ECHO Cohort Study Finds Amount of Time Spent in Childcare Not Associated With Mental Health Risks in Young Children, Including Those Facing Family Challenges

Authors: Michelle Bosquet Enlow, 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?

Children who face early life adversity—such as parental mental illness and household economic hardship—may be at a higher risk for mental health difficulties. Researchers in this study wanted to examine the extent to which attending out-of-home childcare might buffer or magnify the effects of those experiences.

In the U.S., many children under age 5 spend some time in nonparental childcare. However, previous findings on the role of childcare in child mental health have produced mixed results. While many studies highlight positive associations with attending childcare, some raise concerns that childcare may increase the risk for poor child developmental outcomes.

What were the study results?

The study found that children with higher exposure to factors such as family stress and mental illness were more likely to have higher levels of internalizing symptoms (such as anxiety or depression) and externalizing symptoms (such as aggression and hyperactivity), especially if their families also faced socioeconomic hardship. However, researchers also found that the number of hours in childcare did not seem to change the effects of these risks on children’s mental health, nor was childcare attendance significantly associated with improvement or worsening of their symptoms overall. This was true whether they looked at all types of non-parent childcare that were included in the study—including center-based care, home-based non-relative care, and care by a relative—or looked at just center-based care.

What was the study's impact?

The study found that the amount of time spent in childcare didn’t have a clear positive or negative effect on children’s mental health. The findings suggest that challenges like social or emotional stressors and financial hardships should be looked at separately to better understand the risks to children’s mental health in early life.

Who was involved?

The participants in the study were a diverse sample of 2,024 parent-child pairs from three ECHO Cohort Study Sites. Participants were recruited from hospitals in North Carolina, Pennsylvania, and Tennessee, as well as from U.S. adoption agencies across the United States.

What happened during the study?

The study collected data on the type and frequency of childcare attendance from birth to age 3 years. It also looked at early life challenges during that time, such as whether parents had experienced difficult childhood events, showed signs of depression, or had certain factors like age, education, or relationship status that could affect their child’s well-being. Between ages 3 and 5.5 years, the study evaluated children’s symptoms such as anxiety, depression, aggression, or hyperactivity. By following these children over time, researchers could explore the associations among early adversity, childcare attendance, and child mental health outcomes.

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

What happens next?

Future work could examine how and whether childcare quality is associated with child mental health, including whether high-quality care may be associated with a reduction of any adverse effects of early adversity on child outcomes.

Where can I learn more?

Access the full journal article titled “The Influence of Early Childhood Education and Care on the Relation between Early Life Social Adversity and Children’s Mental Health in the Environmental influences for Child Health Outcomes Program” in Development and Psychopathology.

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

Published December 2024

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ECHO Cohort Study Finds Amount of Time Spent in Childcare Not Associated With Mental Health Risks in Young Children, Including Those Facing Family Challenges

Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

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Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

Authors: Amy Non, James Gern, et al.

Who sponsored this study?

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

Why was this study needed?

Spirometry (spy-ROM-uh-tree) is a test used to check how well your lungs work. It measures how much air you breathe in, how much you breathe out, and how quickly you breathe out. Healthcare professionals use spirometry to diagnose asthma and other respiratory conditions. Historically, healthcare providers have used different spirometry equations based on a person’s race for interpreting test results, relying on the assumption that Black and White bodies are biologically different. For this study, researchers wanted to know whether using the same spirometry equations for everyone (race-neutral) or different ones for specific races (race-specific) changes the reliability of lung function tests used to check for asthma in children. This research addresses concerns that race-specific test interpretations might hide lung problems in children from certain backgrounds and could lead to differences in how asthma is diagnosed and treated in kids from racial and ethnic minority groups.

What were the study results?

Black children may be more likely to be identified as having reduced lung function when doctors use the same spirometry equations to interpret test results for everyone (race-neutral) instead of race-specific ones. The study found that using the race-neutral equations resulted in significantly lower lung function scores for Black children compared to the race-specific equations. This led to a higher percentage of Black children being classified as having low lung function. Furthermore, Black children were more likely to be diagnosed with asthma, regardless of the equation The way lung function was measured did not seem to make much difference in how often children needed asthma-related healthcare, like emergency room visits or hospital stays.

What was the study's impact?

The study's findings support using race-neutral equations when evaluating children for asthma, as they may provide a more uniform assessment of lung function across different racial and ethnic groups.

Who was involved?

The research included 8,719 children aged 5 to 12 years from 27 research sites across the United States. These children were grouped by parent-reported race and ethnicity, including Black, non-White Hispanic, and White children, with a smaller percentage classified as "Other Race."

What happened during the study?

The study examined how using the same equations for everyone changes how lung function tests are understood. These tests measure how much air a child can blow out in one second, the total amount of air they can blow out in one breath, and the balance between the two. Researchers also checked if the test results matched real-life asthma problems, like being diagnosed with asthma, needing emergency care, or staying in the hospital.

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 research is needed to better understand the racial differences in lung function and asthma outcomes. Future studies could also explore the impact of environmental and social factors affect respiratory health in children from different racial and ethnic groups.

Where can I learn more?

Access the full journal article, titled “Comparison of Race-neutral Versus Race-specific Spirometry Equations for Evaluation of Child Asthma,” in American Journal of Respiratory and Critical Care Medicine.

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

Published December 3, 2024

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Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

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ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

Authors: Monique Hedderson, Assiamira Ferrara, et al.

Who sponsored this study?

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

Why was this study needed?

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

What were the study results?

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

What was this study's impact?

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

Who was involved?

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

What happened during the study?

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

To assess rapid growth, the study relied on a measurement called the weight-for-length z-score (WLZ) a tool used to track an infant's growth, it compares a baby’s weight to their length, and tells you how far a baby's weight is from the average weight of babies of the same length. Rapid growth was defined as a significant increase in WLZ scores from birth to 6, 12, or 24 months. Babies whose WLZ scores jumped more than expected moved to a higher percentile on the growth chart, meaning they weighed more relative to their peers of the same length.

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

What happens next?

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

Where can I learn more?

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

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

Published November 21, 2024

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ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

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ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

Authors: Rachel Vecchione, 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?

Diet during pregnancy plays a major role in fetal development. Prior research has shown associations between several dietary factors and certain neurodevelopmental conditions in children, including autism spectrum disorder (ASD). ASD is a neurodevelopmental condition that affects social communication and behaviors, and presents in a wide variety of behaviors, abilities, and challenges.

This study helped to fill gaps in understanding the relationship between maternal dietary patterns during pregnancy and ASD-related outcomes in children. Most previous studies examining links between prenatal diet and ASD and other neurodevelopmental outcomes have focused on individual foods or nutrients, rather than overall dietary patterns. Dietary patterns may be useful to examine because they summarize the usual intake of a wide range of foods and may capture combined effects across many nutrients. Dietary patterns that capture the intake of recommended foods may also help to provide clearer communication than summaries across individual nutrients. This study therefore aimed to provide a comprehensive assessment by examining several established dietary patterns and their associations with ASD-related traits and diagnoses.

What were the study results?

Dietary patterns examined in this study included the Healthy Eating Index (HEI) and the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P), as well as the Empirical Dietary Inflammatory Index (EDIP). Both the HEI and AHEI-P are validated dietary patterns that are measures of overall diet quality. Higher scores on these patterns indicate better adherence to dietary guidelines. In contrast, higher scores on the EDIP indicate a more pro-inflammatory diet.

The study found that higher prenatal scores on the HEI the AHEI-P were associated with modest decreases in ASD-related traits. However, there were no significant associations between prenatal intake of these dietary patterns and ASD diagnosis. The findings suggest that while there may not be strong associations between prenatal dietary patterns and ASD diagnosis itself, there may be subtle associations with broader traits like social communication difficulties that warrant further investigation.

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 contributes to the understanding of how prenatal diet may relate to ASD-related characteristics in children. It also highlights the need to further study the potential mechanisms linking prenatal diet to ASD-related traits and to consider broader dietary patterns in addition to individual nutrients and foods.

Who was involved?

The study included 6,084 mother-child pairs from 14 ECHO Cohort Study Sites. The participants were socioeconomically and demographically diverse, drawn from a large U.S.-wide sample, including general population sites and sites with a higher chance of ASD occurring in families.

What happened during the study?

Researchers collected data from individual sites that used Food Frequency Questionnaires to assess diet during pregnancy and enable the calculation of dietary patterns. The study examined associations between three dietary patterns and ASD-related outcomes while adjusting for potential confounding factors such as maternal age, pre-pregnancy BMI, sociodemographic factors, and child characteristics.

What happens next?

Future studies could help researchers confirm the results of this study and explore the subtle associations between prenatal diet and ASD-related traits. Further research could also examine multiple ASD-related outcomes, using larger and more diverse samples, and investigate potential mechanisms linking prenatal diet to ASD-related traits.

Where can I learn more?

Access the full journal article, titled “Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental influences on Child Health Outcomes Consortium,” in Nutrients.

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

Published November 6, 2024

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ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

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

Authors: Alicia K. Peterson, Assiamira Ferrara, et al.

Who sponsored this study?

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

Why was this study needed?

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

What were the study results?

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

What was this study's impact?

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

Who was involved?

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

What happened during the study?

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

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

What happens next?

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

Where can I learn more?

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

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

Published October 17, 2024

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

ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

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ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

Authors: Sarah Dee Geiger, Aruna Chandran, Marie L. Churchill, Susan Schantz 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 study aimed to explore the associations between perceived maternal stress during and after pregnancy and child sleep problems and disturbances. Previous research has suggested prenatal stress could be associated with negative child sleep outcomes, but less is known about how postnatal stress may contribute to this association. This study aimed to address these gaps and provide insights into the potential public health implications of stress during and after pregnancy.

What were the study results?

The study found that maternal stress during pregnancy showed a small but significant association with child sleep problems and sleep disturbance. This effect was seen even when the researchers accounted for the influence of maternal stress after pregnancy.

What was the study's impact?

Maternal stress during and after pregnancy and child sleep problems are both very common, so even small effects may have important public health implications. Interventions that can help mothers manage stress during and after pregnancy could have positive effects on their children’s sleep quality, setting them up for a healthier childhood and adulthood.

Who was involved?

This study used data from a diverse group of 1,965 mother-child pairs enrolled in ECHO Study Sites in 7 U.S. states and Puerto Rico. The study included mothers who reported their stress during and after pregnancy and their child’s sleep at least once between the ages of 4 and 8, resulting in a racially and ethnically diverse sample, with up to 50% of these children being reported as Hispanic by their parents.

What happened during the study?

During the study, researchers measured maternal perceived stress using the Perceived Stress Scale (PSS) and used statistical analysis to investigate the relationship between maternal stress during pregnancy and child sleep quality, adjusting for various factors such as the mother’s age at delivery and level of education and the child’s sex, gestational age at birth, and age when sleep was evaluated. The researchers also conducted an analysis to assess the degree to which stress after pregnancy affected the relationship between prenatal stress and child sleep quality.

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?

Additional studies can help researchers understand the relationship between prenatal stress and child sleep outcomes. Future studies could also investigate the biological mechanisms and social factors underlying the association between prenatal stress and sleep outcomes in childhood.

Where can I learn more?

Access the full journal article, titled “Association Between Maternal Stress and Child Sleep Quality: A Nationwide Environmental Influences on Child Health Outcomes Program Prospective Cohort Study,” 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 October 11, 2024

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ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

Vulnerable Populations More Likely to be Impacted by Small Environmental Effects, ECHO Study Finds

Authors: Janet L. Peacock, et al.

Who sponsored this study?

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

Why was this study needed?

A challenge in public health is determining when the effect of an environmental exposure is large enough to be clinically important. Vulnerable populations—defined by sociodemographic factors such as race, ethnicity, and maternal education—tend to have a higher risk of poor health outcomes than the general population when exposed to the same environmental exposures. This study aimed to interpret the differences in outcomes between different population types, particularly focusing on vulnerable sub-populations, by analyzing differences arising from hypothetical small effects on these groups.

What were the study results?

The researchers used statistical models to examine how different levels of exposures would affect different sub-populations within the nationwide ECHO Cohort. Specifically, the study team considered a hypothetical environmental exposure that could affect a child’s birthweight. They considered four scenarios in which the hypothetical exposure could affect average birthweights in a population: a very small effect reducing average birthweight by 50g, a small effect reducing it by 125g, a medium effect reducing it by 167g, and a large effect reducing it by 250g.

The study found that the percentage of children with low birthweight (LBW) (birthweight<2500g) varied by socioeconomic categories with the greatest percentage LBW seen in the most vulnerable socioeconomic groups. After analyzing the four scenarios, a clear trend was seen such that the greatest impact of an exposure was seen in the most vulnerable sub-populations. This trend was observed for all scenarios including the impact of a small environmental exposure.

What was this study's impact?

This study showed how vulnerable groups, who already face higher risks of poor health, may be more affected by small environmental exposures than the general population. This demonstrates why small effects, which may be overlooked, are actually important when considering vulnerable populations. These results can be used in planning future studies and for designing preventive programs. The findings also help explain how exposures impact vulnerable groups and highlight the need to stratify by socioeconomic variables when assessing health outcomes.

Who was involved?

This simulation study modeled data from more than 28,000 mother-child pairs from the ECHO Cohort.

What happened during the study?

The research team conducted a simulation using data from ECHO Cohort participants to explore how hypothetical exposures could affect babies’ average birthweight and LBW in vulnerable subgroups. The study calculated average birthweight in groups by sociodemographic categories, and then compared the differences in average birthweight and the percentage of LBW.

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?

These findings are relevant for studies where researchers aim to identify the adverse effects of environmental exposures. Future research that uses more social factors and/or outcomes is needed to understand the impact of small environmental exposures on the general population and vulnerable sub-populations, and how these effects contribute to health disparities.

Where can I learn more?

Access the full journal article, titled “Do Small Effects Matter More in Vulnerable Populations? An Investigation Using Environmental influences on Child Health Outcomes (ECHO) Cohorts,” in BMC 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 September 28, 2024

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Vulnerable Populations More Likely to be Impacted by Small Environmental Effects, ECHO Study Finds

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

Authors: Izzuddin M. Aris, et al

Who sponsored this study?

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

Why was this study needed?

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

What were the study results?

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

What was this study's impact?

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

Who was involved?

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

What happened during the study?

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

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

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

What happens next?

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

Where can I learn more?

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

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

Published September 16, 2024

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

ECHO Study Investigates Pollution Exposure and Birth Outcomes in Pregnant Women Living in Historically Redlined Neighborhoods

Authors: Teresa Herrera, Akhgar Ghassabian, 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?

Exposure to tiny air pollutants known as PM2.5 during pregnancy can lead to outcomes like low birth weight and preterm birth. Factors such as weather, government policies, and social conditions can affect how much exposure pregnant women have to these pollutants. One factor that may have affected exposure is redlining, the historical practice of designating certain neighborhoods, often where minority groups lived, as risky investments for lenders. This grading system ranked neighborhoods on an A through D scale—A being the most desirable—which often led to disinvestment and lack of resources in lower-rated areas. While redlining was made illegal following the 1968 Fair Housing Act, it continues to affect the health outcomes of people living in historically redlined areas.

ECHO researchers wanted to learn whether living in historically redlined areas during pregnancy affects air pollution exposure and birth outcomes in New York City (NYC). Understanding what influences PM2.5 levels and their impact on birth outcomes can help improve the health of mothers and their children.

What were the study results?

The study found that living in lower-graded or ungraded census tracts during pregnancy was associated with higher exposure to PM2.5. These women also tended to have babies with lower birth weights. This association was strong even when considering factors such as race, ethnicity, and income at individual and community levels.

What was this study's impact?

The study supports the literature linking redlining to contemporary outcomes. This study highlights the multifaceted nature of structural racism. Findings from non-graded areas indicate that there are likely additional factors, along with redlining, that play a role in perpetuating modern-day inequality.

Who was involved?

The participants were 3,160 pregnant mothers and their babies in the NYC metropolitan area who were enrolled in six ECHO Cohort research sites. The study included pregnant mothers from 2005 to 2022 who had air pollution estimates available for their residential address. Most participants who identified as Black or White lived in neighborhoods that had been given a D grade, the lowest rating. Most participants who identified as Hispanic lived in neighborhoods with B or C grades.

What happened during the study?

Researchers used statistical methods to explore whether living in neighborhoods that were historically redlined was associated with higher exposure to air pollution (PM2.5) during pregnancy. They also examined if living in these neighborhoods was associated with the baby's birth weight, the likelihood of being born early, and the chances of having a low birth weight.

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

What happens next?

The authors note that future research could look at other practices like racial exclusionary zoning to fully understand the ongoing systemic effects of redlining.

Where can I learn more?

Access the full journal article, titled “Redlining in New York City: Impacts on Particulate Matter Exposure During Pregnancy and Birth Outcomes,” in Journal of Epidemiology and Community Health.

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

Published September 5, 2024

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ECHO Study Investigates Pollution Exposure and Birth Outcomes in Pregnant Women Living in Historically Redlined Neighborhoods

Fish But Not Supplements Consumed in Pregnancy Associated With Lower Rates of Autism Diagnosis And Related Traits, ECHO Cohort Study Finds

Authors: Emily Oken, 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?

Fish consumption during pregnancy provides an important source of omega-3 fatty acids, an essential nutrient for supporting child health and neurodevelopment. However, in the U.S., people who are pregnant or can become pregnant are not eating enough fish or get enough omega-3 fatty acids through diet or supplements. Few studies have explored prenatal fish consumption and supplement use in association with autism spectrum disorder (ASD) diagnosis or autism-related traits. This study aims to investigate the relationship between fish consumption or omega-3 supplement use and an ASD diagnosis or the presence of autism-related traits.

What were the study results?

Fish consumption during pregnancy was associated with a 20% lower likelihood of ASD diagnosis and fewer autism-related traits in offspring. The associations were somewhat stronger for female offspring. Taking fish oil supplements containing omega-3 fatty acids during pregnancy was not associated with an ASD diagnosis or autism-related traits. However, supplement use was associated with a slight increase in scores on the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers to report on their child’s possible autism-related traits.

What was the study's impact?

These findings are consistent with current dietary guidelines that support fish intake during pregnancy and support continued public health efforts to encourage fish intake.

Who was involved?

The participants were children born between 1999 and 2019 and their parents at three of the Environmental influences on Child Health Outcomes (ECHO) Cohort research sites. The sites selected from samples considered a higher likelihood for autism, either due to family history or preterm birth.

What happened during the study?

The researchers studied the relationship between maternal fish intake and omega-3/fish oil supplement use during pregnancy and the occurrence of clinician-diagnosed autism and parent-reported autism-related traits. These traits were measured using the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers. Fish consumption and supplement use were assessed based on self-reported dietary information from participants.

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

What happens next?

Future research could examine how chemical contaminants found in some fish could potentially influence child health and development. Additional studies could look at the relationship between self-reported data on fish consumption and supplement use during pregnancy, biological markers of fish consumption, and child health outcomes. Combining biological data and self-reported data could provide a more complete picture of the overall benefits of fish consumption during pregnancy.

Where can I learn more?

Access the full journal article titled “Association of Maternal Fish Consumption and Omega-3 Supplement Use During Pregnancy with Child Autism-Related Outcomes: Results from a Cohort Consortium Analysis” in the American Journal of Clinical Nutrition.

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

Published September 2024

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Fish But Not Supplements Consumed in Pregnancy Associated With Lower Rates of Autism Diagnosis And Related Traits, ECHO Cohort Study Finds