New ECHO Research Looks into Potential Correlation Between Maternal Stress and Early Childhood Obesity

Collaborative ECHO research led by Callie Brown, MD, MPH of Wake Forest University, and Charles Wood, MD, MPH of Duke University, investigates how maternal stress can affect children’s later body mass index (BMI). This research, titled “Maternal stress and early childhood BMI among US children from the Environmental influences on Child Health Outcomes (ECHO) program,” is published in Pediatric Research.

Obesity affects millions of adults, adolescents, and children in the United States. Many children in the United States enter their school years with obesity, and children with obesity at 3 years of age have a 90% probability of having overweight or obesity as an adolescent.

While existing literature suggests a relationship between parental stress and childhood body mass index (BMI), the exact way in which parental stress might affect BMI in children isn’t fully understood. Researchers looked at 1,694 mother-child pairs across 15 research sites in the United States over time to evaluate how maternal stress might be associated with the child’s BMI.

The study did not find any significant link between maternal stress measured in the first year after childbirth and the child’s BMI. While the study did not find an association between maternal stress levels and childhood obesity, it did reveal other information about both maternal stress and childhood BMI.  Researchers found that higher stress levels were more likely among Hispanic and Black mothers, and less likely among mothers with private health insurance. Furthermore, higher child BMI was more likely among Hispanic mothers, when a mother’s BMI before birth was higher, and when the child’s birth weight was higher.

The study’s results suggest that factors other than a mother’s stress level appear to be stronger predictors of increased childhood BMI.

“Parental stress has been associated with childhood obesity and may affect stress levels and eating, sleep, and physical activity patterns during childhood,” said study author Dr. Wood. “There are many factors in the first year of life that are related to higher weight gain and earlier obesity in children, but our results suggest that the level of a mother’s stress in the first year of life is not a risk factor. This may be because stress during pregnancy, stress later in childhood, and the child’s own stress level are stronger predictors of differences in childhood BMI.”

Future studies may look at additional factors that influence children’s risk for increased BMI such as BMI in later childhood, other periods of stress, parent or caregiver-measured stress measured, or specific types of stress.

Read the research summary.

ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

<< Back to Research Summaries

ECHO Study Suggests No Association Between Maternal Stress in the First Year After Birth and Childhood BMI

Authors: Callie Brown, Charles Wood, 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?

Obesity affects millions of adults, adolescents, and children in the United States. Many children in the United States enter their school years with obesity, and children with obesity at 3 years of age have a 90% probability of having overweight or obesity as an adolescent.

While existing literature suggests a relationship between parental stress and childhood body mass index (BMI), the exact way in which parental stress might affect BMI in children isn’t fully understood. There has been some disagreement in what types of stress and at what time points during childhood stress is related to child BMI. This study allowed researchers to look at a large, diverse sample of mothers and children over time to evaluate how maternal stress might be associated with the child’s BMI.

 

What were the study results?

This study suggests that there is no association between stress of mothers during the first year after birth and the risk of their child having obesity between ages 2 and 4.

While the study did not find an association between maternal stress levels and childhood obesity, it did reveal other information about both maternal stress and childhood BMI.  In this study, the researchers found that higher stress levels were more likely among Hispanic and Black mothers, and less likely among mothers with private health insurance. Higher child BMI was more likely among Hispanic mothers, when the mothers’ BMI before birth was higher, and when the child’s birth weight was higher.

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 this study's impact?

Doctors and researchers are working to identify opportunities to prevent childhood obesity. There are many factors in the first year of life that are related to higher weight gain and earlier obesity in children, but this study’s results suggest that the level of a mother’s stress in the first year of life does not appear to be a risk factor for higher obesity risk in very young children. This may be because other factors are stronger predictors of differences in childhood BMI.

 

Who was involved?

The study included 1,694 mothers and their children from across the United States.

 

What happened during the study?

ECHO researchers analyzed data from single pregnancies where maternal stress was measured in the child’s first year of life and a child’s weight and height were measured between 2 and 4 years of age.

In addition to examining maternal stress levels and childhood BMI, researchers analyzed information including a mother’s BMI before pregnancy, the baby’s birthweight, a mother’s race, ethnicity, and age at the time of the child’s birth, and the type of health insurance they had. They also looked at the number of children a mother had and her education level.

 

What happens next?

Future studies may look into additional factors that can influence children’s risk for increased BMI such as BMI later in childhood, other periods or types of stress, and parent- or caregiver-measured stress.

 

Where can I learn more?

Access the full journal article, titled “Maternal stress and early childhood BMI among US children from the Environmental influences on Child Health Outcomes (ECHO) program,” in Pediatric Research.

 

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

Published July 21, 2023

Access the associated article.

ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

<< Back to Research Summaries

ECHO Study Suggests Limiting Sugar-Sweetened Beverages in Home Key to Reduce Total Consumption by Children

Authors: Matt Kasman, 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?

Health experts agree that sugar-sweetened drink consumption by children in the U.S.  should be reduced but finding effective strategies has been a challenge. Large-scale interventions are costly and have shown limited effects. Computer modeling to explore what drives consumption in specific populations could lead to tailored strategies that yield better results.

 

What were the study results?

Through a computer simulation based on data collected over several years from thousands of real children, researchers found that limiting access to sugary drinks in the home could reduce childhood consumption by as much as 87%. Reducing sugar-sweetened drink availability at school and childcare facilities was also helpful. The amount of the reductions also varied between the groups of children simulated.

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

 

What was the study's impact?

This study highlights the importance of tailoring interventions to reduce sugar-sweetened drink consumption for different populations. Using computer models, researchers may gain more information about populations that can help to identify effective targeted interventions.

 

Who was involved?

This study examined data from children ages 2 to 7 years old in three ECHO research sites across the U.S. These children spent time in different environments as they grew—home, childcare, and school—where they had varying access to sugary beverages.

 

What happened during the study?

Researchers entered data based on children from three ECHO research sites into a computer model to recreate their sugar-sweetened beverage consumption.  Based on the computer model, researchers simulated potential interventions and measured their impact on reducing consumption in different populations. Computer models can be affected by certain factors, including socioeconomic status, BMI, time spent in a specific setting, accessible beverages in the home, and access to a pediatrician.

 

What happens next?

In future studies, researchers plan to include older children and adjust computer models to explore the consumption of other foods and beverages with health implications.

 

Where can I learn more?

Access the full journal article, titled “Childhood Sugar-sweetened Beverage Consumption: An Agent-based Model of Context-specific Reduction Efforts,” in the American Journal of Preventive Medicine.

A summary of a previous study that applied computational modeling to a single ECHO research site can be found here.

 

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

Published July 13, 2023

 

Access the associated article.

NIH Study Links Prenatal Per- and Polyfluoroalkyl Substance Exposure to Higher BMI & Obesity Risk in Children

FOR IMMEDIATE RELEASE

 

Exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy was linked to slightly higher BMIs and an increased risk of obesity in children, according to new research funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

“There is a growing interest in understanding the effects of PFAS exposure on children’s health,” said Joseph Braun, PhD, of Brown University. “Studies like this one can help researchers and policymakers better understand the risks of PFAS to take effective actions to protect vulnerable populations.”

The researchers analyzed the levels of seven different PFAS in blood samples collected from mothers during pregnancy. These so-called “forever chemicals” are long-lasting substances that can be found in many household materials, as well as food and drinking water.

Researchers then calculated each child’s BMI, an approximate measure of body fat. Higher levels of PFAS in mother’s blood were related to slightly higher BMIs and increased risk of obesity were seen equally for male and female children.

The study used data collected over two decades from 1,391 children between the ages of 2 and 5 years and their mothers who were enrolled in eight ECHO research sites in California, Illinois, Massachusetts, Colorado, New Hampshire, Georgia, and New York.

Future studies will examine the associations between maternal PFAS exposure and obesity-related health outcomes in older children.

Dr. Braun and Yun Liu, PhD, ECHO Program investigators at Brown University, led this collaborative research published in Environmental Health Perspectives.

###

About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims 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

echo connectorCheck 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 Twitter.

ECHO Researchers Reveal Link Between PFAS Exposure During Pregnancy and Childhood Obesity Risk

Collaborative ECHO research led by Yun Liu, PhD and Joseph Braun, PhD of Brown University investigates the relationship between maternal exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy and obesity risk among children and adolescents. The research team evaluated maternal PFAS levels during pregnancy and child body mass index (BMI) for 1,391 mother-child pairs across eight ECHO cohorts. The researchers found that higher levels of some PFAS during pregnancy were associated with higher BMIs and an increased risk of obesity in children. This research, titled “Associations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI Z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts,” is published in Environmental Health Perspectives.

This study included women who were pregnant between 1999-2019 in California, Illinois, Massachusetts, Colorado, New Hampshire, Georgia, and New York and their children who were evaluated between the ages of 2 and 5 years old. The researchers analyzed the levels of seven different PFAS in blood samples collected from mothers during pregnancy. They then used the children’s height and weight data to calculate their BMI, an approximate measure of body fat, while accounting for each child’s age and sex, as well as other factors related to PFAS exposure and body fat.

“There is growing interest in understanding the effects of PFAS exposure on children’s health,” said Dr. Braun. “Studies like this one will help researchers and policymakers better understand the risks of PFAS in order to take effective actions to protect vulnerable populations.”

Going forward, future studies will examine the associations between maternal PFAS exposure and obesity-related health outcomes in older children.

Read the research summary.

NIH Study Finds Association Between Gestational Diabetes, Maternal Depression, and Early Childhood Behavior Problems

FOR IMMEDIATE RELEASE

 

Gestational diabetes, prenatal depression, and postpartum depression were each individually associated with higher levels of early childhood behavior problems such as attentional problems, anxiety, and depression in new research funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Previous research has linked gestational diabetes to prenatal and postpartum depression. Researchers wanted to determine how that combination of maternal symptoms affected early childhood behaviors.

“Our findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy could benefit from receiving additional monitoring for behavioral problems during early childhood,” said Lauren Shuffrey, PhD, an ECHO Program investigator at Columbia University.

The researchers also found that gestational diabetes was associated with autism-related behaviors only in children whose mothers reported higher levels of depressive symptoms during and immediately after pregnancy. Gestational diabetes was also associated with child behavioral problems only in male children.

This study included 2,379 children from ECHO research sites in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers who were diagnosed with gestational diabetes.

During this study, ECHO researchers collected information from the participating mothers, including gestational diabetes diagnosis and self-reports of depression symptoms during and after pregnancy. To investigate the effect of these maternal conditions on child behavior, the researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5 years old.

Dr. Shuffrey led this collaborative research published in Child Development.

###

About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims 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

echo connectorCheck 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 Twitter.

ECHO Researchers Investigate Associations Between Gestational Diabetes, Perinatal Maternal Depression, and Early Childhood Behavioral Problems

Collaborative ECHO research led by Lauren C. Shuffrey, PhD of Columbia University investigates the effects of gestational diabetes, a type of diabetes that mothers develop during pregnancy, prenatal depression, and postpartum depression on early childhood behavior. This study found gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each independently linked to higher levels of externalizing and internalizing behavior problems during early childhood. The study also found that gestational diabetes was only associated with autism-related behaviors when children were exposed to higher levels of perinatal maternal depressive symptoms. Finally, maternal gestational diabetes was only associated with child behavioral problems for male children.

This research, titled “Association of Gestational Diabetes Mellitus and Perinatal Maternal Depression with Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” is published in Child Development.

Although previous research has shown associations between gestational diabetes and pre- and postnatal depression in mothers, prior studies have not determined if the combination of these conditions affect child behavioral outcomes.

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of child participants (52%) were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as Mixed Race, and 4% as Asian.

In this study, ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5 years old. The researchers also collected information from the mothers, including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

“Our findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy could benefit from receiving additional monitoring for behavioral problems during early childhood,” said Dr. Shuffrey. “Future research should investigate potential biological mechanisms underlying associations between gestational diabetes, maternal depression, and early childhood behavioral outcomes.”

Read the research summary.

New ECHO Research Investigates Link Between Maternal Health, Newborn Metabolism, and Childhood BMI

Collaborative ECHO research led by Britt Snyder, PhD, and Tina Hartert, MD, MPH, of Vanderbilt University Medical Center, and James Gern, MD, of the University of Wisconsin School of Medicine and Public Health, investigates the links between maternal health characteristics and the concentrations of various metabolites in newborns. In addition to identifying these links, the study also demonstrated that some metabolites were linked to childhood body mass index (BMI) at ages 1–3 years. The researchers collected data from 3,492 infants and their mothers and found that certain maternal health factors such as higher BMI before pregnancy or maternal age at delivery seemed to increase the levels of some key metabolites in newborns. This research, titled “The Associations of Maternal Health Characteristics, Newborn Metabolite Concentrations, and Child Body Mass Index among US Children in the ECHO Program,” is published in Metabolites.

This study expanded on previous research investigating links between a variety of maternal characteristics and metabolite levels in newborns and also explored the link between these metabolites and child growth patterns. The researchers also investigated how maternal factors and related chemical changes in utero could possibly contribute to the link between newborn metabolism and childhood BMI. To address these questions, the researchers collected data on maternal health characteristics from self-reported questionnaires, birth certificates, and medical records. They then collected child BMI from medical records and study visits and used statistical tools to evaluate possible links between maternal health characteristics and newborn metabolism.

“These findings provide additional insights on potential in utero pathways through which maternal health characteristics may affect newborn metabolism and later child growth patterns,” said Dr. Snyder.

Future studies are needed to further explore these pathways and understand the relationship between maternal health characteristics and child health.

Read the Research Summary.

Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

<< Back to Research Summaries

Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Authors: Lauren C. Shuffrey, 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?

Previous research has linked gestational diabetes (a type of diabetes mothers develop during pregnancy) to prenatal and postpartum depression in mothers. However, studies have not examined how the combination of gestational diabetes, prenatal depression, and postpartum depression affect early childhood behavior.

 

What were the study results?

The study found that gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each associated with increased child externalizing (e.g., acting out, aggression, hyperactivity) and internalizing (e.g., anxiety, depression) behavior problems. This study also found that gestational diabetes was associated with increased autism behaviors only among children exposed to above average perinatal maternal depressive symptoms. Finally, the researchers observed gestational diabetes was only associated with child behavioral problems for male children, and not for female children.

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 impact?

These findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy should receive additional monitoring for behavioral problems during early childhood.

 

Who was involved?

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as mixed race, and 4% as Asian.

 

What happened during the study?

ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5. They also collected information from the mothers including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

 

What happens next?

ECHO researchers are currently analyzing blood samples collected during pregnancy to investigate potential inflammatory mechanisms that may influence the associations between gestational diabetes, maternal depression, and early childhood behavior.

 

Where can I learn more?

Access the full journal article titled, “Gestational Diabetes Mellitus, Perinatal Maternal Depression, and Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” in Child Development.

 

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

 

Published May 2, 2023

 

Access the associated article.

Rural Family Satisfaction with Telehealth Delivery of an Intervention for Pediatric Obesity and Associated Family Characteristics

<< Back to Research Summaries

Rural Family Satisfaction with Telehealth Delivery of an Intervention for Pediatric Obesity and Associated Family Characteristics

Author(s): Nguyen L, Phan TL, Falini L, Chang D, Cottrell L, Dawley E, Hockett CW, VanWagoner T, Darden PM, Davis AM

 

Why was this study conducted?

Childhood obesity is a serious health problem in the United States and affects more children from rural areas. Experts recommend treating children with obesity within family-based behavioral groups. However, rural areas often don’t have access to these programs. Telehealth is a way to deliver these programs to rural families, but few studies have looked at family satisfaction with behavioral programs delivered this way or who might benefit most from these visits. This study looked at how parents of children living in rural communities rated their experience with telehealth visits to help their child make healthy lifestyle changes, as well as family characteristics associated with satisfaction.

 

What was done?

A study was conducted with families of children aged 6 to 11 years with overweight or obesity living in rural areas. Half of the children received the telehealth program and a health newsletter, while the other half received only the health newsletter. After the study, parents of children who received the telehealth visits rated the visits in four areas:

  • The telehealth technology experience
  • The comfort and privacy they felt with telehealth
  • The speed and ease of getting care with telehealth
  • Their overall satisfaction with telehealth

 

What was found?

Parents were overall very satisfied with the telehealth visits noting they felt comfortable with the technology and satisfied with the privacy. Parents with lower education and income levels reported the highest levels of satisfaction. Race, ethnic group, and in-home internet access did not affect satisfaction ratings.

 

What do the results mean?

These results show that families from rural areas like telehealth visits and that telehealth might be a good way to increase access to treatment for children with overweight or obesity, especially among disadvantaged communities. There are still barriers to overcome, such as health literacy and access to broadband internet and devices. Larger studies are needed to better understand who might benefit most from telehealth.

 

Who sponsored the study?

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

 

Appreciation:

We sincerely appreciate the clinics, staff, children, and parents who participated in this study. The authors thank the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, National Institutes of Health, for supporting this research.

 

You may learn more about this publication here: https://www.liebertpub.com/doi/10.1089/chi.2022.0210

 

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

 

Published: April 10, 2023