January ECHO Connector

Welcome to the ECHO Connector! The Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. The ECHO Connector will keep you informed of program news and our latest research findings.

Message from Matt

A message from the ECHO Director, Matthew W. Gillman, MD, SM

Welcome to the July 2023 edition of the ECHO Connector. This month’s Research Spotlight showcases a recent ECHO study that explores the relationship between maternal exposure to Per- and polyfluoroalkyl substances (PFAS) during pregnancy and obesity risk among children. You can learn more about all recent ECHO PFAS studies on ECHOChildren.org's PFAS research webpage.

Additionally, ECHO is searching for its next Deputy Director to help shape the future of child health research as part of the leadership team for this unique program. I invite you to share this opportunity with your networks. You can learn more here.

We are also pleased to announce our two newest notices of funding opportunities. The awards from these opportunities for postdoctoral fellows and doctoral candidates, respectively, both provide a chance to study child health outcomes by performing secondary analyses of ECHO’s large longitudinal datasets within the Eunice Kennedy Shriver National Institute of Child Health and Development Data and Specimen Hub (DASH) repository. The knowledge and experience generated by these two opportunities will help ECHO pursue its goal of providing a national resource.

—Matthew W. Gillman, MD, SM

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ECHO Research Spotlight

ECHO Researchers Find Association Between PFAS Exposure During Pregnancy and Childhood Obesity Risk

Collaborative ECHO research led by Yun Liu, PhD and Joseph Braun, PhD, both of Brown University, investigates the relationship between maternal exposure to Per- and polyfluoroalkyl substances (PFAS) during pregnancy and obesity risk among children and adolescents.

The researchers found that higher levels of some PFAS during pregnancy were associated with higher body mass index (BMI) and an increased risk of obesity in children. This research, titled “Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts,” is published in Environmental Health Perspectives.

“PFAS are a type of 'forever chemical,' which are very persistent in both the environment and human bodies. This persistence can cause adverse health effects, especially for children,” said Dr. Liu.

The research team evaluated maternal PFAS levels during pregnancy and child BMI by leveraging ECHO’s large sample size and geographic distribution to enroll 1,391 mother-child pairs across eight ECHO cohorts for this study. Researchers use BMI as an approximate measure of body fat.

“We decided to take advantage of the harmonized ECHO data to both look at prenatal PFAS being measured in a comparable way across all ECHO cohorts, and then leverage the BMI data collected in a comparable way across all the cohorts,” Dr. Braun explained.

This study included women who were pregnant between 1999 and 2019 in California, Colorado, Georgia, Illinois, Massachusetts, New Hampshire, and New York; and their children who were evaluated between the ages of 2 and 5 years old. The researchers analyzed the levels of seven different PFAS in blood samples collected from mothers during pregnancy. They then used the children’s height and weight data to calculate their BMI while accounting for each child’s age and sex, as well as other factors related to PFAS exposure and body fat.

Future studies will examine the associations between maternal PFAS exposure and obesity-related health outcomes in older children, which will help researchers and policymakers better understand the long-term risks of PFAS in order to take actions to protect vulnerable populations.

“A lot of the work that needs to be done now is identifying where people have been exposed to PFAS and setting better regulations to protect people by finding ways to reduce ongoing exposure, prevent exposure, or stop exposure-related health effects. The studies we could really use are those that determine what communities should do to reduce the effects of PFAS-related diseases,” said Dr. Braun.

Read the research summary.

ECHO Funding Opportunities

Funding Opportunities Available to Support Secondary Analyses

The ECHO Program Office has released the following Notices of Funding Opportunities available on the NIH ECHO website:

Funding Opportunities

ECHO is an extramurally funded program maintained within the Office of the Director at the NIH, with the mission to enhance the health of children for generations to come.

The goal of the Ruth L. Kirschstein National Research Service Award (NRSA) Individual Postdoctoral Fellowship (F32) is to provide opportunities for postdoctoral fellows to study child health outcomes through the secondary analyses of ECHO’s large longitudinal datasets within the Eunice Kennedy Shriver National Institute of Child Health and Development Data and Specimen Hub (DASH) repository.

The goal of the Dissertation Grant (R36) is to support doctoral candidates studying applicable areas of child health for the completion of their doctoral dissertation research project. The awards resulting from this funding opportunity will provide students working on dissertations the opportunity to access the ECHO data within the DASH repository.

ECHO’s DASH data sets integrate deidentified longitudinal data from more than 41,000 participants across the U.S. and focus on child health outcomes including pre-, peri- and postnatal outcomes; upper and lower airway health; obesity and its complications; neurodevelopment; and positive health.

Available deidentified data include

Demographic information including race, ethnicity, gender, socioeconomic status, and education
Early development data including growth, milestones, physical activity, and sleep
Environmental exposure data including physical, chemical, psychosocial, and natural and built environments
Pregnancy and birth information including maternal diet and physical activity, maternal smoking during pregnancy, weight gain, and delivery outcomes
Data related to public health crises including surveys on the effects of the COVID-19 pandemic

NIH encourages applications supporting candidates from diverse backgrounds, including those from underrepresented groups as described in the Notice of NIH's Interest in Diversity (NOT-OD-20-031).

The ECHO Program Office will post Frequently Asked Questions and pre-recorded informational webinars on the NIH ECHO website as soon as they are available.

Please share these announcements with any individuals or groups you think may be interested.

If you have questions, please reach out to Clay Mash: clay.mash@nih.gov.

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News You Can Use

ECHO Researchers Examine Incidence Rates for Childhood Asthma with Recurrent Exacerbations and Suggest Possible Social and Environmental Risk Factors

Collaborative ECHO research led by Rachel L. Miller, MD, of Icahn School of Medicine at Mount Sinai; and Christine C. Johnson, PhD, MPH, of Henry Ford Health investigates the factors that influence the rates of childhood asthma with recurrent exacerbations (ARE)—a subtype of the condition in which children experience frequent, severe episodes of asthma. The researchers leveraged ECHO data from over 17,000 children born between 1990 and 2017 and found that children ages 2–4 years old, and children who lived in the Midwest and Northeast, had the highest incidence rates of ARE. Additionally, children with a parental history of asthma had ARE rates almost 3 times greater than with no such parental history. ARE rates were also higher in non-Hispanic Black and Hispanic Black children. This research, titled “Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program,” is published in The Journal of Allergy and Clinical Immunology.

While the prevalence of asthma has been reported widely in the U.S. and elsewhere, studies on childhood asthma incidence rates within specific populations and across various types of asthma and age ranges have been limited. “Describing the incidence rates of ARE across a large, diverse population of children is a critical first step for identifying potential risk factors and causes,” explained Dr. Johnson.

To conduct this research, the team leveraged data from children enrolled in 60 ECHO cohorts across the U.S. Child participants or their caregivers reported whether and when the child had an asthma diagnosis and any corticosteroids prescribed regularly over time by their health care providers. Recurrent exacerbations of asthma were based on reports of systemic (not inhaled) corticosteroid use. The researchers calculated incidence rates of ARE for the study population overall, along with rates for subsets of the population defined by the years the ARE was diagnosed, the decade children were born, age and sex, race and ethnicity, residence at birth, and parents’ history of asthma.

“While children with ARE are all different, these findings suggest that we should examine in the future key elements of the early environment, including viral respiratory tract infections, indoor allergens, environmental tobacco smoke, air pollution, stress, and socioeconomic status, which could contribute to ARE,” said Dr. Miller. “Understanding these causes will help researchers determine how to best prevent ARE and associated asthma outcomes.”

Read the research summary.

New ECHO Research Investigates Link Between Maternal Health, Newborn Metabolism, and Childhood BMI

Collaborative ECHO research led by Britt Snyder, PhD and Tina Hartert, MD, MPH, both of Vanderbilt University Medical Center; and James Gern, MD, of the University of Wisconsin School of Medicine and Public Health investigates the links between maternal health characteristics and the concentrations of various metabolites in newborns. In addition to identifying these links, the study also demonstrated that some metabolites were linked to childhood body mass index (BMI) at ages 1–3 years. The researchers collected data from 3,492 infants and their mothers and found that certain maternal health factors such as higher BMI before pregnancy or maternal age at delivery likely increased the levels of some key metabolites in newborns. This research, titled “The Associations of Maternal Health Characteristics, Newborn Metabolite Concentrations, and Child Body Mass Index among US Children in the ECHO Program,” is published in Metabolites.

This study expanded on previous research investigating links between a variety of maternal characteristics and metabolite levels in newborns and explored the link between these metabolites and child growth patterns. The researchers also investigated how maternal factors and related chemical changes in utero could contribute to the link between newborn metabolism and childhood BMI. To address these questions, the researchers collected data on maternal health characteristics from self-reported questionnaires, birth certificates, and medical records. They then collected child BMI from medical records and study visits and used statistical tools to evaluate possible links between maternal health characteristics and newborn metabolism.

“These findings provide additional insights on potential in utero pathways through which maternal health characteristics may affect newborn metabolism and later child growth patterns,” said Dr. Snyder.

Future studies are needed to further explore these pathways and understand the relationship between maternal health characteristics and child health.

Read the Research Summary.

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ECHO Discovery

ECHO Discovery is a monthly webinar series with educational presentations for the ECHO community, stakeholders, and the public.

Join Us for August ECHO Discovery!

Wednesday, August 9, 1pm ET

Matt Gilman, MD, SM, ECHO Program Director, National Institutes of Health

ECHO Program Director Matt Gilman, MD, SM will headline our August 2023 Discovery webinar. Dr. Gillman, who has led the national ECHO Program since 2016, will provide updates on the program as this national scientific resource looks to begin its second 7-year cycle in September of this year. Topics will include significant Cycle 1 accomplishments in ECHO’s health outcome areas for both the observational cohorts and the ISPCTN clinical trial network, the future of ECHO’s large and growing national cohort, and how to access publicly available, deidentified ECHO data.

July ECHO Discovery

On July 12, Donghai Liang, PhD, MPH of Emory University and Candace Lewis, PhD of the University of Arizona, each presented for ECHO Discovery on their ECHO Opportunities and Infrastructure Fund (OIF) Award Studies. The OIF is an NIH-funded grants mechanism for early investigators to support projects for the introduction of new research, tools, and technologies in the ECHO Program.

Effects of prenatal exposure to Per- and polyfluoroalkyl substances on maternal and newborn metabolome and fetal growth: the PFAS Exposures and Child Health (PEACH) Study

Dr. Liang presented on how high levels of Per- and polyfluoroalkyl substance exposure during pregnancy can lead to changes in the amount of small molecules needed for the baby’s development, increasing the potential risk of preterm (3 or more weeks early) or early term (1–2 weeks early) birth. PFAS are known as “forever chemicals” because they do not break down over time, accumulating in the environment and the human body. Exposure to PFAS is very prevalent in the U.S. through everyday products like food packaging, non-stick cookware, and stain-resistant fabrics. Many studies have already demonstrated how PFAS exposure can be linked to poor birth outcomes, such as lower birth weights, but there is little information on why this relationship exists.

Dr. Liang and his team evaluated levels of PFAS in the blood of mothers and newborns, finding that many newborns were exposed during gestation to PFAS which may have disrupted the balance of certain chemical processes in their bodies. In the future, early detection of PFAS in maternal blood samples during pregnancy could help researchers and clinicians identify individuals at risk for preterm birth, which is linked to a variety of negative health outcomes in infancy and childhood.

DNA methylation of myelinating genes measured in peripheral samples predicts brain white matter volume in healthy pediatric cohort

Dr. Lewis presented on how researchers can more easily measure the influence of environmental factors on brain development and mental health. Understanding how epigenetic patterns—changes in the ways genes are expressed—in the brain are influenced by environmental factors is important to help researchers better analyze the role of environmental factors on mental health. However, it can be difficult to evaluate these patterns because brain tissue is difficult to collect.

To address this issue, Dr. Lewis presented recent results indicating that peripheral biosamples, such as blood or saliva, can be used in combination with neuroimaging data to assess how epigenetic patterns and brain structure may be influenced by environmental factors. Future studies could use this technique to evaluate the relationship between environmental factors, epigenetic patterns that shape brain structure and function, and mental health conditions like anxiety and depression.

June ECHO Discovery

On June 14, Izzuddin M. Aris, PhD of Harvard Medical School and Kate Hamlington Smith, PhD of Colorado Anschutz Medical Campus, each presented for ECHO Discovery on their ECHO Opportunities and Infrastructure Fund (OIF) Award Studies. The OIF is an NIH-funded grants mechanism for early investigators to support projects for the introduction of new research, tools, and technologies in the ECHO Program.

Neighborhood Opportunities and Disparities in Child Health Outcomes

Dr. Aris presented on the role of neighborhood opportunity in contributing to disparities in child health outcomes, such as obesity or asthma. Neighborhood factors can contribute to pediatric obesity and asthma by exposing children to health risks and preventing them from accessing health-promoting resources. Many studies that examine disparities in child health outcomes focus on individual socioeconomic factors that contribute to neighborhood disadvantage (e.g., high poverty rates), but these analyses may not adequately capture the totality of early-life social experiences.

ECHO research performed by Dr. Aris and his team found that children who lived in neighborhoods with higher levels of opportunity during early life, compared to those who lived in areas with lower neighborhood opportunity, were at less risk for developing obesity and had lower asthma incidence.

Lung Function Measured by Oscillometry in the Healthy Start and PETALS Cohorts

Dr. Smith presented on how oscillometry—a technique for measuring lung function and respiratory health—can be easily used with young children in a variety of settings to help researchers measure and evaluate the role of maternal health in childhood lung function. Asthma is one of the most common diseases for children in the United States, so it is important for researchers and clinicians to find ways to prevent and treat respiratory diseases and support healthy lung development throughout childhood.

In recent collaborative ECHO research, Dr. Smith and her team used oscillometry to collect measurements of lung function from young children and compared those measurements to learn how maternal factors during pregnancy affect childhood lung health. By studying early-life exposures and measuring lung function in childhood, researchers can identify the exposures that may be modified to protect lung health and decrease the risk of developing respiratory diseases.

Learn More about ECHO Discovery