New ECHO Research Reveals Communication, Collaboration, and Team Science Are Central to the Success of Large, Multi-Site Research Programs

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New ECHO Research Reveals Communication, Collaboration, and Team Science Are Central to the Success of Large, Multi-Site Research Programs

Authors: Elissa Faro, 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?

Large research collaboratives often have more success than single investigators conducting research alone. They produce more publications in journals with higher impact factors that result in more citations and continued research opportunities. As a result, funding agencies continue to increase their support for large, transdisciplinary research groups to address complex and challenging health problems.

The National Institutes of Health’s (NIH) Environmental influences on Child Health Outcomes (ECHO) Program developed multi-site collaboration strategies to promote high-impact, collaborative, observational research on child health. However, few studies have investigated the perspectives of researchers and staff of large research projects like ECHO. Many questions remain about team science, including the effects of research structures and funding mechanisms on team functioning. To address these questions, ECHO researchers sought to develop an in-depth understanding of the elements and conditions that influence the implementation of observational research in the ECHO Program.

 

What were the study results?

Researchers interviewed 24 ECHO investigators and staff and found that communication and working as a team were important for successful collaborations. Most interviewees expressed a desire for more opportunities for direct connection, learning, and sharing with their colleagues. While respondents mostly spoke positively about ECHO’s investigative network and opportunities to collaborate, researchers learned that some respondents felt the network could benefit from engaging more team members across various roles in decision-making processes.

Some interviewees also expressed that communication and the decision-making process within the program may need improvement, but they shared that they had observed the ECHO Program   improving in this regard. They also recognized that the size of the program might contribute to delays with timely, clear, and efficient communication. Overall, respondents felt the ECHO Program excels at conducting solution-oriented, high-impact child health research, but also that the Program has an opportunity to further improve communication, collaboration and decision-making across its vast network of sites and components.

 

What was the study's impact?

This study contributes insight on the implementation of a large, multidisciplinary research consortium, and these lessons may be transferable to other large research consortia. The findings also offer an in-depth understanding of why and how research stakeholders collaborate, and what strategies work better to produce high-impact science.

The study found that ECHO researchers highly valued team science, co-learning, and collaboration. The range of experiences across the program suggests that best practices for large research ventures like ECHO may not be one-size-fits-all but may instead need to be tailored for different groups. However, the collected responses may inform new methods to enhance communication and collaboration across large research consortia in the future.

This study will benefit a variety of research stakeholders, including government agencies and other funding organizations, when they support and design large research projects.

 

Who was involved?

Researchers conducted 24 interviews with ECHO researchers and staff. Most interviewees were affiliated with a study site, but the research team was also able to gather the perspectives of all ECHO Program components except for the Human Health Exposure Analysis Resource (HHEAR)—the ECHO component responsible for testing samples from ECHO participants to help researchers assess the effects of chemical exposures—and the NIH.

 

What happened during the study?

In early 2022, researchers conducted 24 virtual interviews. The research team interviewed internal stakeholders from the ECHO study sites and components, seeking broad representation of research and administrative roles across ECHO. All internal stakeholders were informed of the study via email, and those interested were able to contact the research team and schedule an interview via Zoom. From the respondents, researchers selected a sample to maximize variation and represent diverse perspectives from across ECHO.

The research team developed a semi-structured interview guide, and analyzed both the quantitative and qualitative data collected to understand how individual researcher’s experiences and perspectives reflect the overall implementation of the ECHO Program. As part of this analysis, the researchers tracked metrics organized around four central goals: (1) enrolling and retaining a large and diverse group of participants in ECHO to answer key scientific questions; (2) collecting high-quality data and making it available for analysis; (3) collecting, storing, and using biospecimen samples and data; and (4) publishing and disseminating high-quality, impactful science. These metrics provide complementary, quantitative assessment of ECHO implementation and progress toward key goals and priorities.

 

What happens next?

Future studies are needed to understand how collaborative research affects the experiences of ECHO study participants as well as the perspectives of external stakeholder groups.

 

Where can I learn more?

Access the full journal article, titled “A Mixed-Methods Analysis to Understand the Implementation of a Multi-stakeholder Research Consortium: Environmental influences on Child Health Outcomes (ECHO),” in the Journal of Clinical and Translational Science.

 

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

Published October 12, 2023

 

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ECHO Cohort Study Identifies Best Tests of Biological Age to Use for Different Types of Pediatric Tissue Samples

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ECHO Cohort Study Identifies Best Tests of Biological Age to Use for Different Types of Pediatric Tissue Samples

Authors: Fang Fang, 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?

A molecular process called DNA methylation, or DNAm, that adds a tag to the DNA that can control gene expression. Certain well-studied DNAm have been associated with many age-related chronic diseases, including aging itself.

Researchers have developed biochemical models called epigenetic clocks that use DNAm to estimate an individual’s biological age. Scientists have studied these clocks in adult populations in whom accelerated biological age (DNAm-predicted age older than actual chronological age) seems strongly connected to age-related health complications. However, only epigenetic clocks for pediatric populations have only recently been built. Epigenetic clocks also allow scientists to evaluate the impact of various environmental exposures on early-life development and children’s health outcomes.

This study conducted a comprehensive evaluation on seven of these epigenetic clocks—Horvath, Knight, Bohlin, Lee, Mayne, PedBE, and NeoAge—all of which researchers developed for different purposes and tissue types. It is important for scientists to understand how these clocks perform in different tissue types and developmental stages throughout early life to ensure researchers are designing studies appropriately and then correctly interpreting the results of these studies.

 

What were the study results?

The results of this study suggest that the best epigenetic clock to use depends on the type of sample being studied. For example, the Bohlin and Knight clocks were very similar when predicting gestational age from blood cell samples; the Lee clock outperformed the Mayne clock in predicting gestational age from placental samples; and the PedBE clock was more accurate than the Horvath clock at predicting chronological age from buccal cells. However, the Horvath clock was better at predicting chronological age when using blood cells samples.  The study results suggest the importance of researchers choosing the appropriate clock depending on the focus of their study.

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 provides practical recommendations for selecting the most appropriate epigenetic clock in different research contexts, therefore leading to more accurate estimates of biological age. The findings of this study may help scientists make better research tools, improving child health research.

 

Who was involved?

Researchers used data from 3,789 children, who contributed a total of 4,555 samples, from 20 ECHO research sites. The sample set consisted of 2,273 male and 2,282 female samples.

 

What happened during the study?

The researchers evaluated seven different epigenetic clocks based on the DNAm data generated from the selected sample set. The study evaluated each clock in corresponding tissues based on previous study results, and then compared clocks across different tissue samples. After comparing the suitability of various epigenetic clocks for each tissue type, researchers evaluated their performance across diverse populations. This evaluation included comparing epigenetic clocks between preterm and term infants within the same tissue type, across different self-reported racial groups, between males and females, and across different tissue types within the same set of participants.

 

What happens next?

Future studies may use the various epigenetic clocks as recommended to check the health of babies and children. However, researchers should interpret this data with caution as it pertains to conclusions about the performance of specific epigenetic clocks in pediatric populations with varied health backgrounds. Future studies may examine the effects of genetics on the performance of different epigenetic clocks.

 

Where can I learn more?

Access the full journal article, titled “Evaluation of Pediatric Epigenetic Clocks Across Multiple Tissues,” in Clinical Epigenetics.

 

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

Published October 9, 2023

 

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Does a Mother’s Exposure to Childhood Maltreatment Affect their Child’s Health Outcomes?

Authors: Claudia Buss, Nora K. Moog

Studying the Effects of Preterm Birth and Environmental Exposures on Child Health Outcomes

Authors: Michael O’Shea, Monica McGrath, Judy Aschner, Barry Lester, et al.

Effects of Metal Mixture Exposure During Pregnancy on Fetal Growth

Authors: Caitlin Howe, Margaret R. Karagas, et al.

Exposures to environmental chemicals and their effect on important molecules during pregnancy

Author(s): Brett T. Doherty, et al.

How Chemical Exposures in Pregnancy Affect Gene Changes in the Placenta

Author(s): Alison Paquette, Sheela Sathyanarayana, MD, MPH, et al.

How Environmental Exposures Affect Child Health Across Multiple Generations

Author(s): Carrie Breton, et al.

Do chemicals that break down slowly in the environment affect how long it takes to become pregnant?  

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

A review of studies that look at whether exposure to common non-persistent chemicals in consumer products delays the time it takes to become pregnant

Author(s): Alison E. Hipwell, Linda G. Kahn, Pam Factor-Litvak, et al

ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Authors: Claudia Lugo-Candelas, Tse Hwei, Seonjoo Lee, Cristiane Duarte, 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?

Sleep difficulties are common in pregnancy. Poor prenatal sleep may relate to negative outcomes for both parent and child, including pregnancy complications and certain birth outcomes. The impact of poor prenatal sleep may also extend beyond pregnancy and birth and may increase the risk for neurodevelopment disorders in offspring, particularly attention-deficit/hyperactivity disorder (ADHD).

In this study, ECHO researchers aimed to study potential associations between poor prenatal sleep and an increased risk of ADHD symptoms and sleep problems in offspring.

 

What were the study results?

Prenatal sleep quality and duration, particularly in the second trimester, appeared related to children’s risk for ADHD, emotional reactivity, and sleep problems at age 4. Longer sleep duration in the second trimester was associated with fewer ADHD symptoms in children. Poorer sleep quality scores in the second trimester were associated with greater offspring ADHD symptomatology. Shorter duration and poorer quality of sleep during the second trimester were also associated with more sleep difficulties in children.

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 extends prior work by examining the associations between self-reported prenatal maternal sleep health and offspring ADHD symptoms in early childhood in a large, socio-demographically diverse sample in the U.S., including Puerto Rico.

 

Who was involved?

The research team used data from 794 mother-child pairs across five ECHO research sites. All enrolled pairs with available prenatal sleep and offspring ADHD assessments before age seven were included. The pregnant participants were between 27 and 37 years old.

 

What happened during the study?

Pregnant participants reported on their sleep during pregnancy using self-report questionnaires and reported on children's symptoms and behaviors when children were between 3 and 5 years old. The study assessed the children’s ADHD symptoms and associated characteristics using the Child Behavior Checklist Preschool Version, a widely used parent report that measures behavior problems in children.

What happens next?

Future studies are needed to replicate these findings, as well as investigate the possible mechanisms. Poor sleep may impact inflammation in pregnancy and offspring development, but studies have not examined that association.

 

Where can I learn more?

Access the full journal article, titled “Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: A prospective analysis of timing and sex differences in the ECHO Cohort,” in The Lancet Regional Health - Americas.

 

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

Published October 9, 2023

 

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Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

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Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

Authors: Shuting Zheng, Maxwell Mansolf, Somer Bishop, 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?

Behavior problems observed in a young child can provide information on that child’s risk for certain developmental conditions and later mental health issues. A valid and unbiased measure of childhood behavior is critical for helping researchers and clinicians answer questions about the development of behavior problems in children from different backgrounds.

 

What were the study results?

Scores from the Child Behavior Checklist (CBCL) 1.5–5—a commonly used, caregiver-reported measure of internalizing (e.g., anxious) and externalizing (e.g., aggressive) behavior problems in children ages 1.5 to 5 years—may be biased by demographic factors such as the child’s age or the caregiver’s sex, education level, and primary language. Researchers found that caregiver responses for a number of questions on the CBCL were affected by caregiver or child demographic factors. The language (English vs. Spanish) the caregiver used to complete the survey contributed most to measurement bias, followed by their education level and sex. The child’s age and race also influenced CBCL scores.

By determining the factors contributing to measurement bias, ECHO researchers identified a subset of questions on the CBCL that were less impacted by bias but still reliably captured childhood behavior problems.

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 highlight the need to carefully consider possible sources of bias when using caregiver-reported measures. This study was the first to use a large, diverse sample of families to examine how demographic factors influence the answers given for individual survey questions in the widely used CBCL. Developing surveys with less bias can help researchers and clinicians better measure and compare behavior problems across groups of children who differ in age and family background.

 

Who was involved?

The study included caregivers of 9,087 young children (ages 18 to 71 months) from 26 ECHO research sites across the United States.

 

What happened during the study?

The researchers used data from 26 ECHO research sites to evaluate how caregiver responses to the CBCL varied based on the characteristics (age, sex, race, bilingual status, and neurodevelopmental disorders) of the child and the characteristics (sex, education level, household income level, and depression diagnosis) of the caregiver. Researchers then selected the CBCL questions that showed the least amount of bias and compared how well this subset of questions worked for evaluating childhood behavior problems when compared to the full CBCL survey. Additionally, the researchers mapped the scores from the less biased question sets to the scores provided by the full item sets, allowing them to derive comparable scores to the original CBCL scale.

What happens next?

ECHO researchers plan to apply the newly identified subset of less biased CBCL survey questions, evaluating its reliability in identifying children with clinically significant behavior problems. The identification of question sets with little bias offers researchers and clinicians better alternatives for measuring and comparing behavior problems across groups of children who differ in age and family background.

 

Where can I learn more?

Access the full journal article, titled “Measurement Bias in Caregiver-Report of Early Childhood Behavior Problems across Demographic Factors in an ECHO-wide Diverse Sample,” in the Journal of Child Psychology & Psychiatry Advances.

 

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

Published September 29, 2023

 

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ECHO Research Identifies Variety of Low-calorie, Nutrient-rich Foods for Optimal Prenatal Nutrition

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ECHO Research Identifies Variety of Low-calorie, Nutrient-rich Foods for Optimal Prenatal Nutrition

Authors: Katherine Sauder, Catherine Cohen, 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?

Most pregnant women in the U.S. are at risk of not getting enough of nutrients like vitamin A, vitamin D, folate, calcium, iron, and omega-3 fatty acids from foods alone. Previous ECHO Cohort research found that only one prenatal supplement available in the U.S. may give pregnant women the optimal amounts of each of these six nutrients. However, that supplement costs $200 per month and requires the patient to take seven pills a day. Researchers in this study turned to diet to explore energy-efficient foods that could provide the right amounts of these nutrients for pregnant patients.

 

What were the study results?

Researchers in this study identified more than 2,300 low-calorie foods with enough of at least one of the six nutrients important in pregnancy, including many with reasonable serving amounts to avoid excessive intake. For instance, consuming an additional 0.2 cups of raw carrots could provide the optimal amount of vitamin A. An additional 2.6 cups of reduced-fat milk could provide the optimal amount of vitamin D. An additional 0.4 cups of edamame could provide the optimal amount of folic acid. An additional 1 cup of a nutritional drink or shake could provide the optimal amount of calcium. An additional 0.9 cups of multigrain cereal could provide the optimal amount of iron. An additional 0.1 cups of canned chicken could provide the optimal amount of omega-3 fatty acids.

However, no single food evaluated gave enough of all six nutrients. Seaweed (raw or cooked without fat) provided sufficient vitamin A, folate, calcium, iron, and omega-3s but would require consumption of more than 5 cups per day. Twenty-one other foods and beverages (mainly fish, vegetables, and beverages) provided target amounts of four of the six key nutrients. Few foods met targets for vitamin D or iron, suggesting that dietary supplements may be necessary to meet those nutrient needs.  Other foods could be added in limited amounts to help meet intake targets without exceeding caloric recommendations or nutrient safety limits.

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?

Results highlight the difficulty in meeting nutritional requirements from diet alone and can inform pregnant women and their doctors about dietary changes and additional supplements that can improve nutrition during pregnancy. Pregnant women can focus on boosting prenatal intake of low-mercury fish, low-fat dairy, green and leafy vegetables, and fortified cereals to meet nutrient recommendations.

 

Who was involved?

This study included 2,450 pregnant participants from six ECHO Cohort Study Sites located across the U.S.

 

What happened during the study?

The researchers compared over 2,300 foods and beverages consumed in the U.S., focusing on the nutrients that are most important for maternal and infant health: vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids. ECHO researchers looked at foods and drinks that pregnant participants consumed during their pregnancies and then calculated how much of these six nutrients they were getting from their diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from foods to make up for the gaps in their diet.

 

What happens next?

Future research may focus on studying exactly how much of these nutrients are needed for pregnant women.

 

Where can I learn more?

Access the full journal article, titled “Identifying Foods that Optimize Intake of Key Micronutrients During Pregnancy" in The Journal of Nutrition.

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

Published September 27, 2023

Access the associated article.

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Does a Mother’s Exposure to Childhood Maltreatment Affect their Child’s Health Outcomes?

Authors: Claudia Buss, Nora K. Moog

Studying the Effects of Preterm Birth and Environmental Exposures on Child Health Outcomes

Authors: Michael O’Shea, Monica McGrath, Judy Aschner, Barry Lester, et al.

Effects of Metal Mixture Exposure During Pregnancy on Fetal Growth

Authors: Caitlin Howe, Margaret R. Karagas, et al.

Exposures to environmental chemicals and their effect on important molecules during pregnancy

Author(s): Brett T. Doherty, et al.

How Chemical Exposures in Pregnancy Affect Gene Changes in the Placenta

Author(s): Alison Paquette, Sheela Sathyanarayana, MD, MPH, et al.

How Environmental Exposures Affect Child Health Across Multiple Generations

Author(s): Carrie Breton, et al.

Do chemicals that break down slowly in the environment affect how long it takes to become pregnant?  

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

A review of studies that look at whether exposure to common non-persistent chemicals in consumer products delays the time it takes to become pregnant

Author(s): Alison E. Hipwell, Linda G. Kahn, Pam Factor-Litvak, et al

ECHO Cohort Researchers Find Association Between Some Prenatal Chemical Exposures and Postpartum Depression

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ECHO Cohort Researchers Find Association Between Some Prenatal Chemical Exposures and Postpartum Depression

Authors: Melanie Jacobson, 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?

Postpartum depression affects up to 20% of new mothers, making it the most common pregnancy complication to occur after delivery. Postpartum depression can impact a mother’s daily functioning, quality of life, and long-term health. Furthermore, it is associated with poor mother-child attachment, which can impact child health and development.

Factors like genetics and stress can make some people more likely to experience postpartum depression, but researchers are still trying to understand how synthetic chemicals might also play a role. Chemicals such as phenols, phthalates, and parabens can be found in plastics and personal care products. While these chemicals are nonpersistent, meaning that they don’t linger in the environment, their presence is widespread due to frequent exposure through diet, absorption through skin, and inhalation. The investigators in this study wanted to examine the extent to which exposure to these chemicals might be associated with postpartum depression symptoms.

 

What were the study results?

Prenatal phthalate concentrations were associated with increased odds of slightly higher postpartum depression scores, and the condition was observed to be more likely in people who were Hispanic, had lower education levels, and had prenatal 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?

Of the many synthetic chemicals investigated, only prenatal phthalate concentrations were associated with increased odds of postpartum depression. This suggests that finding ways to reduce prenatal exposure to phthalates might reduce the frequency of postpartum depression.

 

Who was involved?

Researchers used data from 2,174 pregnant individuals across five study sites. This information included data on urinary chemical concentrations from at least one point during the pregnancy and a self-reported postnatal depression assessment between two weeks and 12 months after delivery.

 

What happened during the study?

Researchers measured the concentrations of nonpersistent chemicals in urine samples. Researchers also collected, between two weeks and 12 months after delivery, data using self-reported postnatal depression assessments completed by the same individuals. Screening instruments indicated the presence or absence of postnatal depressive symptoms. Data was then harmonized to the Patient-Reported Measurement Information System (PROMIS) Depression scale.

 

What happens next?

While this is believed to be the largest study to-date examining the effects of environmental chemicals on postpartum depression, future studies are needed to replicate this research with larger sample sizes in diverse populations.

 

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to nonpersistent environmental chemicals and postpartum depression,” in JAMA Psychiatry.

 

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

Published September 20, 2023

 

Access the associated article.

ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles

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ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles

Authors: Marie Camerota, 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?

Birth outcomes for infants born very preterm have steadily improved over the past several decades. More children born at earlier gestational ages are surviving into childhood, however, it is unclear how being born very preterm may influence neurodevelopmental or behavioral problems.

Outcomes of children born at a gestational age of less than 33 weeks (“very pre-term”) vary significantly, with some children showing few neurodevelopmental concerns and others showing significant impairment. Most prior research has looked at single outcomes—for example, whether a child born preterm had a lower neurodevelopmental score or higher levels of behavior problems.  Understanding how these different outcomes may group together can help researchers and healthcare providers provide more comprehensive treatment plans for children born very preterm.

 

What were the study results?

Researchers found evidence for four different neurobehavioral profiles based on different combinations of cognitive, motor, and behavioral outcomes of children at the age of two. These profiles range from few or no developmental concerns to severe impairment in one or more domains. The study placed most children (about 85%) into one of two groups with no/mild developmental delay and a low prevalence of behavioral problems. The remaining 15% fell into one of two profiles with more serious neurodevelopmental problems with (5%) or without (10%) co-occurring behavior problems.

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 helps researchers better understand outcomes for children following a very pre-term birth. The different groups of children this study described might require different types of follow-up services or interventions.

 

Who was involved?

This study included more than 2,000 babies who were born at less than 33 weeks gestational age and were evaluated at the age of two years. Pre-term children from three ECHO research sites in the U.S. were included in this analysis.

 

What happened during the study?

Researchers recruited children born less than 33 weeks gestational age into the ECHO Program shortly after they were born. When these children reached age two years, researchers conducted a neurodevelopmental assessment and a motor exam; parents completed questionnaires about their children’s behavior. ECHO researchers looked for patterns in these data to understand whether there were groups of children with similar strengths and weaknesses.

 

What happens next?

More research is needed to understand why some preterm children develop neurodevelopmental and/or behavioral problems and others do not. To do this, future studies may study risk factors in pregnancy, the perinatal period, and in early infancy.

 

Where can I learn more?

Access the full journal article, titled “Neurodevelopmental and behavioral outcomes of very preterm infants: latent profile analysis in the Environmental influences on Child Health Outcomes (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 September 12, 2023

Access the associated article.

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Does a Mother’s Exposure to Childhood Maltreatment Affect their Child’s Health Outcomes?

Authors: Claudia Buss, Nora K. Moog

Studying the Effects of Preterm Birth and Environmental Exposures on Child Health Outcomes

Authors: Michael O’Shea, Monica McGrath, Judy Aschner, Barry Lester, et al.

Effects of Metal Mixture Exposure During Pregnancy on Fetal Growth

Authors: Caitlin Howe, Margaret R. Karagas, et al.

Exposures to environmental chemicals and their effect on important molecules during pregnancy

Author(s): Brett T. Doherty, et al.

How Chemical Exposures in Pregnancy Affect Gene Changes in the Placenta

Author(s): Alison Paquette, Sheela Sathyanarayana, MD, MPH, et al.

How Environmental Exposures Affect Child Health Across Multiple Generations

Author(s): Carrie Breton, et al.

Do chemicals that break down slowly in the environment affect how long it takes to become pregnant?  

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

A review of studies that look at whether exposure to common non-persistent chemicals in consumer products delays the time it takes to become pregnant

Author(s): Alison E. Hipwell, Linda G. Kahn, Pam Factor-Litvak, et al

“Accelerated” Biological Age at Birth Not Linked to Behavioral and Emotional Health Outcomes in Early Childhood

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“Accelerated” Biological Age at Birth Not Linked to Behavioral and Emotional Health Outcomes in Early Childhood

Authors: Christine Ladd-Acosta, Heather Volk, 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?

Previous studies have shown that early identification and intervention in the development of emotional and behavioral health challenges in children seems connected to better long-term health outcomes. Recently, researchers have begun looking at how epigenetic factors affect children’s biological age and health outcomes.

A molecular process known as DNA methylation, or DNAm, adds a tag to DNA to control gene expression. Researchers measure DNAm to estimate a person’s biological age and compare it with their chronological age to better understand the factors that may influence their long-term health outcomes.  In this study, ECHO researchers looked at the link between biological age at birth, the time between conception and birth (chronological gestational age), and emotional and behavioral health outcomes in children.

 

What were the study results?

Differences between biological age at birth and chronological gestational age did not appear linked to emotional and behavioral problems in childhood. This study did not find any difference between boys and girls in terms of the effect of “accelerated” biological age on behavioral and emotional outcomes.

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?

These results highlight that because biological age at birth does not seem to predict emotional or behavioral health challenges in early childhood, research should investigate how other biological factors at birth may influence neurodevelopmental health outcomes in early childhood.

 

Who was involved?

The study included four ECHO research sites in the United States and a total of 592 children.

 

What happened during the study?

Researchers calculated each child’s “biological age” by analyzing DNA samples collected at birth, and they compared this age to the child’s chronological gestational age. They then tested whether newborns who showed increased biological age relative to their chronological age (“accelerated aging”) were more likely to have emotional and behavioral problems in early childhood.

 

What happens next?

Future research in a larger sample might confirm these findings. The relatively small sample size of this study may have made it difficult to observe differences in behavioral or emotional outcomes based on child sex. Future research with larger samples could help investigate potential differences in the results between boys and girls.

 

Where can I learn more?

Access the full journal article, titled “Accelerated epigenetic age at birth and child emotional and behavioral development in early childhood: a meta-analysis of four prospective cohort studies in ECHO,” 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 September 10, 2023

 

Access the associated article.

How Much Vitamin D do Children with Asthma and Increased Body Weight Need to Correct Low Vitamin D Levels?

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How much vitamin D do children with asthma and increased body weight need to correct low vitamin D levels?

Study title: Pharmacokinetics of Oral Vitamin D in Children with Obesity and Asthma

Author(s): Jason E. Lang, Rodrigo Gonzalez Ramirez, Stephen Balevic, Brian O’Sullivan, Scott Bickel, Christoph P. Hornik, J. Marc Majure, Saranya Venkatachalam, Jessica Snowden, Laura James

 

Why was this study conducted?

Among children with asthma, children who also have increased body weight for their height (body mass index (BMI) of ≥85 percentile) tend to have more severe asthma symptoms than their healthy weight peers. Children with asthma and increased body weight also tend to have lower vitamin D levels than other children. Helping children with asthma and increased body weight reach higher vitamin D levels may help their asthma symptoms by lowering inflammation in the lungs. However, there is not enough information on how much vitamin D children with asthma and increased body weight should take to safely raise their vitamin D levels.

 

What was done?

ECHO ISPCTN research teams in 15 states enrolled children ages 6‑18 years with asthma and increased body weight in a clinical trial. The children took vitamin D capsules for 16 weeks and gave blood samples every month so researchers could check their vitamin D levels. The goal of the study was to find a vitamin D dose that helped children raise their vitamin D levels in their blood to 40 ng/mL, a level that might lower inflammation.

There were two parts of the study. In the first part, children were split into four groups that each took one of four different doses of vitamin D to find a dose that raised children’s vitamin D levels over 16 weeks without causing side effects. All four dosing options were higher than what is usually recommended to raise vitamin D levels. Then, researchers compared the vitamin D dose from part 1 that raised vitamin D levels quickly and safely to the usually recommended daily vitamin D dose to confirm that the higher dose could safely help children reach vitamin D levels that may decrease inflammation. This study was approved by the Institutional Review Board and all participants consented to participate in the study.

 

What was found?

The first part of the study found that taking a 50,000 international units (IU) vitamin D dose on the first day of treatment and then an 8,000 IU vitamin D dose every day for 16 weeks was most effective at raising vitamin D levels safely. In the second part of the study, researchers confirmed that using this approach raised vitamin D levels in most children to the recommended level while avoiding undesired higher levels. In contrast, no children who followed the current standard-of-care dosing of 600 IU each day achieved the target vitamin D level sufficient to potentially reduce inflammation.

 

What do the results mean?

Most children with asthma and increased body weight who take vitamin D the vitamin D dose used in this study (50,000 IU vitamin D on day one, then 8,000 IU each day) can safely raise their vitamin D level in a short period of time. The newly determined dose is much greater than the typically recommended dose. This study shows how important it is that children and adolescents with increased body weight get enough vitamin D in their diet or in vitamin supplements every day since the higher the body weight, the faster vitamin D was processed and removed from the body. The results of this study may help children with asthma or other illnesses if having enough Vitamin D lowers inflammation.

 

Who sponsored the study?

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

 

Appreciation

All of the families in ECHO ISPCTN trials help study teams across the country learn more every day about how to bring rural and underserved families into research studies. This is critical to ensure that families that are not near large academic centers still get the benefits of research and that the “answers” research studies find are meaningful for children and families across all parts of the country, not just those who live in large cities.

 

You may learn more about this publication here: https://link.springer.com/article/10.1007/s40262-023-01285-9

 

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

 

Published: August 30, 2023

Can Neighborhood Conditions Throughout Childhood Shape the Risk of Developing Asthma?

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

Authors: Izzuddin Aris, et al.

 

Who sponsored this study?

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

 

Why was this study needed?

Neighborhood conditions, such as access to housing, healthy food, transportation, and education centers, can contribute to the development of childhood asthma. Researchers often measure these conditions using the Child Opportunity Index and the Social Vulnerability Index, which link residential addresses at birth, infancy (age 0.5‒1.5 years), and early childhood (age 2.0‒4.8 years) to census-tract data about the opportunities and resources available in the surrounding neighborhood. Previous studies looking into this topic lacked geographic diversity or considered only specific socioeconomic aspects of neighborhood disadvantage, which may not fully capture the role of early-life experiences on health outcomes. This study examines the association of conditions and resources available in neighborhoods during different developmental stages with childhood asthma incidence.

 

What were the study results?

Living in a neighborhood with higher opportunity at birth, infancy, or early childhood was associated with lower asthma incidence when compared to living in a neighborhood with lower opportunity. Differences in sociodemographic characteristics, parental asthma history, or the number of births a mother had did not explain this effect.

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 impact?

Neighborhood conditions could help researchers identify vulnerable children who are at high risk for developing asthma. Policymakers, researchers, and community groups can use this information to guide decisions and interventions to improve the health of children and promote equitable opportunities across neighborhoods.

 

Who was involved?

This study used data from 10,516 children at 46 research sites participating in ECHO. The participants have at least one residential address from birth and a parent or caregiver report of a physician’s diagnosis of asthma.

 

What happened during the study?

Researchers linked participants’ residential addresses to the Child Opportunity Index and Social Vulnerability Index. They estimated asthma incidence rates associated with Child Opportunity Index or Social Vulnerability Index data for a child’s neighborhood at each life stage, adjusting for sociodemographic characteristics, maternal and paternal history of asthma, and the number of births a mother had.

 

What happens next?

Future studies can explore the impact of investing in early life health and environmental, social, and economic resources on improving health outcomes for children in disadvantaged neighborhoods. Follow-up studies can also focus on how these neighborhood-level factors are affecting asthma rates and how moving may alter asthma development.

 

Where can I learn more?

Access the full journal article, titled “Associations of Neighborhood Opportunity and Vulnerability with Incident Asthma Among U.S. Children in the ECHO cohorts,” in JAMA Pediatrics.

 

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

 

Published August 28, 2023

 

Access the associated article.

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