Food Insecurity in Early Life, Pregnancy May Be Linked to Higher Chance of Obesity in Children, NIH-Funded Study Finds

Posted on September 16, 2024August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Family in grocery store

The study explores the effects of low-income, low-food-access neighborhoods on children’s obesity over time.

Children who faced food insecurity during early childhood—or whose mothers experienced it during pregnancy—had a higher body mass index (BMI) and more than 50% increased chance of developing obesity or severe obesity in childhood and adolescence, according to a new study funded by the NIH Environmental influences on Child Health Outcomes (ECHO) Program.

While previous research has linked food insecurity to obesity in adults, its impact on children is less clear. ECHO Cohort researchers explored how food insecurity during early life and pregnancy may affect the incidence of obesity in childhood and adolescence.

“Living in neighborhoods with access to healthy foods during these stages may be an important factor in preventing the development of obesity later in childhood and adolescence,” said Izzuddin M. Aris, PhD of the Harvard Pilgrim Health Care Institute. “Our findings support the need for further research on strategies to improve access to healthy food in early life.”

The study looked at data from nearly 30,000 mother-child pairs from 55 ECHO Cohort research sites nationwide. About 23% had mothers who lived in an area with limited access to grocery stores during pregnancy, and around 24% of the children lived in these areas during early childhood. Low-income-low-food-access (LILA) refers to a neighborhood with a third or more residents living more than one-half mile from a grocery store in urban areas or more than 10 miles in rural areas.

Key findings include:

Living in LILA neighborhoods during pregnancy or early childhood was associated with a higher BMI in the child at ages 5 and 15 and a more than 50% higher chance of developing obesity or severe obesity at ages 5, 10, and 15.
The associations became stronger as the children aged and were strongest among those who lived in LILA neighborhoods during early childhood and their mother’s pregnancy.

Researchers used participants' residential addresses from either pregnancy (1994 to 2023) or early childhood (1999 to 2023). They then matched these addresses with food access data from the USDA Food Access Research Atlas, which provides information on household income, vehicle availability, and neighborhood food access.

Data on children's weight and height were collected from birth through adolescence through in-person visits, medical records, and parent or caregiver reports. Researchers analyzed this data alongside the neighborhood information to investigate the relationship between food access and child BMI or obesity.

This collaborative research is published in JAMA Pediatrics.

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Aris, I.M., “Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity in ECHO.” JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2024.3459.

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.

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New ECHO Research Finds Association Between Weight Gain in Preterm Infants and Higher Obesity Risk in Children

Posted on July 24, 2024July 24, 2024 by Jodi Snare

Collaborative ECHO research led by Michael O’Shea, MD, MPH of the University of North Carolina, Chapel Hill, School of Medicine investigates the effects of growth and weight gain during infancy on neurodevelopment and obesity in children born very preterm. This research, titled “Association of Growth During Infancy with Neurodevelopment and Obesity in Children Born Very Preterm: The Environmental influences on Child Health Outcomes Cohort,” is published in the Journal of Pediatrics.

Infants born preterm typically have a period of poor growth in their first few months. After this stretch, they typically exhibit “catch-up” growth defined by an increase in weight z-score—a measure to classify a child’s nutritional status—during childhood and adolescence.

Prior research suggested that a “trade-off” may be associated with catch-up growth, such that individuals with more rapid weight gain during infancy have better neurodevelopmental outcomes than individuals with less weight gain. However, rapid catch-up growth during infancy has also been associated with a higher risk of becoming overweight or obese.

This study involved 1,400 children born before 32 weeks of gestation in hospitals in multiple states in the U.S. between 2002 and 2020. A majority of these children experienced neonatal complications—issues faced during the first 28 days of life—the most common of which was neonatal chronic lung disease. These children were followed for 1 to 4 years, at which point their BMI and neurodevelopmental outcomes were assessed. The data collected allowed for analyses of relationships between weight gain following NICU discharge and neurodevelopmental outcomes and BMI at 1 to 4 years of age.

The study team found that in comparison to infants with low weight gain after birth, infants with very high weight gain after NICU discharge, experienced by 13.6% of participants, had higher body mass index (BMI) scores and a higher risk of obesity at 12-48 months.

The study team also found no evidence that very high weight gain after NICU discharge was associated with better neurodevelopmental outcomes at 12 to 48 months of age. However, infants with very low weight gain after NICU discharge had lower scores on cognitive and language assessments. No significant differences were found between girls and boys.

These results suggest there are possible benefits of close monitoring of post-NICU growth and healthier feeding practices to prevent obesity, which is associated with multiple adverse health outcomes.

“Because this study suggests that very preterm infants who experienced a very high increase in body weight during the first four years after NICU discharge were more likely to have a high BMI with similar neurodevelopmental outcomes, avoiding high weight gain might be beneficial to very preterm infants’ health,” Dr. O’Shea said. “However, as single studies rarely provide sufficient evidence to change clinical practice, this study should not be the sole basis for such changes. If the findings of this ECHO study are replicated in other studies, changes in clinical practice might then be appropriate.”

Future studies are needed to evaluate the relationship between the pace of weight gain during early childhood, long-term developmental outcomes, and changes in children’s BMI. This study focused on weight gain among infants born very preterm after discharge from the NICU. Additional studies are needed to observe the effects of different rates of catch-up growth on infants born closer to term.

Read the research summary.

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.

New ECHO Study Finds No Statistically Significant Associations Between Small Molecules During Pregnancy and Childhood BMI

Posted on February 26, 2024April 11, 2024 by Jodi Snare

Collaborative ECHO research led by Rachel Kelly, PhD and Nicole Prince, PhD, of Brigham and Women’s Hospital and Harvard Medical School, and Donghai Liang, PhD, MPH of Emory University analyzes the relationship between small molecules in a mother’s blood during pregnancy and childhood BMI. This research, titled “Metabolomic Data Presents Challenges for Epidemiological Meta-Analysis: A Case Study of Childhood Body Mass Index from the ECHO Consortium,” is published in Metabolomics.

A child’s body mass index (BMI) can affect their future health. Some researchers are exploring the connection between factors during pregnancy and childhood BMI. Increasingly, researchers use molecular data to analyze the relationship between pregnancy and childhood health outcomes, sometimes combining molecular data from multiple study sites to increase the statistical power of these analyses.

In this study, ECHO researchers combined the results from multiple ECHO Cohort Study Sites to determine whether a relationship existed between small molecules in the mother’s blood during pregnancy and their child’s later BMI. It also aimed to use these data to test a framework for analyzing molecular data across multiple studies.

The study involved mothers in the second and third trimesters of pregnancy and their children from multiple study sites: the Atlanta ECHO Cohort, the New Hampshire Birth Cohort, and the Vitamin D Antenatal Asthma Reduction Trial. Pregnant participants from these sites provided blood samples, which were then used to measure a range of small molecules that provide information on each participant’s health and environment and the biological or genetic factors that could affect their pregnancy. These participants and their children were observed and assessed across pregnancy and the child’s early life. In this analysis, the authors used data from the aforementioned three study sites to evaluate the relationship between molecules measured during pregnancy and BMI at age 2, aiming to identify relationships that were consistent across all three.

The research team found that of all the small molecules tested, 20 showed up in all study sites, and 127 showed up in at least two. The study found that the levels of only six small molecules, primarily related to maternal diet, were associated with child BMI across all sites. However, statistical analysis across these study sites did not identify significant associations between these molecules and child BMI.

This study demonstrates some of the challenges of harmonizing molecular data across diverse study sites and highlights important considerations for researchers trying to conduct similar analyses.

“Differences in how molecular data were collected and measured between the sites in this study made it difficult to draw strong conclusions on the relationship between small molecules during pregnancy and childhood BMI,” Dr. Kelly said. “Future analyses could involve larger, more standardized studies that all use the same methods for sample collection and measurement of molecules present, which would improve the reliability and reproducibility of results.”

Many ECHO Cohort Study Sites are now measuring small molecules in mothers and children with a standardized approach under the ECHO Cohort Data Collection Protocol. ECHO researchers have an opportunity to use these data to power analyses that can explore the relationship between pregnancy health and child health outcomes.

Read the research summary.

New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

Posted on February 2, 2024May 20, 2024 by Jodi Snare

Collaborative ECHO research led by Elena Jansen, PhD of Johns Hopkins School of Medicine, and Kristine Marceau, PhD of the College of Health and Human Sciences at Purdue University reviewed existing literature on what is known about a father’s role in child development, highlighting how a father’s history and personal characteristics can influence their child’s health and well-being. This research, titled “The Role of Fathers in Child Development from Preconception to Postnatal Influences: Opportunities for the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Developmental Psychobiology.

While few studies on parental health and child development include fathers in any substantial way, a growing body of literature emphasizes their vital role—even before birth. This literature review studied existing research on the role of fathers in child development. It evaluated the quality of this research, focusing on three outcome areas of the ECHO Program: obesity, neurodevelopment, and positive health. The review also discussed how the ECHO Program can address gaps in the literature by designing studies that address unanswered questions.

The review first described data collected by the ECHO Cohort and identified critical gaps in the research related to the role of fathers in ECHO’s five key health outcome areas. After understanding the program’s data collection methods, the research team analyzed multiple research papers categorized into three broad stages of child development—preconception, prenatal, and postnatal.

This review focused on which previously studied characteristics or behaviors of fathers have been connected to children’s development. It demonstrated how studying the effect of fathers on child development has revealed additional insights into children’s health outcomes, including reasons for declines in physical or mental health. Compared to the pregnancy and pre-pregnancy stages, this study allowed researchers to better understand a father’s role once a baby is born.

“One unique aspect of this work is describing how fathers can impact the child by first influencing the mother, for example, by helping her follow healthy behaviors, such as cooking or helping to cook healthy meals and eating healthy food himself,” Dr. Jansen said.

This literature review also revealed gaps in the research community’s understanding of the father’s role in child development, highlighting the need to incorporate maternal and paternal reported data on fathers’ characteristics. While many studies offer insights into the role of fathers, often fathers do not provide this information themselves, or existing data do not allow researchers to compare the roles of fathers and mothers.

Additionally, the study team proposed a new conceptual model to guide future inquiry considering paternal influences, and suggest methods researchers can use to help fill in some knowledge gaps.

“Our model can help guide other researchers to focus on the pieces of the puzzle that we currently know very little about,” Dr. Jansen said. “It may help explain how each parent interacts with their child and which influence has a stronger impact or is more prevalent for which parent.”

With more data becoming available from the ECHO Program, information on fathers’ characteristics can be connected to the rich data on family characteristics, mothers’ influences, and child development. Additional data will be gathered to provide further insights and answer remaining questions.

Read the research summary.

ECHO Study Analyzes Relationship Between Molecules During Pregnancy and Childhood BMI

<< Back to Research Summaries

ECHO Study Analyzes Relationship Between Molecules During Pregnancy and Childhood BMI

Authors: Rachel Kelly, Nicole Prince, Donghai Liang, 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?

A child’s body mass index (BMI) can be associated with their future health. Some researchers seek to understand how factors during pregnancy may influence childhood BMI. Increasingly, researchers use molecular data to analyze the relationship between pregnancy and childhood health outcomes. Researchers sometimes combine molecular data from multiple study sites to increase the statistical power of these analyses. This study aimed to evaluate molecular data during pregnancy across multiple study sites while also using these data to test a framework for analyzing molecular data across multiple studies.

What were the study results?

ECHO researchers combined the results from multiple ECHO Cohort Study Sites including mothers and their children to determine whether a relationship existed between small molecules present in the mother’s blood during pregnancy and later childhood BMI. Altogether, 20 molecules showed up in all study sites, and 127 molecules showed up in at least two. The study found that the levels of only six small molecules, primarily related to maternal diet, were associated with BMI across all sites. However, statistical analysis across these study sites did not identify significant associations between these molecules and child BMI.

What was this study's impact?

This study demonstrates some of the challenges that arise when harmonizing molecular data across diverse study sites and highlights important considerations for researchers trying to conduct similar analyses. Ensuring that all of the studies used in an analysis have the same standardized procedures for collecting samples, measuring molecules present in those samples, and collecting related data (e.g., BMI, diet) can improve the reliability and reproducibility of results.

Who was involved?

This study involved mothers and their children from multiple study sites: the Atlanta ECHO Cohort, the New Hampshire Birth Cohort, and the Vitamin D Antenatal Asthma Reduction Trial. The researchers included mothers in the second and third trimesters of pregnancy and measured their children’s BMI at the age of two years.

What happened during the study?

For this study, the authors combined existing results from multiple study sites. Pregnant participants provided blood samples, and researchers used those samples to measure a range of small molecules. These molecules provide information on each participant’s health, environment, and biological/genetic factors that could affect their pregnancy. The researchers continued to follow these participants and their children across pregnancy and early life to assess their ongoing health, height, and weight. Ultimately, in this analysis, the authors used data from these studies to evaluate the relationship between molecules measured during pregnancy and BMI at age two years, aiming to identify relationships that were consistent across all three studies.

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?

Differences in how molecular data were collected and measured between the sites in this study made it difficult to draw strong conclusions on the relationship between small molecules during pregnancy and childhood BMI. Future analyses could involve larger, more standardized studies that all use the same methods for sample collection and measurement. Many ECHO Cohort Study Sites are now measuring small molecules in both mothers and children with a standardized approach under the ECHO Cohort Data Collection Protocol. ECHO researchers have an opportunity to use these data to power analyses that can explore the relationship between pregnancy health and child health outcomes.

Where can I learn more?

Access the full journal article, titled “Metabolomic Data Presents Challenges for Epidemiological Meta-Analysis: A Case Study of Childhood Body Mass Index from the ECHO Consortium,” in Metabolomics.

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

Published January 24, 2024

Access the associated article.

Download this summary

ECHO Study Analyzes Relationship Between Molecules During Pregnancy and Childhood BMI

Early Breastfeeding Linked to Lower Risk of Childhood Obesity, Regardless of Mother’s Weight, NIH Study Finds

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

FOR IMMEDIATE RELEASE

Consistently breastfeeding infants in any amount during their first three months was associated with a lower risk of childhood obesity, regardless of the mother's body mass index (BMI) before pregnancy, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

While previous studies have shown that breastfeeding may protect children against obesity and other chronic conditions, this relationship has not been studied much in women with obesity. ECHO Cohort researchers wanted to explore the possible link between breastfeeding practices in women with obesity and overweight before pregnancy and a child’s BMIz score. Researchers use BMIz scores to compare children’s height and weight to those of their peers, while the more familiar BMI assesses body weight in relation to height.

In this ECHO Cohort study, researchers found that any amount of consistent breastfeeding during an infant’s first three months was associated with lower BMIz scores, calculated later at ages between 2 and 6 years, regardless of the mother’s pre-pregnancy BMI. This protective association appeared stronger for children with mothers who had obesity before pregnancy compared to those categorized as overweight during the same time. (A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or higher is considered obese.)

“Our findings highlight that each additional month of breastfeeding, whether a consistent amount or exclusively, may contribute to a lower weight later in childhood, especially for mothers who had obesity before pregnancy,” said Gayle Shipp, PhD, RDN of Michigan State University.

The study looked at BMI measurements from 8,134 pairs of mothers and kids at 21 study sites in 16 states and Puerto Rico. The researchers calculated BMI and BMIz scores from measurements taken at study visits, medical records, or self-reported data for the mother and child. Additionally, the study examined two breastfeeding situations: whether the mother ever breastfed or whether the mother was exclusively breastfeeding the infant at 3 months old. This continuous breastfeeding measure included the duration of any breastfeeding allowing for formula or other food and the duration of exclusive breastfeeding with no formula feeding or other food.

Exclusive breastfeeding at three months was associated with a lower child BMIz score only among women with a pre-pregnancy BMI in the normal range. Each additional month of any or exclusive breastfeeding correlated with a significantly lower child BMIz, particularly for mothers categorized as overweight (in the case of any breastfeeding) or as having obesity (for any or exclusive breastfeeding) prior to pregnancy.

“Health professionals can use this study’s findings as an opportunity to encourage and promote breastfeeding among all women, especially those who have obesity,” said Shipp.

Dr. Shipp led this collaborative research published in Pediatrics.

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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.