ECHO Study Analyzes Relationship Between Molecules During Pregnancy and Childhood BMI

Authors: Rachel Kelly, Nicole Prince, Donghai Liang, 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 child’s body mass index (BMI) can be associated with their future health. Some researchers seek to understand how factors during pregnancy may influence childhood BMI. Increasingly, researchers use molecular data to analyze the relationship between pregnancy and childhood health outcomes. Researchers sometimes combine molecular data from multiple study sites to increase the statistical power of these analyses. This study aimed to evaluate molecular data during pregnancy across multiple study sites while also using these data to test a framework for analyzing molecular data across multiple studies.

What were the study results?

ECHO researchers combined the results from multiple ECHO Cohort Study Sites including mothers and their children to determine whether a relationship existed between small molecules present in the mother’s blood during pregnancy and later childhood BMI. Altogether, 20 molecules showed up in all study sites, and 127 molecules showed up in at least two. The study found that the levels of only six small molecules, primarily related to maternal diet, were associated with BMI across all sites. However, statistical analysis across these study sites did not identify significant associations between these molecules and child BMI.

What was this study's impact?

This study demonstrates some of the challenges that arise when harmonizing molecular data across diverse study sites and highlights important considerations for researchers trying to conduct similar analyses. Ensuring that all of the studies used in an analysis have the same standardized procedures for collecting samples, measuring molecules present in those samples, and collecting related data (e.g., BMI, diet) can improve the reliability and reproducibility of results.

Who was involved?

This study involved mothers and their children from multiple study sites: the Atlanta ECHO Cohort, the New Hampshire Birth Cohort, and the Vitamin D Antenatal Asthma Reduction Trial. The researchers included mothers in the second and third trimesters of pregnancy and measured their children’s BMI at the age of two years.

What happened during the study?

For this study, the authors combined existing results from multiple study sites. Pregnant participants provided blood samples, and researchers used those samples to measure a range of small molecules. These molecules provide information on each participant’s health, environment, and biological/genetic factors that could affect their pregnancy. The researchers continued to follow these participants and their children across pregnancy and early life to assess their ongoing health, height, and weight. Ultimately, in this analysis, the authors used data from these studies to evaluate the relationship between molecules measured during pregnancy and BMI at age two years, aiming to identify relationships that were consistent across all three studies.

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?

Differences in how molecular data were collected and measured between the sites in this study made it difficult to draw strong conclusions on the relationship between small molecules during pregnancy and childhood BMI. Future analyses could involve larger, more standardized studies that all use the same methods for sample collection and measurement. Many ECHO Cohort Study Sites are now measuring small molecules in both mothers and children with a standardized approach under the ECHO Cohort Data Collection Protocol. ECHO researchers have an opportunity to use these data to power analyses that can explore the relationship between pregnancy health and child health outcomes.

Where can I learn more?

Access the full journal article, titled “Metabolomic Data Presents Challenges for Epidemiological Meta-Analysis: A Case Study of Childhood Body Mass Index from the ECHO Consortium,” in Metabolomics.

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

Published January 24, 2024

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ECHO Study Analyzes Relationship Between Molecules During Pregnancy and Childhood BMI

Can People Living in Rural Areas Accurately Measure Their Height and Weight at Home?

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Can People Living in Rural Areas Accurately Measure Their Height and Weight at Home?

Study title: Validation of remote height and weight assessment in a rural randomized pediatric clinical trial in primary care settings

Author(s): E (Alice) Zhang, Ann M. Davis, Elizabeth Yakes Jimenez, Brittany Lancaster, Monica Serrano-Gonzalez, Di Chang, Jeannette Lee, Jin-Shei Lai, Lee Pyles, Timothy VanWagoner, Paul Darden

Why was this study conducted?

Children living in rural areas have a greater risk for overweight. It may also be hard for them to join weight management programs or studies that require in-person visits. This study compared the accuracy of at-home height and weight measurements to those taken in person at a clinic.

What was done?

A total of 33 parent/child pairs took part in the study; the children were 6-11 years old. We gave each pair a digital bathroom scale, a tape measure, and instructions on measuring height and weight. Then, we guided them as they took their in-home measurements through a video call. The pairs also came to the clinic for their in-person measurements. Then, we compared the at-home and in-person measurements.

What was found?

There were no significant differences in the overall height and weight measurements taken at home compared to those taken in person at the clinic. However, some individual heights and weights differed significantly between at-home and in-person measurements. Age, race, ethnicity, parent education level, household income, and zip code were not significant predictors of at-home and in-person measurement comparisons.

What do the results mean?

It is possible to use everyday tools and technology to measure the weight and height of children living in rural areas. However, using these tools might reduce the accuracy of the measurements. Researchers and clinicians need to decide how accurate they need measurements to be before using these tools in the home.

Who sponsored the study?

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

Appreciation

The researchers thank the wonderful families who made this work possible. We also thank Drs. Rebecca Romine and Kandace Fleming from the Life Span Institute, University of Kansas, for their input on data interpretation.

You may learn more about this publication here: https://www.nature.com/articles/s41598-023-50790-1

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

Published: January 3, 2024

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Can People Living in Rural Areas Accurately Measure Their Height and Weight at Home?

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General health and life satisfaction in children with chronic illness

Author(s): Courtney K. Blackwell, et al

ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Authors: Izzuddin Aris, et al.

New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

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New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

Authors: Elena Jansen, Kristine Marceau, 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?

While few studies on parental health and child development include fathers in any substantial way, a growing body of literature emphasizes their vital role—even in the period before birth. This study reviewed existing literature on what is known about the father’s role in child development. It highlights how a father’s history and personal characteristics before the baby is born, during pregnancy, and after birth can influence their child directly via their parenting behaviors and indirectly by influencing the child’s mother. The study also discusses how the ECHO Program can address key gaps in the literature by designing studies that address unanswered questions.

What were the study results?

The researchers reviewed the existing literature to find out which characteristics or behaviors of fathers have been connected to children’s development, especially their physical and mental health. While many studies give some information about the role of fathers, often fathers do not provide this information themselves, or existing data do not allow researchers to compare the role of fathers to that of mothers. Compared to the pregnancy and pre-pregnancy stages, this study allows researchers to better understand a father’s role once a baby is born. The study team created a model to guide future inquiry and suggest methods researchers can use to help fill in some knowledge gaps in the future. One unique aspect of this work is describing how fathers can impact the child by first influencing the mother, for example, by helping her follow healthy behaviors, such as cooking or helping to cook healthy meals and eating healthy food himself.

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 this study's impact?

This review of other publications reveals gaps in the research community’s understanding of the father’s role in child development. First, very little is known about the father’s role in child development before birth. The study authors noted that more studies are needed to research mothers and fathers before they have children, focusing on including fathers in a substantial way. Some of the father data collected in the existing literature was reported by the mother. This highlights a gap in the literature and the need to incorporate maternal and paternal reported data on father characteristics. Second, this review demonstrates how studying the effect of fathers on child development has revealed additional insights into children’s health outcomes, including reasons for declines in physical or mental health.

This study also introduces a model designed to guide other researchers in focusing on pieces of the puzzle that are currently less understood. The model may help explain how each parent interacts with their child and which influence has a stronger impact or is more prevalent for which parent.

Who was involved?

This literature review involved an in-depth look into existing research on the role of fathers in child development and evaluated its quality. The study focuses on three specific child outcome areas of the ECHO program: obesity, neurodevelopment, and positive health.

What happened during the study?

This literature review begins by describing data collected by the ECHO Cohort and identifying critical gaps in the research related to the role of fathers in ECHO’s five key health outcome areas. After understanding the program’s data collection methods, the research team analyzed multiple research papers categorized into three broad stages of child development—preconception, prenatal, and postnatal. The review concludes with the presentation of a new proposed conceptual model to guide future studies considering paternal influences in ECHO and beyond.

What happens next?

With more data becoming available from the ECHO Program, information on fathers' characteristics can be connected to the rich data on family characteristics, mothers' influences, and child development. Additional data will be gathered to provide further insights and answer remaining questions.

Where can I learn more?

Access the full journal article, titled “The Role of Fathers in Child Development from Preconception to Postnatal Influences: Opportunities for the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program” in Developmental Psychobiology.

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

Published December 27, 2023

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New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

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ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

Authors: Gayle Shipp, Adaeze Wosu, et al.

Who sponsored this study?

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

Why was this study needed?

Obesity in kids is becoming more common around the world. When children have obesity, they often carry it into adulthood, affecting their long-term health outcomes. While previous studies have shown that breastfeeding may protect children against obesity and other chronic conditions, this relationship has not been studied much in women with obesity. ECHO Cohort researchers wanted to explore the possible link between breastfeeding practices in women with obesity and overweight prior to pregnancy and a child’s BMIz score. Researchers use BMIz scores to compare children’s height and weight to those of their peers while the more familiar BMI assesses body weight in relation to height.

What were the study results?

This study found that consistently breastfeeding infants in any amount during their first three months was associated with lower BMIz scores during early childhood (between the ages of 2 and 6) and a lower risk of childhood obesity, regardless of the mother’s pre-pregnancy BMI. This protective association appeared stronger for children with mothers who had obesity before pregnancy (BMI of 30 or higher) compared to those categorized as overweight (BMI between 25 and 29.9) during the same time.

Exclusive breastfeeding at three months was associated with a lower child BMIz score only among women with a pre-pregnancy BMI in the normal range. Each additional month of any or exclusive breastfeeding correlated with a significantly lower child BMIz, particularly for mothers categorized as overweight (in the case of any breastfeeding) or as having obesity (for any or exclusive breastfeeding) prior to pregnancy.

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 highlight that each additional month of breastfeeding, whether a consistent amount or exclusive, may contribute to a lower weight later in childhood, especially for mothers who had obesity before pregnancy. Health professionals can use this study’s findings as an opportunity to encourage and promote breastfeeding among all women, especially those who have obesity.

Who was involved?

The study looked at BMI measurements from 8,134 pairs of mothers and kids at 21 study sites in 16 states and Puerto Rico.

What happened during the study?

The researchers calculated BMI and BMIz scores from measurements taken at study visits, medical records, or self-reported data for the mother and child. Additionally, the study examined two breastfeeding situations: whether the mother ever breastfed or whether the mother was exclusively breastfeeding the infant at 3 months old. This continuous breastfeeding measure included the duration of any breastfeeding allowing for formula or other food and the duration of exclusive breastfeeding with no formula feeding or other food.

What happens next?

Future research and public health prevention efforts could continue to focus on addressing disparities in breastfeeding duration and obesity among mothers that can affect child health outcomes.

Where can I learn more?

Access the full journal article titled “Maternal Pre-pregnancy BMI, Breastfeeding, and Child BMI” in Pediatrics.

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

Published December 19, 2023

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ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

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ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

Authors: Catherine Bulka, Rebecca Fry, 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?

This study found that gene activity in the placenta might differ based on the infant’s sex, suggesting that the placentas of males and females develop differently. The placenta is an organ formed during pregnancy to nourish the fetus that goes through many changes during the length of the pregnancy to support the development of the infant.

Previous studies have found that a number of changes occur in the genetic make-up of the placental tissue throughout pregnancy. The current study suggests that some of these genetic changes may differ based on whether the baby is male or female. The researchers looked at gestational age (the amount time the baby spent in-utero) to compare placentas among males and female fetuses at different points in time. Among females, the researchers saw modifications in genes related to the immune system. Among males, there was modifications in genes related to the transport of molecules into the placenta.

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 identified differences in the location of modifications of placental DNA between male and female infants at different gestational ages. The most prominent differences were linked to genes that play significant roles in immunity, inflammation, and pregnancy complications. These differences seen between male and female infants may be important when looking at sex-specific health and developmental outcomes.

Why was this study needed?

The placenta is crucial for fetal growth and development. No previous study had considered the role of infant sex in placental development, despite accumulating evidence that females and males develop differently in utero.

Who was involved?

This study included 774 infants from 4 ECHO research sites. In total, the study included 355 female and 419 male infants. One of the research sites enrolled infants born at less than 28 weeks, which provided samples from the earliest viable births.

What happened during the study?

Research sites compared the placental tissue of male and female infants to determine associations between gestational age and modifications of placental DNA. Researchers then located the modifications and identified the closest genes, allowing them to analyze the biological significance of the modifications.

What happens next?

Researchers are now using this data to estimate an infant’s “biological” rather than “chronological” gestational age based on the modification of placental DNA. The findings of this study suggest that it may be important to consider the infant’s sex when calculating “biological” gestational age.

Where can I learn more?

Access the full journal article, titled “Sex-based differences in placental DNA methylation profiles related to gestational age: an NIH ECHO meta-analysis,” in Epigenetics.

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

Published December 2023

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ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

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ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

Authors: Courtney K. Blackwell, 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 with co-funding from the Office of Behavioral and Social Sciences Research.

Why was this study needed?

The COVID-19 pandemic and subsequent social distancing strategies may have ongoing negative effects on mental health. To measure this, ECHO researchers developed the Pandemic-related Traumatic Stress Scale (PTSS) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Acute Stress Disorder criteria. This study describes the development and validation of this new measurement tool and reports differences in pandemic-related traumatic stress in a large sample of children and adults.

What were the study results?

On average, caregivers had the highest levels of pandemic-related traumatic stress, followed by adolescents, pregnant/postpartum individuals, and children. Within these groups, the researchers found additional differences related to age and gender. Adolescents, females, and caregivers of children under 5 had higher PTSS scores on average than younger children, males, and caregivers of children 5 and older, respectively.

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 researchers found that PTSS is a reliable way to measure pandemic-related traumatic stress in the context of the COVID-19 pandemic. Higher levels of pandemic-related traumatic stress were associated with greater symptoms of distress and lower life satisfaction. Unlike previous measures that capture traumatic stress reactions to a single event, the PTSS was developed to evaluate potential traumatic stress reactions to ongoing large-scale threats without defined time limits. Researchers and doctors can use this scale to distinguish general stress, depression, and anxiety from traumatic stress, helping them to identify people with higher levels of traumatic stress who may need mental health support.

Who was involved?

This study included 17,830 children and adults from 47 ECHO Cohort study sites representing all 50 states, Washington, DC, and Puerto Rico. Researchers split the sample into four groups including 1,656 pregnant or postpartum individuals; 11,483 adult caregivers; 1,795 adolescents aged 13 to 21; and caregivers who reported on 2,896 children aged 3 to 12.

What happened during the study?

Between April 2020 and August 2021, caregivers reported on behaviors observed in children aged 3 to 12, and adolescents and adults completed self-reported surveys on pandemic-related traumatic stress, depressive symptoms, anxiety, general stress, and life satisfaction.

What happens next?

The PTSS can be used beyond the immediate COVID-19 pandemic context. The PTSS could be adapted to evaluate reactions to other severe stressors that last a long time.

Where can I learn more?

Access the full journal article, titled “Development and Psychometric Validation of the Pandemic-related Traumatic Stress Scale for Children and Adults,” in Psychological Assessment.

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

Read the associated article.

Published November 3, 2023

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ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families

A Qualitative Exploration of COVID-19 Vaccine Hesitancy Among Parents

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A Qualitative Exploration of COVID-19 Vaccine Hesitancy Among Parents

Authors: Aubree Honcoop, James R Roberts, Boyd Davis, Charlene Pope, Erin Dawley, Russell McCulloh, Maryam Y Garza, Melody L Greer, Jessica Snowden, Linda Y Fu, Heather Young, Walter Dehority, Paul Enlow, Delma-Jean Watts, Katie Queen, Lisa Costello, Zain Alamarat, Paul M Darden

Why was this study conducted?

Research has shown that the COVID-19 vaccine is safe and effective at protecting children from severe COVID-19 disease. However, some parents have not yet vaccinated their children. Fewer children from a rural, Spanish-speaking, or Black backgrounds have received the vaccine than others.[i] We wanted to find out what parents from these groups think about the vaccine for their children. We interviewed parents about their concerns to learn how to address them and build their confidence in the vaccines.

What was done?

We selected 36 parents who lived in rural areas, spoke Spanish, and/or identified as Black. We only included parents with one or more unvaccinated children. We spoke with them about their thoughts for or against the COVID-19 vaccine.

What was found?

Many parents, whether they were for, against, or unsure about the COVID-19 vaccine, reported that they would listen to their doctor for vaccine information. Some parents wanted to know how well the vaccine protects children. Some parents also considered their child’s preferences for getting the vaccine. Others were concerned about the vaccine causing side effects or impacting health conditions such as asthma.

What do the results mean?

These results suggest what topics scientists might include in a mobile app designed to inform parents about the COVID-19 vaccine. However, this information was from a small number of parents and may not apply to people from other backgrounds.

Who sponsored this study?

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

Appreciation:

Most of all, we thank the parents who took part in the study. We also thank the site coordinators, clinic staff, and ECHO ISPCTN Data Coordinating & Operations Center staff for their support.

You may learn more about this publication here: https://pubmed.ncbi.nlm.nih.gov/37867449/

To learn more about the COVID-19 vaccine for children, visit:

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

______________________________________

[i] The National Institutes of Health (NIH) has identified individuals from rural, medically underserved, and migrant communities as high priorities for vaccination and vaccine communication efforts. This includes children living in rural areas, from Spanish-speaking households, or who identify as Black. For current data on COVID-19, including vaccination rates, please visit the CDC website.

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A Qualitative Exploration of COVID-19 Vaccine Hesitancy Among Parents

ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

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ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

Authors: Megan Bragg, 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 the study needed?

Improving nutrition during pregnancy and childhood is a key focus for public health in the United States. Many pregnant women and children face deficiencies in essential vitamins and minerals coupled with excess salt, saturated fats, and sugars in their diets. Socioeconomic factors may affect access to nutritious food, contributing to disparities in rates of diet-related chronic disease that could affect pregnancy outcomes and child growth and development. Often, data collected on diet provide only a snapshot that can't address how early-life diet affects later child health outcomes. The ECHO Cohort Consortium is addressing these challenges by gathering information over time about the dietary habits of individuals during pregnancy and childhood from a large, diverse group of participants. This study examines the types of diet information collected from the ECHO Cohort and provides examples of how researchers can use this data to learn more about the role of nutrition in child health outcomes.

What were the study results?

This study aimed to describe dietary intake data available in the ECHO Program as of August 2022, from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health. As of that date, 66 ECHO Cohort Study Sites across the country had collected diet information using a variety of methods, including dietary recalls, food frequency questionnaires, and questionnaires about supplement use. Diet information from these study sites is especially useful because it has been collected from a large group of diverse people, and because many families provided information more than once over the course of pregnancy and childhood.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study highlights the large amount of diet information already available from the ECHO Cohort and the opportunities for researchers to access this publicly available resource to answer important questions about nutrition and child health outcomes.

Who was involved?

This study examined data from pregnant women and children at 66 ECHO Cohort Study Sites in 34 U.S. states who answered questions about their diets by August 2022. Data about more than 26,000 pregnant women and 27,000 children is publicly available.

What happened during the study?

Researchers examined the diet information that study sites collected from pregnant women and children through August 2022, including questionnaires and medical records. Researchers sorted this information by the type of questionnaire and whether it was from a pregnant woman or a child. Many participants contributed data from both the pregnant woman and the child and reported on their diet more than once.

What happens next?

The ECHO Program will continue to collect diet information from participants. Information from over 33,000 pregnancies and more than 31,000 children in the ECHO Program is now accessible to researchers. This de-identified data is publicly available to researchers through the National Institute of Child Health and Human Development Data and Specimen Hub (DASH) to encourage broad use to answer important questions about nutrition and child health.

Where can I learn more?

Access the full journal article, titled “Opportunities for examining child health impacts of early-life nutrition in the ECHO Program: Maternal and child dietary intake data from pregnancy to adolescence” in Current Developments in Nutrition.

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

Published November 2023

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ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

ECHO Study Finds No Association Between Arsenic Exposure and Birth Outcomes

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ECHO Study Finds No Association Between Arsenic Exposure and Birth Outcomes

Authors: Jonathan Lewis, Emily A. Knapp, Amii M. Kress, 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?

Arsenic is a naturally occurring, toxic chemical that can be present in groundwater and surface water. Drinking water, as a result, is one of the most common ways people are exposed to arsenic in the U.S. and globally. There have been a limited number of small studies of the association between arsenic and birth outcomes, mostly outside of the U.S. In this study, ECHO researchers examined a diverse group of pregnant participants from across the country to determine if birth outcomes—birth weight, gestational age at birth, preterm birth, and size at birth—are influenced by arsenic concentrations that are above regulatory action levels.

What were the study results?

Researchers found that low birth weight, gestational age at birth, preterm birth, and birth size were not associated with potential exposure to arsenic among pregnant women living in a county with active arsenic level violations. There was a statistically significant increase in birth weight among infants whose mother’s experienced continuous exposure (from three months before conception through birth) compared with infants from areas without violations.

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 this study's impact?

Overall, drinking water violations for arsenic that could indicate the presence of the chemical above regulatory action levels are relatively uncommon. Researchers captured proxy exposure using residential history arsenic violations from the preconception period throughout pregnancy, a time when environmental influences could disrupt fetal growth.

Who was involved?

The study included over 15,000 mother-child pairs at 51 ECHO Cohort Study Sites across the United States. The children were born in 2006 or later, as the U.S. Environmental Protection Agency (EPA) changed the enforceable standard for arsenic concentrations in drinking water to 10 parts per billion during that year. Only 794 participants experienced arsenic violations.

What happened during the study?

Researchers grouped pregnant participants based on where they lived three months before conception and during pregnancy. Within those areas, investigators determined which public water systems had violations for arsenic. Then they looked at how living in a county with an arsenic violation might affect birth outcomes.

What happens next?

Future research could better identify ECHO participants’ exposure to arsenic by considering other sources of drinking water (e.g., bottled or filtered water) and exposure to arsenic in foods.

Where can I learn more?

Access the full journal article, titled “Associations Between Area-Level Arsenic Exposure and Adverse Birth Outcomes: An ECHO-Wide Cohort Analysis,” 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 1, 2023

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ECHO Study Finds No Association Between Arsenic Exposure and Birth Outcomes

New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

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New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic

Authors: Phillip Sherlock, Maxwell Mansolf, Courtney Blackwell, et al.

Who sponsored this study?

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

Why was this study needed?

Although researchers have looked at how the COVID-19 pandemic affected the mental health of children of all ages, few studies have examined the pandemic’s impact on children and teens with pre-existing mental, emotional, behavioral, and developmental (MEBD) disabilities like depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and Autism Spectrum Disorder (ASD).

Health policies that were put in place to prevent the spread of COVID-19 caused disruption of normal activities for children and families. Schools paused in-person learning, extracurricular activities were cancelled, and stay-at-home orders meant children spent more time quarantined with family members instead of engaging with friends and peers.

This study was needed to understand how the stresses of the COVID-19 pandemic impacted life satisfaction for adolescents with disabilities, as adolescence is a critical period of social development. Researchers aimed to learn which groups of adolescents were most affected by the pandemic, so that mental health practitioners, pediatricians, and family physicians might be better informed of potential intervention and prevention practices that could be implemented to help particularly vulnerable adolescents through difficult times in the future.

What were the study results?

When exposed to certain stresses during the COVID-19 pandemic, adolescents with a history of depression, anxiety, ASD, or ADHD had lower life satisfaction compared to their peers. These stresses included decreased social connectedness, decreased family engagement, stress related to medical care access, pandemic-related traumatic stress, and living in a single-caregiver household.

This study also found that 80% of adolescents, regardless of pre-existing conditions, reported decreases in social connectedness during the COVID-19 pandemic. Although the detrimental effect of decreased social connectedness was amplified among individuals with certain pre-existing MEBD conditions, this risk factor was widespread among the majority of adolescents.

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 found that adolescents with decreased social connectedness typically had lower life satisfaction across several groups with different life circumstances. However, decreased social connectedness was more harmful for individuals with disabilities. This study allowed researchers to identify the groups of adolescents with disabilities who are most vulnerable and may need additional support during future emergencies. Findings from this study also highlight the importance of interventions aimed specifically at increasing social connectedness, family engagement, and access to medical support for all adolescents, and especially for those with disabilities.

Who was involved?

This study included COVID-19 survey data collected from April 2020 to August 2021 from a sample of 1,084 adolescents ages 11–21 years old, and their caregivers. The sample included individuals with and without disabilities from seven ECHO observational research sites in the U.S.

What happened during the study?

In addition to using pre-existing ECHO Cohort data about adolescents and their families, researchers administered a COVID-19-specfic survey to better understand the physical, mental, and social impact of the pandemic on young people and their families. Data were analyzed using a machine-learning process.

What happens next?

Findings from this study showed evidence of potential differences between adolescents with disabilities and their peers in terms of life satisfaction. Future research is needed to design studies that focus on the vulnerable subgroups identified in this study. Additionally, future studies may look into the long-term effects of decreased social connections and other risks resulting from the COVID-19 pandemic during developmentally critical time periods.

Where can I learn more?

Access the full journal article, titled “Life Satisfaction for Adolescents with Developmental and Behavioral Disabilities during the COVID-19 Pandemic,” 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.

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Published October 24, 2023

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New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic