ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

Authors: Katherine Sauder, 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.

What were the study results?

Out of all the prenatal supplements analyzed, the study found one that may potentially give pregnant patients the optimal amounts of the most important nutrients. But, the monthly cost of this supplement can be too high for some people, and it requires pregnant women to take seven pills a day. To ensure that pregnant women have accessible options for prenatal vitamins, the researchers looked for dietary supplements containing close to the needed amounts of nutrients that cost less and required only one to two pills a day.

See the full publication (Appendix A) for a list of the prenatal supplements analyzed during this study and their nutritional contents.

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 can inform pregnant women and their doctors about key nutrients they may be missing in their diet and what prenatal vitamins they can take to get those nutrients. Companies that manufacture prenatal vitamins can also use the results of this study to understand how much of these nutrients should be in the products they make. Importantly, this study highlights the ongoing need for more prenatal vitamin options that are low cost and convenient, while still containing the optimal amounts of key nutrients.

Why was the study needed?

It is important that pregnant women get the right amounts of the nutrients they need for a healthy pregnancy. There are thousands of options for prenatal dietary supplements in the United States, so ECHO researchers conducted this study to help pregnant women and doctors pick the ones that contain optimal doses of key micronutrients to support a healthy pregnancy.

Who was involved?

This study included 2,450 pregnant participants from six ECHO cohorts located across the United States.

What happened during the study?

ECHO researchers first analyzed data about what the participants ate and drank during their pregnancies. Then, they calculated how much vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids the pregnant participants were getting from their diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from a prenatal vitamin to make up what they were missing in their diet.

The researchers compared over 20,000 prenatal vitamins available in the US, focusing on the nutrients that are most important for maternal and infant health: vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids.

What happens next?

In addition to the use of prenatal dietary supplements, pregnant women can adjust their diet to include more of the nutrients they need for a healthy pregnancy. Going forward, more research is needed to identify foods that pregnant women could eat to get enough of these nutrients.

Where can I learn more?

Access the full journal article, titled “Selecting a dietary supplement with appropriate dosing for six key nutrients in pregnancy" in The American Journal of Clinical Nutrition.

Read more information about healthy eating during pregnancy on the American College of Obstetricians and Gynecologists website.

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

Published April 2023

Access the associated article.

Download this summary

ECHO Study Suggests Most Prenatal Vitamins May Not Provide All of the Nutrients Pregnant Women Need

Child Body Mass Index Dropped After Healthy, Hunger-Free Kids Act in Schools

<< Back to Research Summaries

Child Body Mass Index Dropped After Healthy, Hunger-Free Kids Act in Schools

Author(s): Aruna Chandran, Emily Knapp, 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.

What were the study results?

The study showed an overall decrease in BMI in the first few years following the implementation of the HHFKA compared to BMI in the decade prior to the program. Among children ages 12-18 years, who may have more autonomy in purchasing their own lunches or snacks during the school day, BMI decreased from year to year following the start of the HHFKA. This was a reversal of the trends seen during the decade before the program, during which adolescent BMI was increasing each year. This study also supported findings from previous studies that found the HHFKA had a positive effect on the health of children from lower-income families by contributing to an annual decrease in their BMI.

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 National School Lunch Program and School Breakfast Program (NSLP) provides free or low cost meals to over 30 million children annually, providing an estimated 50% of students’ caloric intake each school day. This study found that the HHFKA was associated with decreases in child and adolescent BMI. Increasing BMI trends before the HHFKA was implemented were stopped or even reversed in several populations after the law was implemented, which could critically influence their long-term health. The study also found that the implementation of the HHFKA decreased BMI of children from lower-income families, who are more likely to participate in the NSLP and are at higher risk of obesity. Accessibility to school meals and snacks represents a key opportunity for intervention to combat the childhood obesity epidemic.

Why was this study needed?

Childhood obesity is a serious health concern with long-term consequences for health and quality of life. Nearly 1 in 5 children in America is obese. The 2010 Healthy, Hunger-Free Kids Act (HHFKA) was the first legislation passed in nearly 3 decades aimed at improving the nutritional quality of breakfast, lunch, and snacks sold at schools. Studies have shown that the HHFKA has improved the quality of school meals without affecting cost or program participation, but only a few small studies have explored whether the HHFKA reduced body mass index (BMI) in children over time.

Who was involved?

This study included 14,121 children from the ECHO Program between the ages of 5 and 18 who had at least one height and weight measurement recorded between January 2005 to March 2020.

What happened during the study?

Researchers used height and weight measurements from children across 50 ECHO cohorts to calculate each child’s BMI and adjusted each measurement based on age and sex. They used these data to evaluate yearly BMI trends from before and after the implementation of the Healthy, Hunger Free Kids Act in September 2016.

What happens next?

Future studies are needed to further explore and verify the effect of improving the nutritional quality of school meals on childhood obesity. In addition, policymakers could use data from studies like this to evaluate policies related to improving the nutritional quality of meals provided in schools.

Where can I learn more?

Access the full journal article, titled “Changes in Body Mass Index Among School-Aged Children Following Implementation of the Healthy, Hunger-Free Kids Act,” in JAMA Pediatrics.

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

Published: February 13, 2023

Access the associated article.

Download this summary

Child Body Mass Index Dropped After Healthy, Hunger-Free Kids Act in Schools

ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

<< Back to Research Summaries

ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

Authors: Emily Zimmerman, 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.

What were the study results?

The results from this study suggested that pregnant women who reported eating the most processed food and take-out tended to breastfeed for an average of 16 weeks (4 months), while pregnant women who reported eating the least amount of processed food and take-out breastfed for an average of 41 weeks (10 months).

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 is the first large and diverse cohort study examining the potential link between maternal food quality during pregnancy and breastfeeding duration. The results from this study suggest that pregnant women who eat a lot of processed food or take-out during pregnancy, tend to breastfeed for a shorter period of time.

Why was this study needed?

Breastfeeding promotes positive health outcomes for infants, but few studies have looked at the connection between the quality of mothers’ food during pregnancy and the length of time they breastfed. This study examined the relationship between self-reported food quality and preparation (e.g., organic foods, processed foods, take out) during pregnancy and breastfeeding duration.

Who was involved?

This study included 751 mothers who were at least 18 years old and their infants from 12 ECHO cohorts located across the United States.

What happened during the study?

Mothers reported on their food source and preparation during pregnancy and were placed in one of three groups: high, moderate, or low food source quality. Mothers also reported on their breastfeeding duration. Researchers investigated whether there was a relationship between the mothers’ food quality during pregnancy and the length of time they breastfed.

What happens next?

Future studies are needed to understand the relation between breastfeeding duration and maternal food quality over time. These studies can also provide more specific information on maternal diet, food source, and preparation during pregnancy while considering other important factors, like socioeconomic status, that may affect the types of foods mothers have access too.

Where can I learn more?

Access the full journal article, titled “Association Between Quality of Maternal Prenatal Food Source and Preparation and Breastfeeding Duration in The Environmental influences on Child Health Outcome (ECHO) Program,” 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 21, 2022

Access the associated article.

Download this summary

ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

March is National Nutrition Month

Posted on March 16, 2022June 7, 2023 by Jodi Snare

March is National Nutrition Month. With information from a diverse population of more than 50,000 children followed from birth through adolescence, ECHO researchers are well positioned to investigate how nutrition influences child health across our five outcome areas, including obesity.

This month’s Connector features ECHO research that explores the extent to which treating pregnant women, who cannot quit smoking, with vitamin C can protect lung function for their children. In addition, this issue of the Connector includes ECHO research on the relationship between growth in early childhood and the onset of puberty, as well as facilitators and barriers to clinical trial recruitment in rural settings.

As a reminder, the ECHO Program is back on Twitter. We encourage you to follow the ECHO Twitter account (@ECHOChildHealth) to stay up-to-date on ECHO news and events, including information on recent publications and research.

ECHO Studies Examine Parent-Reported Child Diet Assessments

Posted on March 10, 2022December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Traci Bekelman, PhD, MPH and Dana Dabelea, MD, PhD of the University of Colorado, Anschutz Medical Campus, analyzed parents’ experiences with two parent-reported diet assessments: the Remote Food Photography Method (RFPM)—which involves parents taking pictures of their child’s meals using a smartphone app—and the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24)—which involves parents filling out daily recalls of their child’s meals.

One of their studies, titled “A Qualitative Analysis of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for Assessing Children’s Food Intake Reported by Parent Proxy,” is published in the Journal of the Academy of Nutrition and Dietetics.

This research compared parents’ experience with the RFPM and ASA24. While parents found the RFPM easier to use, they also reported difficulties with missing or forgetting meal photos. Parents appreciated the consolidated workload of the ASA24, but reported that the time commitment was difficult to manage and the food database left out some foods from diverse cuisines.

During the study, researchers collected child diet data from the parents of 40 children aged seven or eight from an ECHO cohort in Colorado and an IDeA States Pediatric Clinical Trials Network site in Louisiana. Parents tracked their child’s diet for three days using either the RFPM or the ASA24 and then for an additional three days using the other method. Afterwards, parents were given surveys on their experience with these tools, and 32 parents participated in focus group discussions.

The insights of parents participating in this study revealed some of the key strengths and weaknesses associated with these tools that may impact participant burden and the accuracy of parent-reported child diet data. “This study has practical implications because researchers have multiple options when selecting a dietary assessment tool,” said Dr. Bekelman, “and must therefore weigh the relative strengths and weaknesses of each method.”

An additional study from this research team compared the accuracy and effectiveness of the RFPM and ASA24 for child dietary assessment by parent-proxy. Caregivers who participated in the study were generally happy with both methods, but each method had drawbacks. The team’s research, titled “A comparison of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for measuring full day dietary intake among school-aged children,” is published in the British Journal of Nutrition.

For this study, the research team recruited participants from the same population in the aforementioned study and asked them to try two ways of measuring what and how much their child ate using the RFPM and ASA24. Participants completed a survey providing information on satisfaction, ease of use, and burdens for each tool.

The team found that most caregivers were happy with both methods. However, some of the main drawbacks that caregivers reported with the ASA24 included challenges using the website and difficulty estimating how much their child ate. On the other hand, the caregivers’ main difficulty with the RFPM was underreporting due to missing photos. These findings will help researchers improve these methods to increase the accuracy of measuring what children eat and reduce participant burden.

Read the research summaries.