options for prenatal dietary supplements in the United States, so ECHO researchers conducted this study to help pregnant women and doctors pick the ones that contain optimal doses of key micronutrients to support a healthy pregnancy.

Who was involved?

This study included 2,450 pregnant participants from six ECHO cohorts located across the United States.

What happened during the study?

ECHO researchers first analyzed data about what the participants ate and drank during their pregnancies. Then, they calculated how much vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids the pregnant participants were getting from their diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from a prenatal vitamin to make up what they were missing in their diet.

The researchers compared over 20,000 prenatal vitamins available in the US, focusing on the nutrients that are most important for maternal and infant health: vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids.

What happens next?

In addition to the use of prenatal dietary supplements, pregnant women can adjust their diet to include more of the nutrients they need for a healthy pregnancy. Going forward, more research is needed to identify foods that pregnant women could eat to get enough of these nutrients.

Where can I learn more?

Access the full journal article, titled “Selecting a dietary supplement with appropriate dosing for six key nutrients in pregnancy" in The American Journal of Clinical Nutrition.

Read more information about healthy eating during pregnancy on the American College of Obstetricians and Gynecologists website.

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

Published April 2023

Access the associated article.

Download this summary

ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

<< Back to Research Summaries

ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

Authors: Britt Snyder, Tina Hartert, James Gern, 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?

Few studies have looked at possible links between maternal health characteristics, including environmental stressors, and the metabolism of newborns. Metabolism refers to chemical reactions that take place within the cells to provide the body with the energy needed for growth and maintaining health. Researchers often study metabolism by measuring the blood levels of certain molecules—called metabolites—that are created during those chemical processes.

This study expanded previous findings that showed links between maternal characteristics (such as pre-pregnancy smoking, pre-pregnancy body mass index, education, occupation status, marital status, age at delivery, asthma diagnosis, diabetes during pregnancy, or type of delivery) and amounts of metabolites in newborns. The study also explored the link between these metabolites and child growth patterns. In addition, this study explores the maternal factors and potential series of chemical changes in utero (in the womb) that may contribute to the link between newborn metabolism and childhood BMI*.

*Body Mass Index (BMI) is a common health screening tool that considers both height and weight.

What were the study results?

The researchers identified links between maternal health characteristics and the concentration of various metabolites in newborns. Additionally, this study showed that some metabolites were also linked to childhood BMI at ages 1–3 years.

The study found that factors like higher BMI before pregnancy or maternal age at delivery seemed to increase the levels of key metabolites in newborns. However, other metabolites which were linked with maternal health characteristics were not associated with changes in childhood BMI.

What was the study's impact?

Previous research has shown associations between levels of some newborn metabolites and childhood growth, overweight, and obesity. This study provides additional insights on the maternal factors and potential in utero pathways connecting newborn metabolism and later metabolic dysfunction in children. Such imbalance may increase a person’s lifetime risk of coronary heart disease, diabetes, stroke, and other serious health problems.

Who was involved?

This study included 3,492 infants enrolled in three ECHO research sites with linked newborn screening metabolic data.

What happened during the study?

The researchers used data on maternal health characteristics collected from questionnaires, birth certificates, and medical records. Child BMI was obtained from medical records and study visits. The researchers used statistical tools to evaluate possible links between maternal health characteristics and newborn metabolism.

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?

This study is an early step in assessing biological pathways through which maternal health characteristics may influence prenatal metabolic development. These metabolic changes may then influence health after birth. Future studies are needed to further explore the potential pathways through which maternal health characteristics may impact child health.

Where can I learn more?

Access the full journal article, titled “The Associations of Maternal Health Characteristics, Newborn Metabolite Concentrations, and Child Body Mass Index among US Children in the ECHO Program,” in Metabolites.

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

Published April 1, 2023

Access the associated article.

Download this summary

ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

Related Research Summaries

Changes in Body Mass Index among School-aged Children Before and After the Healthy, Hunger-Free Kids Act

Author(s): Aruna Chandran, Emily Knapp, et al.

How Does Neighborhood Social Vulnerability Affect Children’s Weight?

Authors: Izzuddin M. Aris, et al.

Changes in Body Mass Index (BMI) during the COVID-19 Pandemic

Authors: Emily Knapp, Aruna Chandran, et al.

The Relationship Between Prenatal Obesity and Child Autism-related Social Behaviors

Author(s): Kristen Lyall, Christine Ladd-Acosta, et al.

ECHO Study Links COVID-19 Stress, Slightly Earlier Births

<< Back to Research Summaries

ECHO Study Links COVID-19 Stress, Slightly Earlier Births

Authors: Kim McKee, Sarah Comstock, et al.

Who sponsored this study?

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

Why was this study needed?

The effects of depression and stress during pregnancy and their relationship to poor birth outcomes, such as preterm birth, are well documented. This study evaluated how maternal stress during the pandemic may have contributed to newborn health outcomes.

What were the study results?

Babies born to ECHO participants who were pregnant during the pandemic had similar birth weights but were born slightly earlier compared to babies born to ECHO participants who were pregnant between 2016-2019, prior to the pandemic. The study also found levels of stress were similar for ECHO participants who were pregnant between March 2020 and May 2021 compared to those who were pregnant between 2016 and 2019. However, more participants who gave birth from March to September 2020 reported being distressed about changes to their prenatal care and delivery compared with those who delivered after September 2020.

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?

While other studies have noted increased levels of depression and anxiety among pregnant individuals during the COVID-19 pandemic, these trends were not observed in pregnant ECHO participants. These results suggest that many pregnant women in the United States may have already been experiencing stress before the pandemic that didn’t significantly increase following the start of the pandemic.

Who was involved?

This study included a total of 2,983 ECHO participants from 30 U.S. states and territories who delivered a baby between January 1, 2016 and May 31, 2021.

What happened during the study?

In this study, researchers evaluated medical records and maternal reports on birth weight, gestational age at delivery, and birth weight percentiles adjusted for gestational age at delivery among participants. Researchers also used data from pregnant participants across all time periods that measured depression and perceived stress. Participants who were pregnant during the pandemic reported on stress during the pandemic using a questionnaire developed during the pandemic for use with ECHO participants.

What happens next?

The study ended in May 2021 while the pandemic continued to create stressful and confusing conditions for pregnant women and their families. Similar analyses with data from additional pandemic periods could shed light on how the pandemic continues to affect pregnancy and infant health outcomes.

Where can I learn more?

Access the full journal article, titled “Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program,” 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.

Download this summary

ECHO Study Links COVID-19 Stress, Slightly Earlier Births

Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

<< Back to Research Summaries

Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

Authors: Aaron Kaat, Kristen Lyall, et al.

Who sponsored this study?

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

Why was this study needed?

Prior research has developed and examined shortened versions of the SRS questionnaire, but this has been mostly done with school-age participants with autism and their family members. Researchers haven’t been able to evaluate the reliability of shortened versions of the SRS for capturing broader traits in the general population or for preschool-age participants. In addition, prior studies have not developed a shortened version of the questionnaire that uses computer-adaptive testing to select relevant questions based on a participants existing answers.

What were the study results?

The Social Responsiveness Scale (SRS) is frequently used to measure autism-related traits and social impairments. The full 65-question SRS can create more burden for participants, so many researchers have attempted to shorten the questionnaire. In this study, ECHO researchers evaluated the SRS questionnaire across two different versions for preschool and school-age groups, comparing the questions used on each and developing a comparable scoring method for both forms. They then used computer-adaptive testing, where a computer program tailors the questionnaire in real-time to each participant, and found that a median of 14 questions was sufficient to reach a reliable score.

What was the study's impact?

The results of this work suggest opportunities to reduce the amount of time participants spend completing questionnaires like the SRS without sacrificing accuracy. Additionally, the results suggest computer-adaptive questionnaires can be used to evaluate autism-related traits in a way that is comparable to standard fixed questionnaires, improving testing efficiency and reducing participant burden.

Who was involved?

This study included 7,030 children from multiple ECHO research sites and other large studies across the United States. Participants included children ranging from ages 2.5-18 years, most of whom did not have an autism diagnosis.

What happened during the study?

The researchers collected data on the preschool and school-age SRS forms from multiple different sources. They then conducted several analyses to assess a variety of factors that may affect how the full SRS and shortened versions of the SRS are scored. The researchers then used these data to simulate how computer-adaptive testing would score each individual after completing the minimum number of questions required to reach a comparable result.

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?

The researchers’ follow-up analyses to this work compared the computerized version developed in this study to other versions of the questionnaire. Future research is needed to examine how these different questionnaires perform in different groups of people, and if results differ when captured according to self vs parent report.

Where can I learn more?

Access the full journal article, titled “Modifying the Social Responsiveness Scale for Adaptive Administration,” in Quality of Life Research.

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

Published March 21, 2023

Access the associated article.

Download this summary

Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

ECHO Study Suggests Exposure to PFAS During Pregnancy May Be Linked to Lower Birthweights

<< Back to Research Summaries

ECHO Study Suggests Exposure to PFAS During Pregnancy May Be Linked to Lower Birthweights

Authors: Amy Padula, Tracey Woodruff, et al.

Who sponsored this study?

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

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

What were the study results?

PFAS were found in almost all participants in the study. Researchers also found that in this study, participants with higher levels of PFAS exposure were more likely to have babies born with lower birthweight. These results did not find that stress played a role in the relationship between PFAS exposure and birthweight.

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 suggest that PFAS exposure during pregnancy is associated with lower birthweight in infants. However, outside of research studies, pregnant women are not usually tested for PFAS and are often unaware of their potential harms despite PFAS exposure from the environment being common. Therefore, it is important to address efforts to reduce and prevent further exposure to PFAS. Researchers need to better understand where people are most likely to be exposed to these chemicals given the wide range of exposure sources, from PFAS contamination in water to PFAS used in certain consumer products.

Why was this study needed?

It is important to know what the effects of per- and polyfluoroalkyl substances (PFAS) exposures may be on child and maternal health. This study is the largest of its kind and includes participants from across the US to help inform future research related to potential effects of PFAS exposures.

Who was involved?

This study included eleven ECHO pregnancy cohorts with a total of 3,339 participants from several states.

What happened during the study?

The researchers measured the concentration of PFAS, chemicals used in a wide range of consumer products, in the blood of pregnant women. They also surveyed these women about their stress levels throughout pregnancy. These measurements occurred over the past 20 years. The researchers then compared the birthweight for babies resulting from these pregnancies and recorded any instances of preterm birth.

What happens next?

The next step for researchers is to examine potential sources of PFAS exposures, including exposures from drinking water and consumer products. Future studies within ECHO may also examine how body mass index and preexisting conditions, such as diabetes during pregnancy or high blood pressure, may interact with PFAS exposures and contribute to the effects of PFAS on infant birthweight. Future studies may also examine additional chemicals that could contribute to lower birthweight in infants.

Where can I learn more?

The US Environmental Protection Agency (EPA) created a Roadmap to protect people and communities from PFAS contamination.

Access the full journal article, titled “Birth Outcomes in Relation to Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Stress in the Environmental influences on Child Health Outcomes (ECHO) Program” 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 March 15, 2023

Access the associated article.

Download this summary

ECHO Study Suggests Exposure to PFAS During Pregnancy May Be Linked to Lower Birthweights

ECHO Researchers Demonstrate Reliability of Room-Temperature, Methanol-Preserved Placental Samples for Measuring Metabolism

<< Back to Research Summaries

ECHO Researchers Demonstrate Reliability of Room-Temperature, Methanol-Preserved Placental Samples for Measuring Metabolism

Authors: Jennifer Straughen, 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?

The results show that metabolic data with similar quality can be obtained from placental tissue samples preserved in methanol at room temperature than from flash-frozen samples—though a greater number of metabolites were typically detected in the methanol-fixed samples and the methanol extract.

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 results of this study show that placental tissue preservation in methanol at room temperature may be a suitable alternative method for analysis of placental metabolism. This method is more feasible and cost-effective than flash freezing, especially in community-based hospitals. As such, this study may make it easier for researchers to study the function of placentas and their potential relation to health outcomes.

Why was the study needed?

The placenta is an organ that provides nourishment to a developing fetus before it is born. Understanding metabolism within the placenta—the production and breakdown of molecules that provides energy to the placenta—might help researchers learn more about its function during pregnancy. To date, methods to collect placental samples to measure metabolism are expensive and require specialized equipment. In this study, researchers compared data from placental samples collected at room temperature to samples collected by flash-freezing, the standard method.

Who was involved?

The researchers collected placental samples from mothers within 15 minutes after delivery of the placenta at Henry Ford Health in Detroit, Michigan. All samples were anonymous.

What happened during the study?

The researchers collected pea-sized pieces of placenta tissue using the flash-freezing method and the test method (fixed in a solution of methanol at room temperature) and compared the resulting metabolism data.

What happens next?

More work is needed to describe the placental metabolic data revealed during this study and compare it to data from previous studies. Researchers will also need to repeat this study with a larger number of placentas to confirm the findings.

Where can I learn more?

Access the full journal article titled “Comparison of methanol fixation versus cryopreservation of the placenta for metabolomics analysis” published in Scientific Reports.

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

Published March 11, 2023

Access the associated article.

Download this summary

ECHO Researchers Demonstrate Reliability of Room-Temperature, Methanol-Preserved Placental Samples for Measuring Metabolism

Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

<< Back to Research Summaries

Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

Authors: Alison E. Hipwell, Irene Tung, 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.

What were the study results?

This study compared ECHO participants who were pregnant during the COVID-19 pandemic with participants who were pregnant before the pandemic. Participants who were pregnant during the pandemic reported more stress and symptoms of depression. Lower levels of physical activity were associated with more distress, and higher levels of emotional support were associated with less distress during pregnancy for both groups. The results also showed that pregnancies during the pandemic were slightly shorter on average but there was no impact on infant birth weight.

What was the study's impact?

This study highlights the importance of providing access to emotional support and mental health care during pregnancy and identifying ways to promote physical activity to help improve maternal health and well-being, regardless of external conditions like the pandemic.

Why was this study needed?

Previous studies on the effects of the COVID-19 pandemic on pregnancy outcomes have been mixed. This is partly because background information about pregnant participants has been missing and partly because the effects of the pandemic are different for different populations across the country. This study involved pregnant participants from across the United States and collected information about their mental health and well-being along with data on their pregnancy outcomes. The study also focused on positive factors that can be used to improve pregnancy health and birth outcomes, such as physical activity and emotional support.

Who was involved?

This study included 501 pregnant participants who gave birth during the COVID-19 pandemic (between March 12, 2020 and May 30, 2021) and 501 pregnant participants who gave birth before the pandemic (prior to March 11, 2020). Participants were 31 years old on average and enrolled in one of 16 ECHO research sites across the United States.

What happened during the study?

Participants answered questions about their experiences with stress and depression, reported on their physical activity, and described the emotional support they received during pregnancy. The researchers also collected information on participants’ birth outcomes from medical records and maternal reports.

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?

More research is needed to understand how social support and physical activity during pregnancy may protect pregnant women from stress or depression during difficult times. Future research may look for more details about the types of experiences during the COVID-19 pandemic that had the most influence on pregnancy health and well-being.

Where can I learn more?

Access the full journal article, titled “Impact of Sedentary Behavior and Emotional Support on Prenatal Psychological Distress and Birth Outcomes During the COVID-19 Pandemic,” in Psychological Medicine.

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

Published March 8, 2023

Access the associated article.

Download this summary

Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

<< Back to Research Summaries

ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

Authors: Marie Camerota, 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, and a career development award from the National Institute of Mental Health.

What were the study results?

ECHO researchers used the neurobehavioral scores to classify babies into one of six groups based on different patterns of behavior. While each group exhibited different characteristics, 4 of these groups contained infants with normal patterns of behavior. Only two of the six groups were characterized as poorly regulated. The first of these groups was hyper-aroused, or too excitable. The other group was hypo-aroused, or slow to respond.

Babies with poorly regulated behavior were more likely to be male, have younger mothers, and have mothers who were depressed or used tobacco during pregnancy. Babies born at all different gestational ages were found in each of the six groups.

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

What was the study's impact?

This study describes a possible link between demographic and health characteristics of mothers and babies with patterns of behavior in newborns. Previous studies conducted in single cohorts have described similar patterns of poorly regulated behavior in infants. The current study replicated those findings using a larger and more diverse population. If these patterns of behavior continue to be found in other large studies, this might suggest that these patterns could generalize to babies outside these studies. This information could be used to identify babies at risk for poorly regulated behavior who might benefit from early interventions and prevention services to help promote positive health outcomes for children.

Why was the study needed?

Behavior patterns in newborns can be used as indicators of long-term developmental outcomes. Previous studies have looked at the link between demographic and medical characteristics of mothers and their infant’s behavior shortly after birth, but these studies were conducted with smaller groups of babies who were very similar to one another (e.g., studies with babies who were all born full term). There is a need for studies that include a larger sample representing more diverse pairs of mothers and their babies, including babies who were born all across the gestational age spectrum.

Who was involved?

This study included 1,112 mother-infant pairs from 5 ECHO cohorts across the United States. Infants were born at gestational ages from 22 to 42 weeks.

What happened during the study?

The babies received a neurobehavioral exam shortly after they were born to test their responses to objects and people, their reflexes, and their movement. Either mothers reported information about their own and their babies’ demographic characteristics and health information or it was collected from their medical records. ECHO researchers looked at how the mothers’ demographic characteristics and health during pregnancy were related to their newborns’ behavior patterns.

What happens next?

More research is needed to determine which of the characteristics studied are stronger predictors of babies’ neurobehavior patterns, and whether the impact of these factors changes in babies born at different gestational ages. Further research is also needed to learn more about how babies’ neurobehavior shortly after birth is related to their health and development later in childhood.

Where can I learn more?

Access the full journal article, titled “Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the 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 February 25, 2023

Access the associated article.

Download this summary

ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns