ECHO Study Identifies Depression, Anxiety, and Other Drug Use as Risk Factors for Opioid Use During Pregnancy

Authors: Ruby H.N. Nguyen, Monica McGrath, 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?

Most of the participants who used opioids were non-Hispanic White and had at least some college education. Opioid use was more common among people who used tobacco or illegal drugs, and those with a history of depression or anxiety. Additionally, opioid use during pregnancy in this study was rare—only 2.8% of participants used opioids during pregnancy, and the majority of opioid use originated from a prescription.

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 is among the largest observational studies of opioid use during pregnancy thus far, and the diverse sample of pregnant participants is more representative of the U.S. population than previous studies. Results from this study strengthened evidence about the co-occurrence of opioid use in pregnancy with depression and use of multiple substances (such as tobacco and illegal drugs). These findings will help to inform further research on screening tools for opioid use during pregnancy. Additionally, the finding that most opioid use originated from prescriptions reinforces the need to reduce the amount of circulating prescription drugs and to better monitor over-prescription of opioids to pregnant women and provide them with alternative treatment solutions for pain management and opioid dependency.

Why was this study needed?

Opioids are a class of drugs used as prescription pain relievers that can cause dependence or addiction. The opioid crisis has disproportionately affected women, and use of these drugs can have detrimental effects on women of reproductive ages and on developing fetuses. Previous studies of opioid use during pregnancy have been limited to individuals in specific geographic locations or those with specific types of insurance. The stigmatization of this population has also complicated the collection of data on maternal opioid use during pregnancy. Using a large sample size, this study examined opioid use in a diverse population of pregnant women across the United States to investigate rare exposures – such as polysubstance use - and characteristics associated with opioid use during pregnancy.

Who was involved?

This study included over 20,000 pregnant participants from 32 ECHO cohorts across the U.S., creating a large and geographically diverse sample.

What happened during the study?

The researchers gathered data from pregnant women who were already participants in ECHO cohorts between 1991 and 2021. Medical records, laboratory tests, and self-reports were used to assess opioid use and potentially related factors, such as demographics, use of other substances, and history of anxiety or depression.

What happens next?

This study shows that further research is needed on the factors that may lead to use of multiple substances during pregnancy and the association between substance use and depression. This research can help inform the development of screening tools and procedures for identifying individuals who are potentially at risk for opioid use during pregnancy.

Where can I learn more?

Access the full journal article, titled “Characteristics of Individuals in the U.S. who Used Opioids during Pregnancy,” in the Journal of Women’s Health.

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

Published November 9, 2022

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ECHO Study Identifies Depression, Anxiety, and Other Drug Use as Risk Factors for Opioid Use During Pregnancy

Exposure to Certain Phthalates During Pregnancy May Affect Brain Development in Infant Girls

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Exposure to Certain Phthalates During Pregnancy May Affect Brain Development in Infant Girls

Authors: Leny Matthew, Craig Newschaffer, 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?

In this study, researchers found that certain phthalates measured in the infant’s meconium, or first stool, were associated with lower scores on a common test that measures motor, visual, and language skills in girls under age 5.

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 suggests that prenatal exposure to certain types of phthalates may worsen early childhood learning outcomes for girls but have a neutral or slightly positive effect on boys. By studying meconium, instead of maternal urine, the researchers may be able to capture a longer timeframe of potential pre-natal exposure.

Why was the study needed?

Phthalates are widely used in personal care products, cosmetics, plastics, and other household items. These chemicals can cause the body to make substances that are thought to reduce a mother’s level of thyroid hormones, which are critical for fetal brain development. Phthalates are also associated with a reduction in the hormones necessary for sex-specific fetal brain development. Therefore, it is important to test the levels of prenatal phthalate exposure and the potential effects on developing fetuses.

Who was involved?

The study involved 956 mother and child pairs from two ECHO research sites—the Safe Passage study (SPS) and the Early Autism Risk Longitudinal Investigation (EARLI). Researchers focused on children who were higher risk for brain and nervous system disorders based on a family history of Autism or exposure to alcohol during pregnancy.

What happened during the study?

ECHO researchers measured phthalate levels in meconium from children who had a higher risk for developing brain and nervous system disorders. When the children were 12 months old, researchers tested their motor, visual, and language skills. Researchers used meconium samples rather than the mother’s urine to capture longer-term fetal exposure to phthalates.

What happens next?

Future prenatal phthalate exposure studies using meconium samples from newborn infants could investigate the differing effects of phthalate exposure on male versus female infants in order to better understand the reasons why these differences may occur.

Where can I learn more?

Access the full journal article, titled “The associations between prenatal phthalate exposure measured in child meconium and cognitive functioning of 12-month-old children in two cohorts at elevated risk for adverse neurodevelopment,” in Environmental Research.

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

Published November 2022

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Exposure to Certain Phthalates During Pregnancy May Affect Brain Development in Infant Girls

Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

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Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

Author(s): Lauren Shuffrey, et al.

Who sponsored this study?

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

What were the study results?

The study found that participants with gestational diabetes were more likely to be classified as having prenatal depression compared to those without gestational diabetes. Participants with both gestational diabetes and prenatal depression had an increased risk of developing postpartum depression. But gestational diabetes on its own, without prenatal maternal depression, was not linked to an increased risk of postpartum depression.

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?

These findings underscore the importance of universal depression screenings during pregnancy and for at least a year following birth.

Why was this study needed?

There is a lack of research into how the combination of gestational diabetes (a type of diabetes that develops during pregnancy) and prenatal depression affects a person’s risk for postpartum depression.

Who was involved?

This study included 5,822 participants from 16 ECHO cohorts across 13 U.S. states and Puerto Rico. A total of 4,606 participants had neither gestational diabetes nor prenatal depression, 416 had gestational diabetes only, 689 had prenatal maternal depression only, and 111 had both gestational diabetes and prenatal maternal depression.

What happened during the study?

Researchers collected information from the participants including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The researchers then used that data to evaluate the relationship between gestational diabetes, prenatal depression, and postpartum depression.

What happens next?

Future studies should examine potential mechanisms underlying the relationship between gestational diabetes, prenatal depression, and postpartum depression. The ECHO Program is currently working towards analyzing blood samples collected during pregnancy to identify potential factors involved in this relationship.

Where can I learn more?

Access the full journal article, titled “Gestational Diabetes Mellitus, Prenatal Maternal Depression, and Risk for Postpartum Depression: An Environmental Influences on Child Health Outcomes (ECHO) Study” in BMC Pregnancy and Childbirth.

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

Published October 8, 2022

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Diabetes and Depression During Pregnancy May Be Linked to Higher Risk of Postpartum Depression in Mothers

During the COVID-19 Pandemic, Children’s Sleep Schedules Changed, But Their Time Asleep Stayed the Same

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During the COVID-19 Pandemic, Children's Sleep Schedules Changed, But Their Time Asleep Stayed the Same

Authors: Maristella Lucchini, 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?

During the COVID-19 pandemic, children in the United States went to bed later, woke up later, and took longer to fall asleep, but their overall time spent asleep did not change. Interviews with caregivers revealed that they prioritized routines to maintain their children’s amount of sleep but were more flexible about bedtime. Across all time periods studied, children from racial and ethnic minority communities went to bed later, slept less, and napped more often.

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 is one of the first studies investigating changes in childhood sleep habits in the United States during the COVID-19 pandemic using data collected before and during the pandemic. The researchers found significant changes in children’s sleep habits, as well as differences in children’s sleep behaviors between racial/ethnic groups. These results highlight potential areas for future research and support the need to examine and address root causes of racial/ethnic sleep disparities in childhood.

Why was this study needed?

Sleep health during childhood is important for overall health and brain development. Poor sleep can increase a child’s risk for chronic illnesses, behavioral problems, and poor memory. Factors that affect sleep health may have been significantly impacted by the COVID-19 pandemic due to lockdowns and curfews, increased stress, and changes in social support. Many studies have shown that, due to systemic and structural inequities, the pandemic has affected the health behaviors of children differently based on their socioeconomic status, race, and ethnicity. These differences may worsen existing gaps in children’s health.

Several studies have reported on how the pandemic has affected childhood sleep habits, but few of these studies involved children in the United States. Most previous studies have relied on self-reported or time-limited data and have focused primarily on early stages of the pandemic. The goal of this study was to investigate changes in nighttime sleep habits and frequency of daytime naps during the COVID-19 pandemic.

Who was involved?

This study included 528 children aged 4 to 12 from 14 ECHO cohorts across the United States. The caregivers of 38 participants provided additional information about how they thought their children’s sleep habits may have been affected by the COVID-19 pandemic.

What happened during the study?

The researchers compared data from before the pandemic with data collected at two different time periods during the pandemic. They used this data to examine the length of time it took children to fall asleep, time spent asleep at night during the week and on weekends, and the frequency of later bedtimes and daytime naps. They also collected sociodemographic information (child sex, age, race and ethnicity, maternal education) from self-reports and medical records.

What happens next?

ECHO researchers are currently analyzing and publishing results on changes in diet, physical activity, and screen time during the COVID-19 pandemic from the same cohort of children.

Where can I learn more?

Access the full journal article, titled “Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO 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 4, 2022

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During the COVID-19 Pandemic, Children's Sleep Schedules Changed, But Their Time Asleep Stayed the Same

ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children

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ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children

Authors: Sara Nozadi, Andréa Aguiar, 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?

Patterns of attention were similar across the two groups of children despite the differences in their cultures, demographics, or assessment settings. Overall, children paid more attention to emotional faces compared to neutral faces. They were particularly quick to identify angry faces, which might be an adaptive response to a perceived threat. These findings replicate previous research results with both adults and children.

Indigenous children with socially withdrawn behaviors avoided emotional faces—a response observed in children with higher levels of socially withdrawn behaviors from other populations.

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 work suggests that eye tracking can be used as an objective measure of attention patterns in children across different settings and cultures, which can help researchers and clinicians more reliably identify children with early behavior problems. Because eye tracking technology does not rely on clinical observations or parents’ reports, it can be used as an unbiased measure across different communities to validate data collected through clinical assessments and parent reports in hard-to-reach communities.

Why was this study needed?

Humans tend to give more attention to emotional information than neutral information. Past research indicates departures from this pattern typically occur in children with socially withdrawn behaviors. However, this research is limited because it has been conducted mostly in controlled settings among primarily White children from urban areas.

In this study, ECHO researchers examined the extent to which two eye-tracking–based measures could be used cross-culturally to assess attention biases and how these biases might relate to children’s socially withdrawn behaviors.

Who was involved?

To evaluate whether eye-tracking technology could be applied effectively across cultures, researchers compared information from two ECHO cohorts that were very different demographically, geographically, racially, and culturally.

The researchers analyzed data from 125 children from the Navajo Birth Cohort Study, a cohort of indigenous children with relatively low socioeconomic status (SES) living in rural tribal lands, and 70 children from the Illinois Kids Development Study (IKIDS), a primarily Non-Hispanic White and high-SES cohort living around the University of Illinois at Urbana-Champaign campus in central Illinois.

What happened during the study?

Children between the ages of 3.5 years to 5.5 years completed two eye-tracking tasks that measured their attention to photos of human faces with positive, negative, and neutral expressions. Indigenous children were assessed in different locations in the Navajo territory, whereas IKIDS children came to a research laboratory in the University campus. Mothers also reported on children’s socially withdrawn behaviors, such as avoiding eye contact, using the Child Behavioral Checklist—a survey commonly used in research and clinical settings to evaluate risk for behavioral and emotional problems in children.

What happens next?

The researchers will look at how the responses they see in these young children change with age and determine whether eye tracking continues to be an unbiased tool for assessing attention throughout development.

Where can I learn more?

Access the full journal article titled “Cross-Cultural Applicability of Eye-Tracking in Assessing Attention to Emotional Faces in Preschool-Aged Children” published in the Emotion Journal.

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

Published: September 15, 2022

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ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children

ECHO Study Reveals Pregnant Women Are Exposed to Dangerous Chemicals Found in a Variety of Household Products

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ECHO Study Reveals Pregnant Women Are Exposed to Dangerous Chemicals Found in a Variety of Household Products

Authors: Giehae Choi, Jessie Buckley, Tracey Woodruff, 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?

Melamine and cyanuric acid were found in over 99% of the study participants. Four types of aromatic amines were also found in nearly all pregnant participants. Levels of these chemicals were higher among Hispanic and non-Hispanic Black participants and in those exposed to tobacco smoke. For example, levels of 3,4-dichloroaniline—a chemical used in the production of dyes and pesticides—were more than 100% higher among Black and Hispanic women compared to White women.

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 is the first national study to reveal that pregnant women in the U.S. are widely exposed to melamine, cyanuric acid, and aromatic amines—chemicals that may be harmful to maternal health and child development. This raises concerns for the health of pregnant women and babies.

Why was this study needed?

Chemicals like melamine, cyanuric acid, and aromatic amines are commonly used to make a variety of household products. Melamine can be found in dishware, plastics, flooring, kitchen counters, and pesticides. Cyanuric acid can be found in disinfectants, plastics, and swimming pools. And aromatic amines can be found in hair coloring, mascara, tattoo ink, paints, tobacco smoke, and diesel fumes. People can be exposed to these chemicals through the air, contaminated food, household dust, water, plastics, products that contain dyes and pigments, and many other sources.

Melamine was globally recognized as toxic after baby formula poisoning incidents in 2007 to 2008, which resulted in health problems in children including kidney stones, kidney failure, and in some cases, death. Research suggests that melamine may also be linked to reduced brain development. There is limited research on the effects of melamine on adults, although preliminary evidence suggests that it may be linked to cancer and other negative health outcomes. Prior studies on melamine were only conducted among pregnant women in Asian countries or limited to non-pregnant women in the U.S. Despite melamine’s potential harm and common use in household products, population-level exposure is not regularly monitored in the U.S.

Who was involved?

This study included 171 pregnant participants from nine ECHO cohorts located in California, Georgia, Illinois, New Hampshire, New York, and Puerto Rico. Of these participants, 40% were Hispanic, 34% were White, 20% were Black, 4% were Asians, and the remaining 2% were from other or multiple racial groups.

What happened during the study?

Researchers measured the levels of 45 chemicals in urine samples collected from participants during pregnancy. They used new methods to capture the levels of these chemicals in the urine samples, even those present in small amounts. Then, the researchers compared chemical levels across participants with different sociodemographic backgrounds.

What happens next?

Researchers are expanding on this study to look at the effects of higher exposures to these chemicals during pregnancy in over 1,700 pregnant participants and investigate whether these exposures are linked with child health outcomes.

Where can I learn more?

Access the full journal article, titled “Exposure to melamine and its derivatives and aromatic amines among pregnant women in the United States: The ECHO Program,” in Chemosphere.

Published August 30, 2022

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ECHO Study Reveals Pregnant Women Are Exposed to Dangerous Chemicals Found in a Variety of Household Products

Conducting a Pediatric Randomized Clinical Trial During a Pandemic: A Shift to Virtual Procedures

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Conducting a Pediatric Randomized Clinical Trial During a Pandemic: A Shift to Virtual Procedures

Authors: James Roberts, Sheva Chervinskiy, Russell McCulloh, Jessica Snowden, Paul Darden, Thao-Ly Phan, Erin Dawley, Victoria Reynolds, Crystal Lim, Lee Pyles, DeAnn Hubberd, Jaime Baldner, Lora Lawrence, Ann Davis

Who sponsored this study?

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

What was done?

The study's goal was to enroll 128 children aged 6 to 12 years old and one parent at four rural clinics over 10 weeks. However, the trial was paused after 6 weeks due to COVID-19. Over the next 12 weeks, the trial resumed using virtual visits where investigators completed enrollment, obtained informed consent, and assessed height and weight of children. Because all study activity was virtual, digital scales and height measurement equipment were shipped to participants' homes, and a second virtual visit was conducted to monitor these measurements. Some participants who did not have internet and needed support for virtual visits received internet-enabled tablets.

What was found?

When the trial was paused, 42 patients had been enrolled. When the trial resumed virtually, 28 of the 42 continued in the trial, and an additional 89 new participants were enrolled for a total of 117 children. Flexibility was key to solving problems and continuing to enroll and retain participants.

The investigators discovered the challenges and benefits of conducting a virtual trial of this nature. Some challenges to conducting a virtual trial include unreliable equipment delivery, unreturned study equipment, slow Internet speeds and/or poor Internet access in rural areas, and the added costs of buying and shipping equipment and mailing other study materials. However, the benefits of a virtual trial included the ability to conduct study visits at other times of the day, including evenings and weekends. For example, research staff could conduct study visits at any time of the day, and study-related travel was limited.

What do the results mean?

The lessons learned from this trial can be applied by any study team recruiting participants from rural areas for a clinical trial. These include:

Virtual visits and procedures enable successful recruitment and retention of participants from rural areas.
Research teams must be agile, flexible, and willing to adapt study procedures to meet clinic resources and unanticipated situations.
While there are considerable additional expenses for buying and shipping study equipment to participants, these costs may be offset by decreased travel to and from rural areas by study staff.

Why was this study conducted?

In the United States, children living in rural areas have higher rates of being overweight. Unfortunately, children from rural areas seldom participate in clinical research trials. A clinical research trial on changing lifestyle behaviors in rural children who were overweight started in early 2020 but, due to the COVID-19 pandemic, had to switch to virtual procedures instead of in-person visits. Sharing the solutions to problems faced and the lessons learned in completing this trial may help other research teams recruit participants living in rural areas.

Appreciation:

The authors appreciate the children, families, and clinics whose participation made the research possible.

You can read the full publication here: https://doi.org/10.1017/cts.2022.453

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

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Conducting a Pediatric Randomized Clinical Trial During a Pandemic: A Shift to Virtual Procedures

During the COVID-19 Pandemic, Children’s Screen Time Increased

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During the COVID-19 Pandemic, Children's Screen Time Increased

Authors: Traci Bekelman, 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 study found that overall children’s screen time increased significantly during the pandemic with Hispanic children and non-Hispanic Black children having the most noticeable increase in screen time. The study didn’t find any significant increase in the amounts of sugary drinks and unhealthy snack foods children consumed during the pandemic, but it did find a more noticeable increase among Hispanic children and older children. The amount of time children spent asleep increased but only among children whose sleep time was below the recommended range before the 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?

This study shows how the disruptions caused by the COVID-19 pandemic affected children’s daily lives. The results of this study suggest that the pandemic may have worsened sociodemographic disparities for some child health behaviors, particularly in relation to the amount of time children spent looking at screens. This research suggests that families may need more support to re-establish healthy routines and reduce the negative effects of the pandemic on their children’s health behaviors.

Why was this study needed?

For many children, public health measures to mitigate the spread of the COVID-19 pandemic disrupted their daily routines, and prevented them from using community resources, such as parks and organized sports. During the first few months of the pandemic, there were changes in children’s health behaviors—such as diet, screen time, physical activity, and sleep habits. However, there are limited data on what happened to children’s health behaviors after the earliest, most restrictive lockdown period. This is an important topic because children’s health behaviors have been linked to their overall mental and physical health, academic achievement, and quality of life.

Who was involved?

The study included 347 children between the ages of 4 to 12 years and their caregivers recruited from ECHO cohorts in California, Colorado, North Dakota, and New Hampshire. Of those participants, 47% percent were female, and 62% were non-Hispanic White.

What happened during the study?

ECHO researchers collected data on children’s diet, physical activity, screen time, and sleep habits before and during the pandemic. The researchers also surveyed caregivers on how they thought their children’s health behaviors had changed during the pandemic. This study also explored how sociodemographic factors affected children’s health behaviors to identify children who are more likely to experience less recommended changes in behaviors.

What happens next?

This research may help us identify ways to support families with children in future public health emergencies. The ECHO Program is currently working to study changes in other related health behaviors. This includes changes in how well children follow national dietary guidelines, use of social media, and bedtimes/wake-up times.

Where can I learn more?

Access the full journal article, titled “Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children,” in the International Journal of Environmental Research and Public Health.

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

Published August 19, 2022

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During the COVID-19 Pandemic, Children's Screen Time Increased

ECHO Researchers Investigate Effects of Preterm Birth, Environmental Exposures on Child Health

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ECHO Researchers Investigate Effects of Preterm Birth, Environmental Exposures on Child Health

Authors: Michael O’Shea, Monica McGrath, Judy Aschner, Barry Lester, 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?

ECHO researchers are collecting extensive data from very preterm infants, including data on learning and intellectual impairments, asthma, obesity, sleep health, and the effects of the COVID-19 pandemic. This article provides an overview of how data from ECHO cohorts are being used to address questions about the combined effects of preterm birth and environmental exposures on child health outcomes.

What was the study's impact?

Researchers can use the information in this review to enhance their knowledge of the ECHO Program’s resources to study preterm infants. Researchers can use ECHO data to investigate the relationship between preterm birth, environmental exposures, and childhood risk of chronic and developmental health conditions.

Why was this study needed?

Infants who are born premature (before 32 weeks of pregnancy) are at a high risk for multiple health disorders. This review paper outlines resources available within the ECHO Program for researchers seeking to study the effects of preterm birth and environmental exposures on child health outcomes.

Who was involved?

This review article includes ECHO cohorts that enrolled infants who were born premature. These cohorts enrolled almost 1,800 preterm infants across 14 states that were born between April 2002 and March 2020, including three ECHO cohorts that are almost exclusively comprised of preterm infants.

What happened during the study?

A team of experts reviewed the characteristics of the ECHO cohorts that are collecting data on preterm infants. Through this review, they sought to describe the research goals, participant selection criteria, key environmental exposures, and child health outcomes of each cohort.

What happens next?

ECHO researchers will continue to investigate early life factors and environmental exposures that may affect children’s health outcomes later in life. Researchers not participating in the ECHO Program will be able to obtain de-identified data from preterm children in the ECHO-wide Cohort, along with data from around 30,000 children born at term through a controlled-access public use database. This data will include information about a broad range of environmental exposures and outcomes related to chronic illness among children in the United States. Using this data, researchers can continue to build off of ECHO’s mission to enhance the health of children for generations to come.

Where can I learn more?

Access the full journal article, titled “Environmental influences on Child Health Outcomes: Cohorts of Individuals Born Very Preterm,” 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 August 10, 2022

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ECHO Researchers Investigate Effects of Preterm Birth, Environmental Exposures on Child Health

ECHO Study Suggests Air Pollution, Secondhand Smoke, Formaldehyde Exposure Affect Length of Time to Get Pregnant

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ECHO Study Suggests Air Pollution, Secondhand Smoke, Formaldehyde Exposure Affect Length of Time to Get Pregnant

Author(s): Eva Siegel, Linda Kahn, 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, the National Institutes of Health, with co-funding from the Office of Behavioral and Social Sciences Research (OBSSR).

What were the study results?

The strongest evidence points to an association between exposures to traffic-related air pollution, secondhand smoke, and a chemical called formaldehyde—a common workplace exposure in construction sites and nail salons—and longer time to pregnancy. Specifically, exposure to particulate matter and nitrogen oxide gases lowered couples’ chances of becoming pregnant. Traffic and the burning of other types of materials besides gas and diesel create particulate matter and nitrogen oxide gases. Volatile organic compounds, which are used in manufacturing processes, did not appear to affect time to pregnancy.

What was the study's impact?

This review suggests that certain chemicals in the air may lengthen the time it takes for couples to become pregnant. More research is needed to better understand how these chemicals affect reproductive health. To collect this information, future studies can provide participants with personal air monitors that can let researchers know about the quality of air participants are actually breathing instead of relying on imprecise data from outdoor monitors or participant recall.

The research team also pointed out that there are remaining questions about whether the air people breathe around the time of conception is what matters most or whether there are certain life stages, such as puberty, when being exposed to air pollution may be especially damaging. The ECHO-wide Cohort, which allows researchers to access information from a large and diverse population, can serve as an important resource for answering these questions.

Why was this study needed?

Previous studies have looked at how air pollution may affect how long it takes to become pregnant. Time to pregnancy is a measure used to estimate a couple’s ability to conceive and is commonly used to diagnose infertility. In this paper, the authors review past studies on air pollution to identify types of air pollutants—including pollution from traffic, chemicals in the workplace, and secondhand smoke—that might affect how long it takes to get pregnant.

Who was involved?

This review includes all papers published in English on this topic from January 1, 1990 to February 11, 2021. The analysis covered 33 articles, of which eight looked at outdoor air quality, six looked at secondhand smoke exposure, and 19 looked at air quality in the workplace.

What happened during the study?

The research team searched six leading science libraries and identified 33 human studies related to exposure to outdoor and indoor air pollutants and time to pregnancy. The team read each article, assigned it a score based on the quality of the study design, and created summary tables containing the most important findings of each study. They then compared the consistency of results between studies, especially among high-quality papers, about whether certain types of air pollution affected time to pregnancy.

What happens next?

This is the third review this team of authors has written on chemicals and time to pregnancy. Individual authors will continue to fill in the research gaps previously mentioned, including conducting studies where women will be wearing personal air monitors.

Where can I learn more?

Access the full journal article, titled “Indoor and outdoor air pollution and couple fecundability: a systematic review” in Human Reproduction Update.

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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Published July 27, 2022

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ECHO Study Suggests Air Pollution, Secondhand Smoke, Formaldehyde Exposure Affect Length of Time to Get Pregnant