Fertility Challenges Associated with Small Differences in Children’s Neurodevelopment, NIH Study Finds

Posted on June 9, 2026June 9, 2026 by Jodi Snare

Father and child playing

Difficulty conceiving a pregnancy may be associated with small differences in children’s learning and behavior, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health (NIH).

Neurodevelopmental differences in childhood, including behavioral concerns and conditions such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), can affect long-term health and well-being. As more families use fertility treatments, researchers are working to understand whether these treatments—or the underlying fertility challenges that preceded them—may be linked to children’s development. Previous studies have often been small or unable to separate the effects of infertility from the effects of treatment.

To address these gaps, researchers analyzed data from the ECHO Cohort, examining how fertility history and fertility treatments were related to children’s neurodevelopment. The study included 15,382 mother–child pairs from 44 study sites across the U.S., including Puerto Rico. Researchers combined survey data and medical records to categorize pregnancies by fertility history, including infertility diagnoses, fertility treatments, multiple miscarriages, and extended time trying to conceive. Children’s development between ages 2 and 10 was assessed using parent-completed questionnaires and reports of clinician diagnoses of ASD and ADHD.

In this study, children of parents with fertility challenges showed slightly higher behavior-problem scores, slightly more autism-like traits, and higher odds of an ASD diagnosis, even when conceived without fertility treatment. The study also found an association between children conceived using non–in vitro fertilization (IVF) fertility treatments had higher odds of ADHD compared with those conceived naturally. However, researchers did not find clear evidence that IVF itself was associated with neurodevelopmental outcomes.

Key takeaways include:

Parental fertility challenges were associated with small differences in children’s behavioral and developmental outcomes.
Conception using non-IVF fertility treatments was associated with higher odds of ADHD.
IVF was not clearly associated with neurodevelopmental outcomes in this study.

“This study contributes to the growing body of evidence indicating that infertility treatment itself is not independently associated with child neurodevelopment outcomes,” said ECHO researcher Linda Kahn, PhD, of NYU Langone Health. “Rather, it appears that the parents’ underlying fertility problems—whether stemming from genetic, environmental, or other influences—are likely driving these associations.”

This collaborative research, titled “Associations of subfecundity and infertility treatment with child neurodevelopment in ECHO,” is published in JAMA Network Open.

About ECHO

The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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Fertility Challenges May Be Associated With Slight Differences in Child Behavior and Autism-like Symptoms, ECHO Study Finds

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Fertility Challenges May Be Associated With Slight Differences in Child Behavior and Autism-like Symptoms, ECHO Study Finds

Authors: Linda Kahn, 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?

More children are being conceived with the help of fertility treatments, and ECHO researchers wanted to assess whether these treatments or the fertility challenges that necessitate them might be linked to children’s behavior or autism-like symptoms. Fertility treatments include in vitro fertilization (IVF), where an egg is fertilized outside the body before being implanted in the uterus, as well as non-IVF treatments such as fertility medications or procedures like intrauterine insemination. Earlier studies investigating this association were often small, didn’t follow children for long, and couldn’t clearly distinguish the effects of treatment from the effects of infertility itself. They also did not consistently compare different types of fertility treatments. To address this gap, ECHO researchers used a large sample of study participants to compare children conceived with and without fertility treatment, including among families who experienced fertility challenges but conceived naturally, to better understand whether any differences in child behavior or autism-like symptoms are more likely related to treatment or to underlying fertility challenges.

What were the study results?

Trouble conceiving a pregnancy was associated with small differences in children’s behavior and autism-like symptoms. Children whose parents had fertility challenges had slightly higher behavior-problem scores, slightly more autism-like traits, and higher odds of an autism spectrum disorder (ASD) diagnosis, even when they were conceived without fertility treatment. The study also found that children conceived using non-IVF treatments had higher odds of ADHD compared with children conceived naturally (regardless of whether parents had reduced fertility). Researchers did not find clear evidence in this data that IVF itself was linked to brain development outcomes, and results did not meaningfully differ by the child’s sex or age group.

What was this study's impact?

These findings suggest that small increases in some behaviors such as aggression and rule-breaking or social communication problems in children conceived through fertility treatments may be related to the underlying fertility issues rather than the treatment itself. The possible link between non-IVF fertility treatments and ADHD needs more research, especially to understand whether the medical reasons for using these types of treatments rather than IVF explain the difference.

Who was involved?

The study included 15,382 mother-child pairs from 44 sites in the ECHO Cohort in the U.S. The analysis did not include adopted children or pregnancies using donor eggs or sperm. For twins or other multiples, the researchers included only one randomly selected child per pregnancy.

What happened during the study?

Researchers combined information from surveys and medical records to identify participants with a history of fertility challenges, including whether the parents had ever been told they had infertility, had infertility treatment, had two or more miscarriages, or had tried to conceive for 12 months without success. They also identified whether assisted conception involved IVF or non-IVF treatments (like fertility medications or intrauterine insemination). They then looked at the children’s development and diagnoses from ages 2–10, using parent-completed questionnaires and reports of clinician diagnoses of ASD and ADHD.

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?

Future studies could help researchers better understand which specific fertility problems might be linked to outcomes like ADHD and help to identify the possible biological pathways behind these associations.

Where can I learn more?

Access the full journal article, titled “Associations of subfecundity and infertility treatment with child neurodevelopment in ECHO,” in JAMA Network Open.

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

Published June 01, 2026

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Fertility Challenges May Be Associated With Slight Differences in Child Behavior and Autism-like Symptoms, ECHO Study Finds

Perceived Stress During Pregnancy Associated with Autism-related Traits in Children

Posted on April 8, 2026April 8, 2026 by Jodi Snare

Higher perceived stress during pregnancy may be associated with greater severity of autism-related traits in children, according to a recent ECHO Cohort study led by Luke Grosvenor, PhD, of Kaiser Permanente Northern California.

Many mothers experience higher levels of stress and other mental health challenges during pregnancy. Previous studies have found that pregnancy stress may be associated with increased risk of autism spectrum disorder (ASD) in children, but these studies have mostly focused on the occurrence of isolated adverse or stressful events that occur in the mother’s life during pregnancy. Fewer studies have measured general perceived stress among mothers during pregnancy. To better understand whether this prenatal exposure may be associated with severity of autism-related traits in children, researchers collected information from over 4,000 mothers and their children enrolled in 20 ECHO Cohort Study Sites across the United States.

Key Takeaways include:

Higher perceived stress during pregnancy was associated with slightly more severe autism‑related traits in children.
At higher prenatal perceived stress levels, children showed slightly higher scores on tests measuring social and behavioral traits related to autism. Children whose mothers had either moderate or high categorical stress scored higher than those whose mothers reported low or no stress.
The link between pregnancy stress and autism‑related traits did not differ between boys and girls.
The relationship between prenatal stress and autism‑related traits remained consistent even when the researchers accounted for mothers’ co-occurring prenatal depressive symptoms.
Stress during pregnancy is normal and common to experience. While the results of this study indicate that there may be a small association between pregnancy stress and autism-related traits, they do not imply that stress during pregnancy causes autism spectrum disorder or autism-related traits to occur in children.

“This study provides evidence for small yet significant associations between higher prenatal perceived stress and greater severity of autism-related traits,” said Dr. Grosvenor. “These results could have implications for prenatal mental health screening and behavioral interventions aimed at improving child outcomes.”

Future studies could help researchers better understand the specific periods during pregnancy during which stress may have the greatest association with child health and development and how other related social and emotional factors may influence this effect.

This collaborative research, titled “Associations between Prenatal Perceived Stress and Child Autism-Related Traits in the ECHO Cohort,” is published in The Journal of Pediatrics.

Read the research summary.

Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

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Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

Authors: Luke Grosvenor, 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?

Many mothers experience higher levels of stress and other mental health challenges during pregnancy. Previous studies have found that pregnancy stress may be associated with increased risk of autism spectrum disorder (ASD) in children, but these studies have mostly focused on the occurrence of isolated adverse or stressful events that occur in the mother’s life during pregnancy. Fewer studies have measured general perceived stress among mothers during pregnancy. This study examined the potential association between perceived stress during pregnancy and autism-related traits in children and evaluated how that association may differ according to the child’s sex or the mother’s experience of depression during pregnancy.

What were the study results?

Higher perceived stress during pregnancy was associated with slightly more severe autism‑related traits in children. At higher prenatal perceived stress levels, children showed slightly higher scores on tests measuring social and behavioral traits related to autism. Children whose mothers had either moderate or high categorical stress scored higher than those whose mothers reported low or no stress. The link between pregnancy stress and autism‑related traits did not differ between boys and girls. The relationship between prenatal stress and autism‑related traits remained consistent even when the researchers accounted for mothers’ co-occurring prenatal depressive symptoms.

What was the study's impact?

Stress during pregnancy is normal and common to experience. While the results of this study indicate that there may be a small association between pregnancy stress and autism-related traits, they do not imply that stress during pregnancy causes autism spectrum disorder or autism-related traits to occur in children.

Who was involved?

The study included 4,115 mother–child pairs from 20 ECHO Cohort Study Sites across the United States. Children ranged in age from about 2.5 to 18 years old.

What happened during the study?

Mothers reported their stress levels during pregnancy using a standard questionnaire. Later, parents reported on their children’s autism-related traits using a validated survey. Researchers analyzed the data using statistical models that accounted for factors such as child age, sex, and study site.

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?

Future studies could help researchers better understand the specific periods in pregnancy when stress may have the greatest association with child health and development and how other related social and emotional factors may influence this effect.

Where can I learn more?

Access the full journal article, titled “Associations between Prenatal Perceived Stress and Child Autism-Related Traits in the ECHO Cohort,” in The Journal of Pediatrics.

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

Published March 2, 2026

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Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

Exposure to Air Pollution During Pregnancy Associated with Higher Risk for Autism-related Outcomes

Posted on July 29, 2025July 29, 2025 by Jodi Snare

Exposure to certain air pollutants during pregnancy was associated with autism-related traits and increased odds of autism spectrum disorder (ASD) diagnosis in children, according to a recent ECHO Cohort study led by Akhgar Ghassabian, MD, PhD of NYU Grossman School of Medicine and Heather Volk, PhD of Johns Hopkins Bloomberg School of Public Health.

Air pollution is a significant environmental health concern and contributes to many illnesses and early deaths worldwide. Ambient air pollution can have detectable effects on the brain. Recent studies show that being exposed to air pollution during pregnancy and early life can affect how a child’s brain develops. This can happen through several pathways, such as causing inflammation in the brain, disrupting hormones, or changing how genes work. Previous research has suggested potential links between air pollution and neurodevelopmental disorders, but the relationship between exposure to air pollution, even at low levels, during pregnancy and ASD has been unclear.

This study included 8,035 mother-child pairs from 44 ECHO Cohort study sites, including over 1,000 children who were potentially at higher risk for ASD based on being born preterm or having siblings with autism.

Key takeaways include:

Prenatal exposure to ozone was associated with autism-related traits and increased risk of ASD diagnosis.
Exposure to fine particulate matter (PM₅) and nitrogen dioxide was also associated with a higher risk of autism, but associations varied by geographical regions.
There was little evidence for differences between boys and girls in the association between prenatal air pollution exposure and autism outcomes.

These findings suggest that even low levels of air pollution exposure during pregnancy can be associated with autism-related outcomes. This highlights the importance of understanding the risks associated with air pollution exposure during pregnancy and its effects on neurodevelopment.

This collaborative research, titled “Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium,” is published in Environmental Health Perspectives.

Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

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Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

Author(s): Heather Volk, Akhgar Ghassabian, 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?

Air pollution is a significant environmental health concern and contributes to many illnesses and early deaths worldwide. Ambient air pollution can have detectable effects on the brain. Recent studies show that being exposed to air pollution during pregnancy and early life can affect how a child’s brain develops. This can happen through several pathways, such as causing inflammation in the brain, disrupting hormones, or changing how genes work. Previous research has suggested potential links between air pollution and neurodevelopmental disorders, but the relationship between exposure to air pollution, even at low levels, during pregnancy and ASD has been unclear. This study examined the associations between prenatal air pollution exposure and autism spectrum disorder (ASD) in children.

What were the study results?

The study team observed that higher prenatal exposure to ozone was associated with autism-related traits and increased risk of ASD diagnosis. Exposure to fine particulate matter (PM_2.5) and nitrogen dioxide was also associated with a higher risk of autism, but associations varied by geographical regions. There was little evidence for differences between boys and girls in the association between prenatal air pollution exposure and autism outcomes.

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 study's findings suggest that even low levels of air pollution exposure during pregnancy might be associated with autism-related outcomes. This highlights the importance of understanding the risks associated with air pollution exposure during pregnancy and its effects on child neurodevelopment.

Who was involved?

The study involved 8,035 mother-child pairs from 44 ECHO study sites across the United States. This sample included over 1,000 child participants who were potentially at higher risk for ASD due to being born preterm or having siblings with autism. The remaining participants were recruited from samples representative of the general population.

What happened during the study?

This study looked at scores from the Social Responsiveness Scale (SRS), a parent-report tool that measures autism-related traits in children, with higher scores indicating higher autism-related traits. During the study, researchers estimated daily exposure to particulate matter, nitrogen dioxide, and ozone at the residential addresses of pregnant women. They then analyzed the associations between these air pollutants and autism-related traits using the Social Responsiveness Scale (SRS) and physician-diagnosed ASD.

What happens next?

The study results suggest that even small changes in prenatal air pollution exposure could have a significant impact on child neurodevelopment. Future studies are needed to understand why these connections exist and to look at the impact of specific air pollution components.

Where can I learn more?

Access the full journal article, titled “Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium,” in Environmental Health Perspectives.

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

Published June 11, 2025

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Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

NIH Study Finds No Association Between Prenatal Dietary Patterns and Autism Diagnoses, But Potential Links with Broader Traits

Posted on March 17, 2025 by Jodi Snare

Three validated dietary patterns were not associated with diagnosis, but healthy eating during pregnancy showed a modest link with lower scores for traits related to autism

Expectant mothers with higher diet quality—measured by the Healthy Eating Index (HEI) and the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P)—had children with modestly lower scores for traits related to autism spectrum disorder (ASD), according to ECHO Cohort research led by Kristen Lyall, ScD, and Rachel Vecchione, MPH, of Drexel University. However, the study did not find a significant association between these prenatal dietary patterns and a formal ASD diagnosis.

Previous research has suggested potential links between prenatal diet and neurodevelopmental conditions, but most studies focused on individual foods or nutrients rather than overall dietary patterns. In this study, ECHO researchers examined overall dietary patterns to better understand effects of usual dietary intake across foods.

“This study broadly supports the importance of a healthy diet during pregnancy. Autism is a complex condition with many contributing factors. Here, we found some evidence to suggest a healthy diet during pregnancy may be linked with reduced likelihood of broader traits related to autism, but effect sizes were small,” said Dr. Lyall.

The study included up to 6,084 mother-child pairs from 14 ECHO Cohort Study Sites, which included general population sites and sites with a higher chance of ASD occurring in families.

This collaborative research, titled “Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental influences on Child Health Outcomes Consortium,” is published in Nutrients.

ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

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ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

Authors: Rachel Vecchione, 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 this study needed?

Diet during pregnancy plays a major role in fetal development. Prior research has shown associations between several dietary factors and certain neurodevelopmental conditions in children, including autism spectrum disorder (ASD). ASD is a neurodevelopmental condition that affects social communication and behaviors, and presents in a wide variety of behaviors, abilities, and challenges.

This study helped to fill gaps in understanding the relationship between maternal dietary patterns during pregnancy and ASD-related outcomes in children. Most previous studies examining links between prenatal diet and ASD and other neurodevelopmental outcomes have focused on individual foods or nutrients, rather than overall dietary patterns. Dietary patterns may be useful to examine because they summarize the usual intake of a wide range of foods and may capture combined effects across many nutrients. Dietary patterns that capture the intake of recommended foods may also help to provide clearer communication than summaries across individual nutrients. This study therefore aimed to provide a comprehensive assessment by examining several established dietary patterns and their associations with ASD-related traits and diagnoses.

What were the study results?

Dietary patterns examined in this study included the Healthy Eating Index (HEI) and the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P), as well as the Empirical Dietary Inflammatory Index (EDIP). Both the HEI and AHEI-P are validated dietary patterns that are measures of overall diet quality. Higher scores on these patterns indicate better adherence to dietary guidelines. In contrast, higher scores on the EDIP indicate a more pro-inflammatory diet.

The study found that higher prenatal scores on the HEI the AHEI-P were associated with modest decreases in ASD-related traits. However, there were no significant associations between prenatal intake of these dietary patterns and ASD diagnosis. The findings suggest that while there may not be strong associations between prenatal dietary patterns and ASD diagnosis itself, there may be subtle associations with broader traits like social communication difficulties that warrant further investigation.

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 contributes to the understanding of how prenatal diet may relate to ASD-related characteristics in children. It also highlights the need to further study the potential mechanisms linking prenatal diet to ASD-related traits and to consider broader dietary patterns in addition to individual nutrients and foods.

Who was involved?

The study included 6,084 mother-child pairs from 14 ECHO Cohort Study Sites. The participants were socioeconomically and demographically diverse, drawn from a large U.S.-wide sample, including general population sites and sites with a higher chance of ASD occurring in families.

What happened during the study?

Researchers collected data from individual sites that used Food Frequency Questionnaires to assess diet during pregnancy and enable the calculation of dietary patterns. The study examined associations between three dietary patterns and ASD-related outcomes while adjusting for potential confounding factors such as maternal age, pre-pregnancy BMI, sociodemographic factors, and child characteristics.

What happens next?

Future studies could help researchers confirm the results of this study and explore the subtle associations between prenatal diet and ASD-related traits. Further research could also examine multiple ASD-related outcomes, using larger and more diverse samples, and investigate potential mechanisms linking prenatal diet to ASD-related traits.

Where can I learn more?

Access the full journal article, titled “Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental influences on Child Health Outcomes Consortium,” in Nutrients.

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

Published November 6, 2024

Read the related research alert.

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ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

New ECHO Research Finds Children with Autism at Higher Risk for a Range of Health Outcomes

Posted on October 2, 2024April 1, 2025 by Jodi Snare

Collaborative ECHO research led by Elizabeth Kaplan-Kahn, PhD, Kristen Lyall, ScD of the A.J. Drexel Autism Institute at Drexel University and Heather Volk, PhD, MPH of the Bloomberg School of Public Health at Johns Hopkins University investigates the factors that influence the overall health and well-being of people on the autism spectrum. This research, titled “Describing Multidomain Health Outcomes in Autistic Children in the ECHO Program,” is published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Approximately 3% of children in the United States have a diagnosis of autism spectrum disorder (or autism). A large proportion of autism research focuses on understanding the factors that influence the development of autistic traits. However, many people on the autism spectrum report that they would rather prioritize research into the factors that influence their overall health and well-being. This study addressed that priority by investigating the physical, emotional, and overall health outcomes of children on the autism spectrum.

The study included over 4,500 children and adolescents at 29 ECHO research sites across the United States, including 286 participants with autism, with participants varying in age from 5 to 20 years old. The research team conducted an initial analysis on the 4,511 participants by comparing data on their health outcomes and demographic characteristics. They then used a subsample of 1,809 participants, of which 116 were autistic, to group children with similar physical health, emotional health, and overall well-being outcomes into one of three categories, “positive health,” “poorer health,” and “mixed health.”

These profiles were categorized based on data from the research team’s primary outcome measures—multiple Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scores, the Child Behavior Checklist (CBCL) Dysregulation score, the Social Responsiveness Scale, Second Edition (SRS-2), and standardized Body Mass Index (BMI). These measures evaluated participants’ peer relations, life satisfaction, behavior dysregulation, sleep disturbances, physical activity, etc. The three profiles of participants were then further analyzed to study differences in health outcomes between children on the autism spectrum to non-autistic children.

The study results indicate that autistic children are at higher risk than non-autistic children for poorer health outcomes indicated by lowest scores in Global Health and highest dysregulation scores (e.g. attention problems, aggressive behavior, and anxious-depressive symptoms). However, there is variability in health outcomes within autistic youth as shown by a group of autistic participants who showed high scores on positive health outcomes across domains. Additionally, compared to non-autistic children, more autistic children were born prematurely, had diagnoses of intellectual disability and ADHD, and had a sibling with autism.

“The results of this study offer a glimpse into the range of emotional, physical, and overall health outcomes for children on the autism spectrum,” Dr. Kaplan-Kahn said. “A deeper understanding of the range of health outcomes children with autism experience, and the factors that can affect these outcomes, may help families and practitioners identify and target areas for support or intervention.”

Future work may focus on understanding the factors that influence poor or positive health for children with autism and how those factors change over time. This work might identify opportunities to support these children and promote positive health outcomes.

Read the research summary.

ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

Authors: Claudia Buss, Nora K. Moog

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?

Results from this study suggest that mothers’ maltreatment experience as children may influence their own children’s future health. Children of mothers who were neglected or abused during childhood were more likely to have diagnoses of asthma, ADHD, and ASD. These children were also more likely to demonstrate symptoms and behaviors linked to depression (i.e., internalizing behaviors). Additionally, girls whose mothers experienced maltreatment during childhood were more likely to have obesity. Children with mothers who experienced childhood maltreatment were also more likely to develop several of these health outcomes at once. Furthermore, exposure to several different forms of maternal childhood maltreatment was associated with highest risk increases for most offspring health outcomes suggesting the more severe the maternal childhood experiences were, the higher the risk for adverse health outcomes in her child.

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 highlights the impact of maternal childhood maltreatment experiences as a major determinant of health across generations. While not all children of mothers who experienced abuse or neglect during childhood develop health problems, those who do are at higher risk for developing more than one condition. Results from this study suggest that screening and identifying these children early on, can allow the opportunity to direct targeted interventions to interrupt the intergenerational impact of adversity.

Why was the study needed?

Childhood maltreatment increases the risk for adverse health outcomes, and this risk can be transmitted from one generation to the next. Previous studies have investigated single health outcomes in children of mothers that were exposed to childhood abuse or neglect. However, health outcomes can often be connected to one another and affected by the same factors. This study investigated six health outcomes simultaneously and investigated whether a mother’s own exposure to maltreatment affects a child’s risk for experiencing more than one of these health outcomes.

Who was involved?

This study included over 4,000 mothers and their children from 21 ECHO cohorts. About 44% of mothers who participated in the study reported experiencing some form of abuse or neglect during their own childhood.

What happened during the study?

Mothers self-reported on their childhood experiences, and researchers used this information to assign mothers to one of two groups: 1) exposed to childhood maltreatment and 2) not exposed to childhood maltreatment. The researchers compared the risk for physical and mental conditions, including asthma, internalizing behaviors (e.g., social withdrawal, trouble sleeping, symptoms of anxiety or depression), autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and obesity, between the children in the two groups. They also examined whether multiple health outcomes co-occur in the same child.

What happens next?

Follow-up studies will investigate the pathways between maternal childhood maltreatment experiences and child health outcomes. Other studies may also investigate if other forms of negative childhood experiences are linked to different consequences of childhood maltreatment in the next generation.

Where can I learn more?

Access the full journal article, titled “Intergenerational transmission of the consequences of maternal exposure to childhood maltreatment – a United States nationwide study of multiple cohorts in the ECHO program” in The Lancet Public Health.

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

Published February 23, 2023

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

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Fertility Challenges May Be Associated With Slight Differences in Child Behavior and Autism-like Symptoms, ECHO Study Finds

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Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

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Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

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ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

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