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.

PFAS Exposures During Pregnancy Not Significantly Associated with Child Behavior Issues

Posted on September 22, 2025September 22, 2025 by Jodi Snare

Exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy was not significantly associated with behavior issues in children, according to a new ECHO Cohort study led by Catherine Bulka, PhD of the University of South Florida and Rebecca Fry, PhD of the University of North Carolina, Chapel Hill.

PFAS are man-made chemicals used in some consumer and industrial products like cookware, stain-resistant fabrics, and foams used to fight fires. They are often referred to as “forever chemicals” because they don’t break down easily, causing them to build up in water, soil, and air. Previous findings on the effects of prenatal PFAS exposure on child behavior have been inconclusive due to small sample sizes, limited exposure variability, and differing measures of child behavior. This study included children from nine ECHO Cohort study sites across the United States, including 1,723 preschool-age children (1.9-5.9 years) and 627 school-age children (6-15 years). Researchers measured mothers’ PFAS exposure through blood samples collected during pregnancy (between 2- and 42-weeks’ gestation) and assessed children’s behavior using the Child Behavior Checklist (CBCL).

Key Takeaways include:

Most of the PFAS detected in pregnant mothers were not clearly linked to behavior problems in their children overall.
Children whose mothers had medium levels of exposure to perfluorohexane sulfonate (PFHxS) during pregnancy showed more emotional problems, like being easily upset or withdrawn, especially when they were preschoolers. This pattern was not seen at very high or low levels of PFHxS exposure.
There were no strong connections between PFAS exposure before birth and behavior problems when the children were older (school-age).
Looking at combined exposures to multiple PFAS also did not show any clear relationship with child behavior.

“While most PFAS showed no association with behavioral problems, some suggestive, non-linear relationships emerged, indicating that these exposures may influence neurodevelopment in complex and unexpected ways,” said Dr. Bulka.

Additional studies could help researchers assess the effects of PFAS exposure during the postnatal period, which may be a more relevant window for childhood brain development and behavioral issues. Also, as some PFAS are being phased out of consumer products and replacements are emerging, future studies could help researchers understand the potential effects of exposures to these newer replacement chemicals.

This collaborative research, titled “Prenatal Exposure to Per- and Polyfluoroalkyl Substances: Association with Child Behavior in the Environmental influences on Child Health Outcomes (ECHO) Cohort,” is published in Environment International.

Read the research summary.

Stronger Executive Functioning Skills in Children May Support Healthier Behaviors and Lower Chronic Disease Risk, Study Finds

Posted on March 7, 2025March 7, 2025 by Jodi Snare

Children with stronger executive functioning skills may be better equipped to develop health-promoting behaviors that reduce their risk of chronic disease, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Key takeaways include:

Across all pediatric life stages, children with higher working memory consumed fewer sugary drinks and saturated fats.
In middle childhood, greater cognitive flexibility and behavioral inhibition were linked to eating more fruits and vegetables. These skills were also associated with increased physical activity.
In adolescence, higher scores in all executive functioning domains were linked to greater physical activity.

“The results of this study allow us to get more specific in how and when we intervene,” said ECHO Cohort investigator Nichole Kelly, PhD of the University of Oregon. “For example, targeting working memory as a specific domain of executive functions may be most fruitful in improving children’s dietary behaviors, particularly through early intervention, as the link between working memory and diet was evident in early childhood.”

The findings suggest that early interventions targeting executive functioning, particularly working memory, could improve dietary habits throughout childhood. However, the effects of executive functioning on health behaviors were small, indicating that additional strategies may be necessary to support families in fostering healthier lifestyles. Additionally, because this study looked at this association at only one point in time for each child, it isn’t clear whether executive functioning influences health behaviors or vice versa.

This collaborative research, titled “Children’s executive functioning and health behaviors across pediatric life stages and ecological contexts,” was published in the Journal of Behavioral Medicine.

NIH Study Finds No Significant Link Between Time Spent in Childcare and Young Children’s Mental Health, Even Amid Early Adversity

Posted on December 17, 2024August 27, 2025 by Jodi Snare

Sending children to childcare outside the home may not significantly affect children’s mental health, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health. This finding holds true even for children who face challenges, such as a parent’s mental illness or financial struggles at home.

Many children in the U.S. under the age of 5 years spend some time in childcare outside the home. Researchers wanted to learn whether attending childcare influenced the mental health of children, particularly those who had experienced early adversity.

“Despite the extensive use of childcare in the U.S. and documented benefits, there are still some concerns that childcare attendance (vs. staying at home with a parent) increases the risk for poor child outcomes,” said Michelle Bosquet Enlow, PhD, of Boston Children’s Hospital and Harvard Medical School. “This can lead to considerable feelings of guilt and worry for parents who use childcare.”

The study looked at various forms of childcare, including center-based care, home-based non-relative care, and care by a relative. However, previous findings on the role of childcare in child mental health have produced mixed results. While many studies highlight positive associations with attending childcare, some raise concerns that childcare may increase the risk for poor child developmental outcomes. “Understanding how childcare can influence children's development, especially for those facing extra challenges, can help shape public policies that promote healthy outcomes for kids,” said Dr. Bosquet Enlow.

Key Findings

Children facing early life adversity were more likely to have higher levels of anxiety, depression, aggression, or hyperactivity symptoms.
Childcare attendance did not seem to be associated with increased or decreased levels of mental health symptoms, including among children facing adversity.
The study did not find any evidence that the number of hours in childcare corresponded to worse mental health outcomes for children, even those at elevated psychosocial and socioeconomic risk.

The findings suggest that while children facing higher levels of stress, mental illness in the family, and economic hardship were more likely to have higher levels of internalizing symptoms (such as anxiety and depression) and externalizing symptoms (such as aggression and hyperactivity), number of hours in childcare did not appear to play a significant role in altering these outcomes.

About the study

The study followed 2,024 parent-child pairs from three diverse U.S. research groups within the ECHO Cohort. Participants were recruited from hospitals in North Carolina, Pennsylvania, and Tennessee, as well as from adoption agencies across the United States.

Researchers measured children’s childcare experiences from birth to age 3 years and examined parental factors like childhood adversity, depression, and education level. Between ages 3 and 5.5 years, the children’s mental health was assessed for symptoms like anxiety, depression, and aggression.

This collaborative research was published in Development and Psychopathology.

Bosquet Enlow, M., et al. (2024) The Influence of Early Childhood Education and Care on the Relation between Early Life Social Adversity and Children’s Mental Health in the Environmental influences for Child Health Outcomes Program. Development and Psychopathology. DOI: 10.1017/S0954579424001822

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About ECHO: Launched in 2016, 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. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X.

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.

Neighborhood Impact on Children’s Well-Being Shifted During COVID-19 Pandemic, ECHO Study Suggests

Posted on July 11, 2024August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

The COVID-19 pandemic significantly disrupted daily life and has raised concerns about its impact on children’s well-being. A new study from the NIH Environmental influences on Child Health Outcomes Program (ECHO) sheds light on how a neighborhood’s physical and social environment influenced a child’s well-being before and during the pandemic.

According to an analysis of ECHO Cohort data, the neighborhood environment was less likely to be associated with child well-being during the pandemic than in the pre-pandemic period. The pandemic brought unprecedented social changes, altering how people and families interacted with their neighborhoods. For example, during the pandemic, neighborhood safety was less of a concern for children who spent more time indoors at home and less time outside. Likewise, the closure of parks and playgrounds limited access to green spaces and recreation, making those factors less important to a child’s well-being at that time.

The study authors point out that the new findings align with previous research showing a link between neighborhood characteristics and child well-being. For instance, previous studies indicate that living in neighborhoods with higher poverty levels, lower educational attainment, and poorer housing conditions are associated with worse child health outcomes, including physical and mental health, cognitive development, and academic achievement.

“Neighborhood characteristics were widely known to be associated with children's well-being. Until now, we hadn't looked at how the COVID-19 pandemic might change their relationships,” said Xueying Zhang, PhD, of Baylor College of Medicine. “Additionally, the impacts of the pandemic may be different among children of different races.”

The study involved 1,039 children from more than 10 ECHO Cohort Study sites across the U.S., mostly between the ages of 11 and 19. These children completed a well-being questionnaire called the Patient-Reported Outcomes Measurement Information System (PROMIS) before (2019 to March 1, 2020) and during (March 1, 2020 to August 31, 2021) the pandemic The PROMIS survey measures mental and physical health as well as peer and family relationships in children.

The researchers then matched U.S. Census tract data with a child’s residential address to examine the neighborhood characteristics. They looked at factors including race, education, occupation composition of residents, house capacities, and property features. They analyzed how these factors were associated with child well-being, considering the impacts of the pandemic and differences across child racial groups.

"Our findings highlight the significance of how child race intersects with the impact of the pandemic on child well-being,” said Dr. Zhang. “Future research could examine how people respond differently to environmental impacts during the pandemic and help to address disparities.”

Dr. Zhang led this collaborative research published in Environmental Research.

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About ECHO: Launched in 2016, 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. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth on X for the latest ECHO Program updates.

ECHO Cohort Study Finds Link Between Infant Gut Microbiome and Autism-Related Traits

Posted on July 2, 2024July 2, 2024 by Jodi Snare

Collaborative ECHO research led by Vanja Klepac-Ceraj, PhD, of Wellesley College, and Juliette C. Madan, MD, MS, of Dartmouth Hitchcock Medical Center, investigates the relationship between the infant gut microbiome and childhood autism-related traits. This research, titled “Prospective Association of the Infant Gut Microbiome with Social Behaviors in the ECHO Consortium,” is published in Molecular Autism.

The study sought to identify gut bacteria linked to social traits and brain development in two ECHO Cohort Study Sites. Researchers found that certain features of the gut microbiome of infants were associated with higher scores on the Social Responsiveness Scale-2 (SRS-2), a questionnaire that measures autism-related traits. Specifically, certain bacteria and their functional genes, particularly those related to the production of short-chain fatty acids, were linked to autism-related traits. These associations varied between sex and age groups.

“The findings of this study help us understand the potential likelihood of autism-related traits through the gut-brain axis,” said Dr. Klepac-Ceraj. “This understanding could open up new avenues for targeted early interventions.”

Researchers studied 481 samples from 304 healthy child participants from ECHO Cohort study sites in New Hampshire and Rhode Island. The children were between 6 weeks and 2 years old when they provided stool samples and between 3 and 19 years old when social traits were assessed.

In this study, researchers compared groups of participants from two different study sites, focusing on their gut microbiomes when they were younger and social traits related to ASD at a later age. Both study sites contributing to this analysis had previously sequenced bacterial DNA from fecal samples collected from infants or toddlers. They calculated how common certain bacteria were in each sample and related that to the participant’s social behavior scores.

Future studies could explore interventions that could change the gut bacteria and potentially influence how the brain develops. Researchers also plan to investigate the influence of the developing gut microbiome on other neurobehavioral outcomes, such as anxiety and depression.

Read the research summary.

ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

Authors: Jiwon Oh, Julie B. Schweitzer, Deborah H. Bennett, 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?

Phthalates are widely used chemicals found in many everyday items such as food packaging, flooring, building materials, medicine coatings, medical supplies, cosmetics, and personal care products. When phthalates enter the body, they are metabolized and converted into various smaller molecules, known as metabolites.

Animal studies suggest that exposure to phthalates during early life may negatively affect the nervous system, but there has been limited investigation into potential associations between early childhood phthalate exposure and attention-deficit/hyperactivity disorder (ADHD) behaviors in later childhood and adolescence.

For this study, ECHO researchers wanted to investigate whether exposure to phthalates in children at ages 2-5 years was associated with ADHD symptoms when these children were ages 8-18 years.

Learn how to say phthalate.

What were the study results?

ECHO Cohort researchers evaluated the levels of several metabolites that result from phthalate exposure. They saw that in children ages 2-5 years, most of these molecules were not associated with ADHD behaviors in these children at ages 8-18 years.

However, among children who had been diagnosed with autism spectrum disorder (ASD), one of these metabolites—mono-2-heptyl phthalate (MHPP)—was associated with more ADHD behaviors. Among typically developing children, a different small molecule—mono-carboxy isooctyl phthalate (MCiOP)—was associated with more hyperactive/impulsive behaviors.

What was this study's impact?

This study suggests that early childhood exposure to certain phthalates may be associated with having both ASD and ADHD traits. Since ADHD behaviors are more commonly found in children with ASD, deepening the understanding of how exposure to environmental chemicals, such as phthalates, could contribute to this comorbidity may be important for managing and treating these conditions effectively.

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

Who was involved?

This study included 243 children living in Northern California and taking part in the ReCHARGE (Revisiting Childhood Autism Risks from Genetics and Environment) study. This study included both neurotypical and neurodiverse children, with about 60% of them having ever had neurodevelopmental concerns. Therefore, the children included in the study tended to have more ADHD behaviors compared with children in the general population.

What happened during the study?

Phthalate metabolites can be measured in biological samples, such as urine, to assess exposure to phthalates. In this study, the researchers measured 15 phthalate metabolites in urine samples of young children ages 2-5 years. Parents answered questions about each child’s ADHD symptoms at ages 8-18 years.

What happens next?

While the metabolite MHPP and the phthalate it’s derived from, di-n-heptyl phthalate (DHPP), are commonly found in children’s urine, their influence on neurodevelopment has not been studied as much as other phthalates. Since exposure to DHPP has been linked to problems with development and behavior in animals, further studies need to look more closely at this compound to understand its effects on how the brain develops in children.

Where can I learn more?

Read the full research article, titled “Early childhood exposures to phthalates in association with attention-deficit/hyperactivity disorder behaviors in middle childhood and adolescence in the ReCHARGE study,” in the journal International Journal of Hygiene and Environmental Health.

Learn more about ECHO’s other chemical exposure research.

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

Published June 2024

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

ECHO Researchers Examine the Effect of Perinatal Synthetic Oxytocin Exposure and Maternal BMI on Child Neurodevelopmental Outcomes

Posted on May 28, 2024May 29, 2024 by Jodi Snare

Collaborative ECHO Cohort research led by Lisa Kurth, PhD of the University of Colorado, Anschutz Medical Campus investigates the potential influence of maternal exposure to synthetic oxytocin during childbirth—and the contribution of maternal obesity—on neurodevelopmental outcomes in children. Synthetic oxytocin (e.g., Pitocin, Syntocinon) is a drug commonly used to assist women during childbirth by stimulating uterine contractions.

The researchers examined data from over 12,000 mother-child pairs to look at possible associations between maternal exposure to synthetic oxytocin, maternal pre-pregnancy body mass index (BMI), and childhood ADHD and Autism Spectrum Disorder (ASD). The results of this study found no significant correlation between synthetic oxytocin exposure and the risk of ADHD and ASD in children. However, an unexpected finding in this study was that synthetic oxytocin exposure was associated with a decreased childhood risk of ADHD in children born to mothers with pre-pregnancy obesity. Additionally, mothers with pre-pregnancy obesity demonstrated a modest trend toward labor intervention with synthetic oxytocin. This research, titled “Intrapartum Exposure to Synthetic Oxytocin, Maternal BMI and Neurodevelopmental Outcomes in Children within the ECHO Consortium,” is published in the Journal of Neurodevelopmental Disorders.

Previous studies on the association between synthetic oxytocin and children’s risk of ADHD and ASD have been decidedly mixed, and the potential impact of the mother’s pre-pregnancy BMI on this association has, until now, not yet been examined. This study analyzed data from participating mothers, 48% of whom were exposed to synthetic oxytocin during childbirth, and their children from ECHO Cohort research sites across the U.S.

Although no significant correlation was found between synthetic oxytocin-assisted childbirth and neurodevelopmental outcomes in children, future research may further unravel the effects of childbirth factors such as synthetic oxytocin dosage, maternal labor duration, maternal gestational obesity and Caesarean delivery rationale, indicators of newborn health (e.g., initial Apgar score, meconium stain, newborn birthweight), and maternal BMI at time of delivery on infant well-being in relationship to child neurodevelopmental outcomes. Important next steps include analysis of biospecimens (placental tissue and cord blood) aimed at understanding the specific mechanism(s) of action involved in synthetic oxytocin exposure.

“Casting a wider net and including additional factors will allow future studies to more precisely examine the effects of important perinatal factors, including environmental exposures, and effect modifiers, such as maternal obesity, on child neurodevelopmental outcomes,” said Dr. Kurth.

Read the research summary.

No Significant Correlation Found Between Labor-inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

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No Significant Correlation Found Between Labor-Inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

Synthetic oxytocin was associated with lower ADHD risk among children born to mothers with pre-pregnancy obesity. Mothers with pre-pregnancy obesity were more inclined to receive labor-inducing medication.

Authors: Lisa Kurth, PhD, et al.

Who sponsored this study?

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

Why was this study needed?

More than 50% of U.S. childbirths are assisted with synthetic oxytocin (sOT)—known by trade names such as Pitocin or Syntocinon—a drug that promotes labor by stimulating the muscles in the uterus to contract. As rates of child ADHD and autism spectrum disorder (ASD) diagnoses are steadily rising, researchers have attempted to identify risk factors that might be contributing to these increases. There have been conflicting results from previous studies investigating the link between sOT exposure and childhood risk of ADHD and ASD. Additionally, the potential effect of the mother’s pre-pregnancy body mass index (BMI) on this association has not yet been studied.

What were the study results?

Analysis of data from a large and diverse ECHO Cohort sample suggests that maternal exposure to sOT during childbirth was not associated with an increased risk for ADHD or ASD in offspring. Associations did not differ by sex. Unexpectedly, sOT was associated with lower ADHD risk among children born to mothers with pre-pregnancy obesity.

The study also found that 48% of laboring mothers received sOT. Researchers saw slightly higher usage of sOT in mothers with pre-pregnancy obesity.

What was this study's impact?

The findings raise questions about how these drugs might affect health outcomes, especially when combined with maternal obesity during pregnancy. Additionally, the findings indicate that maternal obesity may influence the need for interventions during childbirth. These results do not currently support a need to modify the clinical use of sOT during childbirth.

What happened during the study?

A team of researchers used statistical analysis to examine the association between sOT exposure during labor and child ADHD or ASD diagnosis. Investigators also evaluated whether maternal pre-pregnancy BMI and child sex affected this correlation.

Note: 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.

Who was involved?

This study included over 12,000 mother-child pairs from 44 ECHO Cohort research sites across the U.S. Of the mothers participating in this study, 48% were exposed to sOT during childbirth.

What happens next?

More research is needed to evaluate if the dosage and duration of sOT has any influence on children's neurodevelopment. Future studies may clarify how environmental exposures and other contributing factors, such as delivery method and maternal obesity at delivery, influence a child’s neurodevelopment. Examining maternal/fetal biospecimens could also reveal how this exposure affects mothers and babies.

Where can I learn more?

Access the full journal article, titled “Intrapartum Exposure to Synthetic Oxytocin, Maternal BMI, and Neurodevelopmental Outcomes in Children within the ECHO Consortium” in the Journal of Neurodevelopmental Disorders.

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

Published May 26, 2024

Read the associated article.

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No Significant Correlation Found Between Labor-Inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

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No Significant Correlation Found Between Labor-Inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

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