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ECHO Research Explores the Relationship Between Growth in Early Life and Onset of Puberty

Recent ECHO Program collaborative research published in JAMA Network Open found that children who grew more quickly than their peers in the first five years of life were more likely to start puberty at an earlier age. Early puberty may be associated with the later onset of certain diseases, such as type 2 diabetes and obesity. Led by ECHO investigator Izzuddin M. Aris, PhD of Harvard University, this collaborative study aimed to understand the potential impacts of early life factors on puberty development.

Dr. Aris and ECHO investigators studied how participant weight and height data were related to the timing of puberty later in childhood. They specifically looked at the age at which the child experienced the most growth due to puberty, their age when they had their first period (in female children only), puberty development score, and pubic hair development.

The investigators found that male children in the study were more likely to enter puberty at a younger age if they gained weight or grew faster than their peers in the first five years of life. Additionally, they found that females who had faster weight gains from age two to five were more likely to enter puberty at a younger age. Study results also suggest that females with faster weight gains from six months to two years of age may start their periods earlier and have more advanced pubic hair development.

ECHO investigators involved with this study have planned additional follow-ups with participants to identify mechanisms behind these initial observations.

Read the research summary for more information on this study.

ECHO Researchers Explore How Maternal Stress During Pregnancy Relates to Infant Suck Patterns

ECHO Program investigators Emily Zimmerman, PhD, CCC-SLP of Northeastern University, and Andrea Aguiar, PhD of the University of Illinois at Urbana-Champaign, recently led a collaborative research effort published in Pediatric Research that found that maternal stress throughout pregnancy may be linked to changes in the way infants suck on a pacifier.

Non-nutritive suck (NNS) is an infant suck pattern, which is characterized by the absence of nutrient delivery. Measuring sucking patterns soon after birth can provide an early marker of later brain function. However, more research is needed to understand how maternal stress can affect brain function and sucking patterns. Therefore, study investigators leveraged participant data from two ECHO cohorts (Urbana-Champaign, Illinois, and Manati, Puerto Rico) to study the relationship between maternal stress in pregnancy and infant sucking patterns.

Throughout the study, the investigators utilized the Perceived Stress Scale to survey mothers on their stress levels during late pregnancy. One to eight weeks after the infants were born, researchers measured infants sucking patterns for about five minutes by having them suck on a pacifier that was connected to a pressure detector.

The results suggest that mothers who had higher rates of stress during late pregnancy gave birth to infants with fewer but longer sucking times. The investigators propose that it is possible that infants of more stressed mothers suck for longer intervals as a self-soothing mechanism, but this notion needs further testing. Interestingly, study results differed between the two cohorts, which could be attributed to differences in cultures, geographical locations, ethnicities, incomes, or education status.

The innovative and collaborative study could help promote maternal stress awareness and earlier detection. This could benefit not only mothers but also long-term health outcomes of stress-exposed infants. However, as this is the first study investigating the correlation between maternal stress and infant sucking patterns, it is important that more studies of this kind confirm these findings. Future studies could also investigate the relationship between early infant sucking patterns and infant growth and development, particularly brain and cognitive development.

Read the research summary for more information on this study.

Facilitators and Barriers to Pediatric Clinical Trial Recruitment and Retention in Rural and Community Settings

Children in rural settings are often underrepresented in clinical trials, which may contribute to rural health disparities. ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) researchers performed a review of studies describing barriers and facilitators that influence participation in pediatric clinical trials in rural and community-based (non-clinical) settings. The authors identified 27 articles describing 33 studies. Ten of these studies spanned urban and rural settings or were set in rural areas. The majority (23) were conducted in urban, suburban, or unspecified community settings.

Tactics or factors that helped facilitate recruitment and retention were similar across settings and included: contacts/reminders, community engagement and relationship building, consideration of participant logistics, and incentives. Inadequate staff and resources were commonly cited barriers to recruitment and retention.

The authors of this review note that few studies have examined optimal ways to recruit and retain rural participants in pediatric clinical trials. They recommend that future studies examining recruitment and retention strategies should include an assessment of rurality, and should address the relative impact of different strategies.

Read the full article in Clinical and Translational Science.

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