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.

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ECHO Study Links COVID-19 Stress, Slightly Earlier Births

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

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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

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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

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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

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

The Influence of Opioid Use Disorder Medications During Pregnancy on the Severity of Neonatal Opioid Withdrawal Syndrome

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The Influence of Mediators on the Relationship Between Antenatal Opioid Agonist Exposure and the Severity of Neonatal Opioid Withdrawal Syndrome

Author(s): Lori A. Devlin, Zhuopei Hu, Songthip Ounpraseuth, Alan E. Simon, Robert D. Annett, Abhik Das, Janell F. Fuller, Rosemary D. Higgins, Stephanie L. Merhar, P. Brian Smith, Margaret M. Crawford, Lesley E. Cottrell, Adam J. Czynski, Sarah Newman, David A. Paul, Pablo J. Sánchez, Erin O. Semmens, M. Cody Smith, Bonny L. Whalen, Jessica N. Snowden, Leslie W. Young

Why was this study conducted?

Opioid use disorder is a treatable disease that can be managed with medicine for opioid use disorder (MOUD). This type of treatment is recommended for pregnant individuals by healthcare professionals to improve pregnancy and newborn outcomes.

Babies who were exposed to opioids during pregnancy may develop signs of neonatal opioid withdrawal syndrome (NOWS), including tremors; excessive crying and irritability; and problems with sleeping and feeding. This study looked at how MOUD use during pregnancy influenced the severity of NOWS symptoms.

What was done?

Data were collected from the medical records’ of 1294 opioid-exposed infants born at or cared for in 30 U.S. hospitals between July 2016 and June 2017. There were 859 infants exposed to MOUD (methadone or buprenorphine) and 435 infants exposed to opioids other than MOUD. We looked to see if infants needed medication to treat NOWS and how long they stayed in the hospital.

What was found?

The results suggest that exposure to MOUD (buprenorphine or methadone) during pregnancy increased the severity of NOWS. Infants exposed to MOUD were two times more likely to need an opioid medication to treat withdrawal. They also remained in the hospital 1.7 days longer than infants not exposed to MOUD. Some factors that reduced the severity of NOWS in infants treated with MOUD were adequate prenatal care, exposure to a single type of opioid, and not being exposed to other mood-changing drugs simultaneously. These factors also decreased the likelihood that infant would need opioid medicine to treat their NOWS symptoms and shortened their hospital stay. Infants exposed to buprenorphine instead of methadone had a shorter length of hospital stay and needed less treatment with opioid medication.

What do the results mean?

Medical experts recommend that pregnant women with an opioid use disorder use MOUD for healthier pregnancies. MOUD can reduce the chances of pregnancy loss, premature birth, infection, and poor growth of the infant. However, using MOUD may be related to increases in the severity of NOWS. Learning more about how MOUD affects the severity of NOWS can help doctors improve the health of mothers using MOUD and their babies. These results also suggest that adequate prenatal care can help improve pregnancy and birth outcomes, and highlight the importance of identifying barriers to receiving sufficient prenatal care as an opportunity to improve infant outcomes.

Who sponsored the study?

This research was supported by the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health.

Appreciation:

We deeply appreciate the doctors, nurses, and hospitals that participated in the study and helped identify and extract information from the required medical records. Their enthusiastic collaboration made this study possible.

You may learn more about this publication here: https://link.springer.com/article/10.1007/s10995-022-03521-3

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

Published: March 11, 2023

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The Influence of Mediators on the Relationship Between Antenatal Opioid Agonist Exposure and the Severity of Neonatal Opioid Withdrawal Syndrome

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

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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

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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

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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

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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

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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

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

Pregnancy Complications Like Preeclampsia and Gestational Diabetes May Be Linked to Slower Biological Development in Babies

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Pregnancy Complications Like Preeclampsia and Gestational Diabetes May Be Linked to Slower Biological Development in Babies

Authors: Carrie Breton, Christine Ladd-Acosta, 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 researchers found that babies who were exposed to preeclampsia or gestational diabetes while they were developing in the womb were biologically younger than babies without those exposures, indicating that these exposures may have slowed down babies’ biological development. This difference was more noticeable in female babies compared to male babies.

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?

In this study, researchers found that certain pregnancy complications are related to slower biological development at birth, with girls being more affected than boys. These results provide an important clue about how pregnancy complications can affect underlying biological processes in newborn infants, as preeclampsia and gestational diabetes have been linked to child health outcomes.

Why was the study needed?

Preeclampsia (high blood pressure that can cause kidney or other organ damage during pregnancy) and gestational diabetes (high blood sugar during pregnancy) have been linked to a number of birth complications and children’s health outcomes, including birth weight. More research is needed to identify the biological processes in newborn babies that are affected by these pregnancy complications so doctors can use that information to provide treatments to improve children’s health. This study evaluated how pregnancy complications affect newborn infant’s epigenetic age, a measure of their “biological age” based on molecular markers in their cells.

Who was involved?

The study included 1,801 children from 12 ECHO cohorts across the United States. The participants were born between 1998 and 2008 to mothers who had preeclampsia or gestational diabetes during pregnancy.

What happened during the study?

ECHO researchers calculated each infant’s biological age by analyzing DNA samples collected at birth and compared their biological age (epigenetic age) to their chronological age at birth (measured in pregnancy weeks). Then, the researchers compared the biological ages of newborns exposed to pregnancy complications to the biological ages of babies who were not exposed.

What happens next?

The researchers will continue this research with a larger number of participants. They also plan to see whether the same biological changes detected at birth are related to health outcomes later in childhood.

Where can I learn more?

Access the full journal article, titled “Analysis of Pregnancy Complications and Epigenetic Gestational Age of Newborns,” 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 February 24, 2023

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Pregnancy Complications Like Preeclampsia and Gestational Diabetes May Be Linked to Slower Biological Development in Babies

ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

Authors: Claudia Buss, Nora K. Moog

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?

Results from this study suggest that mothers’ maltreatment experience as children may influence their own children’s future health. Children of mothers who were neglected or abused during childhood were more likely to have diagnoses of asthma, ADHD, and ASD. These children were also more likely to demonstrate symptoms and behaviors linked to depression (i.e., internalizing behaviors). Additionally, girls whose mothers experienced maltreatment during childhood were more likely to have obesity. Children with mothers who experienced childhood maltreatment were also more likely to develop several of these health outcomes at once. Furthermore, exposure to several different forms of maternal childhood maltreatment was associated with highest risk increases for most offspring health outcomes suggesting the more severe the maternal childhood experiences were, the higher the risk for adverse health outcomes in her child.

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 highlights the impact of maternal childhood maltreatment experiences as a major determinant of health across generations. While not all children of mothers who experienced abuse or neglect during childhood develop health problems, those who do are at higher risk for developing more than one condition. Results from this study suggest that screening and identifying these children early on, can allow the opportunity to direct targeted interventions to interrupt the intergenerational impact of adversity.

Why was the study needed?

Childhood maltreatment increases the risk for adverse health outcomes, and this risk can be transmitted from one generation to the next. Previous studies have investigated single health outcomes in children of mothers that were exposed to childhood abuse or neglect. However, health outcomes can often be connected to one another and affected by the same factors. This study investigated six health outcomes simultaneously and investigated whether a mother’s own exposure to maltreatment affects a child’s risk for experiencing more than one of these health outcomes.

Who was involved?

This study included over 4,000 mothers and their children from 21 ECHO cohorts. About 44% of mothers who participated in the study reported experiencing some form of abuse or neglect during their own childhood.

What happened during the study?

Mothers self-reported on their childhood experiences, and researchers used this information to assign mothers to one of two groups: 1) exposed to childhood maltreatment and 2) not exposed to childhood maltreatment. The researchers compared the risk for physical and mental conditions, including asthma, internalizing behaviors (e.g., social withdrawal, trouble sleeping, symptoms of anxiety or depression), autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and obesity, between the children in the two groups. They also examined whether multiple health outcomes co-occur in the same child.

What happens next?

Follow-up studies will investigate the pathways between maternal childhood maltreatment experiences and child health outcomes. Other studies may also investigate if other forms of negative childhood experiences are linked to different consequences of childhood maltreatment in the next generation.

Where can I learn more?

Access the full journal article, titled “Intergenerational transmission of the consequences of maternal exposure to childhood maltreatment – a United States nationwide study of multiple cohorts in the ECHO program” in The Lancet 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 February 23, 2023

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

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Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

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.

What were the study results?

Total screen time among children ages 4 to 12 increased during the early stages of the COVID-19 pandemic as lockdowns and school closures were widespread. Screen time remained higher in the later pandemic, even after several restrictions had been lifted. The study found that children used screens an average of 1.75 hours/day more during the early pandemic (December 2020 – April 2021) compared to before the pandemic (July 2019 – March 2020). During the later pandemic (May 2021 – August 2021), screen time remained on average 1.11 hours/day higher than the pre-pandemic average. Both recreational and educational screen time increased during the COVID-19 pandemic.

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 shows that increases in screen time among children persisted more than one year into the pandemic, after many COVID restrictions had been lifted. These findings can help inform clinical guidelines that could aid parents and their children in re-establishing healthy media use habits. Pediatricians can help parents reset family media use priorities and limits that may have changed during the early stages of the COVID-19 pandemic using tools like the American Academy of Pediatrics Family Media Plan.

Why was this study needed?

Excessive screen time among children may be associated with obesity-promoting health behaviors and adverse mental health. The COVID-19 pandemic initially led to widespread school closures, shelter-in-place laws, closures of recreational facilities and cancellation of youth sports, increases in number of parents working from home, and social distancing recommendations, all of which may have impacted screen time among children. Prior studies have reported screen time levels during the pandemic but were unable to document changes in screen time because most lacked pre-pandemic assessments. This study is among a handful of ECHO studies to include pre-pandemic assessments of screen use in order to document changes during the pandemic.

Who was involved?

The study included 228 parent-child pairs from three ECHO cohorts across the United States (Colorado, California, and South Dakota). Parents reported their children’s screen time. The geographically, racially, and ethnically diverse participants ranged in age from 4 to 12 at the start of the study.

What happened during the study?

ECHO researchers surveyed parents about their children’s media use before, during the early, and later periods of the pandemic. The study assessed total, educational (not including remote school), and recreational screen time and examined trends in screen use before and at two points during the pandemic.

What happens next?

Additional studies are needed to determine whether the increases in screen time among children during the pandemic impacted longer term obesity and mental health outcomes in children. Future studies can also clarify whether specific types of screen time adversely impacted children’s health during the pandemic.

Where can I learn more?

Access the full journal article, titled “Trends in screen time use among children during the COVID pandemic, July 2019 through August 2021” 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 February 15, 2023

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Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted