Prenatal Exposure to Phenols and Parabens Higher Among Minority Populations, ECHO Study Finds

Authors: Michael S. Bloom, Adaeze Wosu Nzegwu, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, National Institutes of Health supported this research.

Why was this study needed?

Exposure to endocrine-disrupting chemicals (EDCs), such as environmental phenols (EPs) and parabens, is common during pregnancy through everyday products like plastics, food packaging, and personal care items. These chemicals can cross the placenta and, despite their short breakdown time in the body, EPs are often detected in human tissue. Prenatal exposure has been linked to risks such as pregnancy complications, developmental issues, and long-term health problems, particularly in underserved populations. Low-income and minority communities may face higher exposure to chemicals like EPs due to closer proximity to factories and waste facilities, as well as limited access to a broader range of consumer products and fresh foods. This study investigated racial and ethnic differences in prenatal exposure to EPs and parabens across the U.S., addressing the limitations of earlier, smaller studies that did not fully explore these differences among pregnant women.

What were the study results?

Urinary levels of most EPs examined varied significantly by race and ethnicity, with non-Hispanic Black and Hispanic participants having higher levels of certain EPs than non-Hispanic White participants. Specifically, non-Hispanic Black and Hispanic participants had higher average levels of a chemical that comes from paradichlorobenzene in their urine compared to non-Hispanic White participants. Paradichlorobenzene is found in mothballs, fumigants, and air fresheners, and it is mainly inhaled. Non-Hispanic Black participants also had higher levels of specific parabens, which are preservatives used in processed foods and personal care products. These chemicals can be absorbed through eating or using such products.

What was this study's impact?

The study highlighted the disproportionately high levels of exposure to EPs among pregnant racial and ethnic minorities in the U.S.

Who was involved?

The study included 4,006 pregnant participants from 11 ECHO Cohort Study Sites across the U.S., representing various racial/ethnic identities, including Hispanic, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White individuals.

What happened during the study?

The study analyzed 7,854 urine specimens collected during pregnancy. Researchers measured the levels of 10 different urinary EPs.

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?

Further studies could examine the sources of these exposure differences.

Where can I learn more?

Access the full journal article, titled “Racial and ethnic differences in prenatal exposure to environmental phenols and parabens in the ECHO Cohort,” in the Journal of Exposure Science and Environmental Epidemiology.

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

Published February 15, 2025

Access the associated press release.

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Prenatal Exposure to Phenols and Parabens Higher Among Minority Populations, ECHO Study Finds

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.

###

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.

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.

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Follow @ECHOChildHealth for the latest ECHO Program updates on X (formerly known as Twitter).

New ECHO Research Investigates Relationship Between Phthalate Exposure and High Blood Pressure, Related Complications During Pregnancy

Posted on June 5, 2024July 2, 2024 by Jodi Snare

Collaborative ECHO research led by John Meeker, ScD of the University of Michigan, and Jordan Kuiper, PhD of George Washington University, investigates the relationship between phthalate exposure and high blood pressure during pregnancy. This research, titled “Urinary concentrations of phthalate metabolites in relation to preeclampsia and other hypertensive disorders of pregnancy in the Environmental influences on Child Health Outcomes (ECHO) program,” is published in Environment International.

This study aimed to evaluate whether phthalate exposures could be linked to ongoing high blood pressure during pregnancy and more severe pregnancy complications like preeclampsia or eclampsia.

“The findings of this study suggest that exposure to certain phthalates found in plastics and other consumer products may be associated with pregnancy complications such as gestational hypertension or preeclampsia,” said Meeker.

Researchers evaluated data from 3,430 participants from eight ECHO sites across the U.S., which enrolled pregnant participants from 1999 to 2019. In the study, researchers measured the levels of 13 metabolites linked to phthalate exposure in urine samples collected at least once during pregnancy. They then evaluated the association between individual phthalates, as well as the combined mixture of phthalates, with the risk of developing preeclampsia, eclampsia, or ongoing high blood pressure during pregnancy.

The researchers measured phthalate exposure by checking urine levels of certain small molecules, called metabolites, that the body makes when it breaks down chemicals. They found that higher levels of these metabolites were linked to a higher risk of pregnancy complications like preeclampsia, eclampsia, and ongoing high blood pressure. For example, if the level of a metabolite called mono (3-carboxypropyl) phthalate (MCPP) doubled, the risk of developing preeclampsia or eclampsia increased by 12%. MCPP is related to phthalates found in PVC plastics and insect repellents.

The researchers also examined combined phthalate exposure by dividing participants into four groups based on their exposure levels. Each increase in exposure level was linked to a 27% higher risk of preeclampsia or eclampsia, which was generally higher for pregnant women carrying female fetuses.

Future studies can help researchers understand how exposure to phthalates might be linked to high blood pressure during pregnancy, how this happens in the body, and what we can do to reduce the risk of these pregnancy complications.

Read the research summary.

ECHO Cohort Study Finds Association Between PFAS and Bioactive Lipids

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ECHO Cohort Study Finds Association Between PFAS and Bioactive Lipids

Authors: Himal Suthar, Max Aung, 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?

Per- and polyfluoroalkyl substances (PFAS) are a large, complex group of synthetic chemicals that have been used in consumer products around the world since about the 1950s. They are ingredients in various everyday products. For example, PFAS are used to keep food from sticking to packaging or cookware, make clothes and carpets resistant to stains, and create firefighting foam that is more effective. People are most likely exposed to these chemicals by consuming PFAS-contaminated water or food, using products made with PFAS, or breathing air containing PFAS.

Because PFAS break down slowly, if at all, people and animals are repeatedly exposed to them, and blood levels of some PFAS can build up over time. Scientific studies have identified multiple health effects associated with PFAS exposure.[1] Women exposed to PFAS during pregnancy are at increased risk for adverse birth outcomes and pregnancy complications.

Lipids are fatty molecules that perform a variety of functions in the body—from forming the membranes of cells to serving as a building block for certain hormones. Changes in bioactive lipids—broadly defined as a category of lipids with signaling properties that cause biological effects and changes in the body—have been linked to PFAS exposure and adverse pregnancy outcomes. This study aimed to compare the concentration of PFAS in the blood of pregnant participants with levels of bioactive lipids in three important metabolic pathways.

[1] National Institute of Environmental Health Sciences: Perfluoroalkyl and Polyfluoroalkyl Substances (PFAS) (nih.gov)

What were the study results?

The research team analyzed the associations between 12 types of PFAS, in pairs and as mixtures, and 50 bioactive lipids in blood plasma in pregnant participants across three ECHO Cohort Study Sites. When researchers looked at data from different study sites, they found that higher levels of PFAS in blood were often linked with higher levels of certain bioactive lipids. The research team also noticed differences in the distribution of bioactive lipid compounds between individual study sites, possibly driven by variations in the genetic makeup and sociodemographic characteristics of the populations or differences in environmental exposures due to diet.

Footnote: Results reported here are for a single study and reflect an observed correlation. 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 this study's impact?

The similarity of results researchers found from the analysis of mixtures of PFAS chemicals and individual PFAS chemicals indicate that specific bioactive lipids could be useful biomarkers of PFAS exposure. Biomarkers are biological indicators of a particular health effect or status – in this case, PFAS exposure. They can be found in blood, urine, or other body fluids and can be substances, characteristics, genes, or proteins. This insight could help in understanding and addressing the health effects of PFAS by expanding screening methods.

The bioactive lipids measured in this study have not yet been tested as routine biomarkers in clinical settings. However, these findings aid in advancing the future of healthcare as additional and more complex lipid biomarkers become measurable and are tested for clinical use.

These findings encourage researchers to prioritize the study of PFAS and bioactive lipids pairs in future testing in addition to individually studying the effect of different types of PFAS. Additionally, this study highlights the importance of regulating the 12 types of PFAS observed.

Who was involved?

This study included 414 pregnant participants from three ECHO Cohort study sites: Chemicals in Our Bodies based in San Francisco, ECHO-PROTECT based in Puerto Rico, and Illinois Kids Development Study based in Chicago.

What happened during the study?

The research team estimated associations between prenatal PFAS exposure and bioactive lipids, measuring the levels of 12 types of PFAS and 50 bioactive lipids in 414 pregnant participants. Researchers quantified associations by using various statistical analyses while controlling for several factors (e.g., maternal age, gestational age at sample collection, maternal education, pre-pregnancy BMI).

What happens next?

The researchers plan to measure associations between bioactive lipids and peri- and prenatal mental health outcomes including perinatal and postpartum depression. Future studies could also look at the influence of other variables on this relationship. For example, researchers could investigate the influence of diet, which has been linked to changes in both PFAS and bioactive lipid concentrations.

Where can I learn more?

Access the full journal article, titled “Cross-Sectional Associations between Prenatal Per- and Poly-Fluoroalkyl Substances and Bioactive Lipids in Three Environmental Influences on Child Health Outcomes (ECHO) Cohorts,” in Environmental Science and Technology.

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

Published May 14, 2024

Read the associated article.

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ECHO Cohort Study Finds Association Between PFAS and Bioactive Lipids

ECHO Study Investigates Relationship Between Phthalate Exposure and High Blood Pressure, Related Complications During Pregnancy

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ECHO Study Investigates Relationship Between Phthalate Exposure and High Blood Pressure, Related Complications During Pregnancy

Authors: John Meeker, Jordan Kuiper, 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?

High blood pressure during pregnancy, which can develop into the more serious conditions of preeclampsia* or eclampsia*, can pose significant health risks to pregnant women and their children. Potential environmental risk factors for ongoing high blood pressure during pregnancy and more severe pregnancy complications like preeclampsia or eclampsia have not been well-studied. Phthalates are chemicals used in various products, including plastics, personal care products, and food packaging. There is evidence, though limited, that exposure to some phthalates may be associated with preeclampsia and ongoing high blood pressure during pregnancy.

*Preeclampsia and eclampsia are pregnancy-related high blood pressure disorders. In preeclampsia, the mother’s high blood pressure reduces the blood supply to the fetus, which may get less oxygen and fewer nutrients. Eclampsia is when pregnant women with preeclampsia develop seizures or coma.

Link to source

What were the study results?

The researchers evaluated phthalate exposure by measuring urine levels of certain metabolites, which are small molecules the body makes when it breaks down foods, drugs, chemicals, or its own tissues (for example, fat or muscle tissue). This study found that higher levels of these metabolites were associated with a higher risk of developing preeclampsia, eclampsia, and/or ongoing high blood pressure during pregnancy. For example, a doubling of mono (3-carboxypropyl) phthalate (MCPP)—a metabolite linked to phthalates found in PVC-based plastics and insect repellents—was associated with 12% increased risk of developing preeclampsia or eclampsia.

For combined exposures, researchers divided participants into four groups, or quartiles, by increasing level of exposure. A quartile increase in the combined phthalate mixture was associated with a 27% increased risk of preeclampsia or eclampsia. This effect was generally larger among pregnant participants carrying female fetuses.

What was this study's impact?

The findings of this study suggest that exposure to certain phthalates found in plastics and other consumer products may be associated with pregnancy complications like gestational hypertension or preeclampsia.

Who was involved?

The study included data from 3,430 participants from eight ECHO sites across the U.S. which enrolled pregnant participants from 1999 to 2019.

What happened during the study?

The researchers measured the levels of 13 metabolites linked to phthalate exposure in urine samples collected at least once during pregnancy. They then evaluated the association between individual phthalates, as well as the combined mixture of phthalates, with the risk of developing preeclampsia, eclampsia, or ongoing high blood pressure during pregnancy.

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.

What happens next?

Additional well-designed studies are needed to better understand the association between phthalate exposure and high blood pressure during pregnancy, the underlying biological mechanisms, and effective interventions that could reduce the risk of these kinds of pregnancy complications.

Where can I learn more?

Access the full journal article, titled “Urinary concentrations of phthalate metabolites in relation to preeclampsia and other hypertensive disorders of pregnancy in the Environmental influences on Child Health Outcomes (ECHO) program,” in Environment International.

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

Published May, 2024

Access the associated article.

Download this summary

ECHO Study Investigates Relationship Between Phthalate Exposure and High Blood Pressure, Related Complications During Pregnancy

Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal: A Post Hoc Subgroup Analysis of the ESC-NOW Randomized Clinical Trial

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Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal: A Post Hoc Subgroup Analysis of the ESC-NOW Randomized Clinical Trial

Author(s): Lori A. Devlin, Zhuopei Hu, Stephanie L. Merhar, et al.

Why was this study conducted?

This secondary analysis of infants enrolled in the Eating, Sleeping and Consoling for Neonatal Opioid Withdrawal (ESC-NOW) trial, which was conducted at 26 hospitals across the U.S., focused specifically on infants who received opioid treatment for NOWS after birth. The analysis was conducted to identify whether the ESC care approach decreased total postnatal opioid exposure when compared to sites’ usual care practices, which included the use of the Finnegan Neonatal Abstinence Scoring Tool (FNAST).

What was done?

The authors analyzed data from 463 infants who were enrolled in the ESC-NOW trial. All infants were born at 36 weeks’ gestation or later and received pharmacologic treatment for NOWS after birth. Three hundred and twenty infants were assessed and managed for NOWS with usual care, and 143 infants were assessed and managed with the ESC care approach.

What was found?

In this subgroup analysis, the authors found that total postnatal opioid exposure was substantially less for infants who were assessed and managed with the ESC care approach when compared to usual care.

The absolute mean difference in total opioid exposure was 4.1 morphine milligram equivalents (MME)/kilogram (kg) less for infants in the ESC group when compared to the usual care group (4.8 vs. 8.9 MME/kg respectively). Infants in the ESC group also received an average of 48.7 fewer opioid doses than those in the usual care group (67.5 vs. 116.1 doses respectively). In addition, the mean length of opioid treatment was 6.3 days less in the ESC group than in the usual care group (11.8 vs. 18.1 days respectively), and the mean length of hospital stay was 6.2 days less in the ESC group than in the usual care group.

The authors also found that the mean time from birth to the initiation of pharmacologic care was 22.4 hours longer in the ESC group than in the usual care group (75.4 vs. 53.0 hours respectively), but there was no difference in the mean peak opioid dose between groups.

What do the results mean?

Infants who were assessed and managed with the ESC care approach received less opioid medication for the treatment of NOWS after birth when compared to those who were assessed and managed with usual care, including the FNAST.
Infants assessed and managed with the ESC care approach also had fewer days of opioid treatment and a shorter length of hospital stay when compared to usual care.
The time from birth to the initiation of opioid treatment was longer in infants who were assessed and managed with the ESC care approach, but there was no difference in the peak dose of opioid medication, which suggests that the ESC care approach aptly assesses and supports acute opioid withdrawal.

Who sponsored this study?

This clinical trial is a collaboration between the NIH Environmental influences on Child Health Outcomes (ECHO) Program and the NIH’s Eunice Kennedy Shriver Institute of Child Health and Human Development (NICHD), funded through the NIH Helping to End Addiction Long-term® Initiative (HEAL).

Where can I learn more?

Access the full journal article, titled “Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal: A Post Hoc Subgroup Analysis of the ESC-NOW Randomized Clinical Trial,” in JAMA Pediatrics.

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

Download this summary

Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal: A Post Hoc Subgroup Analysis of the ESC-NOW Randomized Clinical Trial

Read Related Research Summaries

“Eat, Sleep, Console” approach shown to be more effective in caring for newborns with neonatal opioid withdrawal syndrome

Authors: Leslie Young, Lori Devlin, Stephanie Merhar, et al.

How does prenatal opioid exposure affect child outcomes?

Author(s): Elisabeth Conradt, Sheila Crowell and Barry Lester

Understanding characteristics associated with opioid use during pregnancy

Authors: Ruby H.N. Nguyen, Monica McGrath, et al.

Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Author(s): Stephanie Merhar, Songthip Ounpraseuth, Lori Devlin, et al.

Site-Level Variation in the Characteristics and Care of Infants with Neonatal Opioid Withdrawal

Author(s): Leslie Young, Zhuopei Hu, Robert Annett, et al.

The ACT NOW Clinical Practice Survey: Gaps in the Care of Infants With Neonatal Opioid Withdrawal Syndrome

Author(s): Jessica Snowden, Akshatha, Robert Annett, et al.

Pre, Peri, and Postnatal

Pregnancy and birth

ECHO researchers use data from more than 64,000 diverse children and their families across the U.S. to investigate the pre-, peri-, and postnatal periods. In addition, the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) conducts clinical trials focused on pre-, peri-, and postnatal health, among other areas of health.

ECHO Discovery
Webinar Recordings

Microbiomes of Pregnancy and Infancy: Implications for Child Health Outcomes

Fish Consumption during Pregnancy and Impacts on Child Health

Pregnancy and
Birth Resources

CDC: Pregnancy
Contains facts and information on staying healthy during pregnancy.

MedlinePlus: Premature Babies
Provides information, links, and resources to help understand premature babies and the health issues that they may face. Shares tips and support for parents of premature babies.

QUESTIONS

For more information, please email the NIH at NIHKidsandEnvironment@od.nih.gov.
For media inquiries or to request an interview, contact Rebekah Yeager at rebekah.yeager@nih.gov.

How ECHO Advances Pre-, Peri-, and Postnatal Health

The ECHO Program investigates factors that can influence child health outcomes before, during, and just after birth. These factors include environmental exposures during pregnancy, a pregnant woman's physical and mental health, and whether there are pregnancy complications such as gestational diabetes or preeclampsia. The program also looks at how exposure to opioids can affect child health outcomes.

Many factors before, during, and just after birth can influence child health outcomes. These factors can affect birth outcomes such as preterm birth or being born small for gestational age. They can also affect outcomes later in childhood, like how well they breathe, how much they weigh, how their brain develops, and how healthy they are overall. In addition, studying the pre-, peri-, and postnatal periods can give researchers insight into factors that affect the health of mothers and babies and contribute to health disparities.

What We're Learning

Since its launch, the ECHO Program has published more than 2,000 research articles on a wide range of child health topics. Within this body of work, many studies have examined the pre-, peri-, and postnatal periods.

Here are some research highlights:

Wildfire Smoke Exposure May Be Linked to Higher Risk of Preterm Birth, ECHO Study Finds
November 2025
Higher than average wildfire smoke exposure during pregnancy was linked to a slight increase in risk for preterm birth.

PFAS Exposure Associated with Changes in Gut Microbiome During Pregnancy
August 2025
Mothers with prenatal PFAS exposure did not show changes in overall gut microbiome diversity, but had higher or lower levels of certain gut bacteria.

Prenatal Vitamin D Levels Associated with Children’s Brain Development, ECHO Study Suggests
August 2025
Children whose mothers had higher vitamin D levels early in pregnancy tended to score better on problem-solving and learning new information at ages 7–12.

Adverse Birth Outcomes May be Associated with Arsenic Levels in Public Drinking Water
June 2025
Babies born to mothers potentially exposed to low levels of arsenic in public drinking water—even at levels below the federal safety standard—were more likely to be born preterm, with lower birthweight, or be smaller than expected.

Obesity, Diabetes, & High Blood Pressure Before and During Pregnancy are Associated with Higher Blood Pressure in Children
May 2025
Children born to mothers with cardiometabolic health issues before or during pregnancy may face a higher risk of elevated blood pressure in childhood and adolescence.

Neighborhood-Level Poverty and Food Insecurity During Pregnancy Associated With Lower Birthweight and Small for Gestational Age Infants, NIH Study Finds

Posted on March 22, 2024August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Living in neighborhoods where residents have lower incomes and limited food access during pregnancy was associated with an increased risk of babies born small for gestational age or with lower birthweight, according to a new study from the NIH Environmental Influences on Child Health Outcomes (ECHO) Program.

Previous studies have shown that maternal diet during pregnancy can impact the physical and mental health of a mother. However, less is known about how food insecurity affects health outcomes for newborns. In a new research article, ECHO researchers analyzed data to understand what connections might exist between where a pregnant woman lives, their access to food, and birth outcomes.

This ECHO analysis, recently published in the American Journal of Clinical Nutrition, indicates a possible connection.

“Given the long-term effects of adverse birth outcomes on later cardiovascular disease risk and other conditions, more research is needed to evaluate whether interventions and policies that improve food access during pregnancy would be effective in improving birth outcomes and promoting child health,” said Izzuddin M. Aris, PhD, of the Harvard Pilgrim Health Care Institute.

Using nationwide data from more than 22,000 ECHO Cohort participants, a team of ECHO researchers found that, during pregnancy, 24% of those participants lived in a low-income neighborhood where a third or more residents lived over one mile from a grocery store (or more than 10 miles in rural areas). They also found that about 14% of the participants lived in neighborhoods with high poverty rates and where more than 100 households had no access to a vehicle and lived more than half a mile from the nearest grocery store.

Residence in low-income, low-food-access and low-income, low-vehicle-access neighborhoods was associated with lower birth weight, higher odds of babies born small for gestational age, and lower odds of babies born large for gestational age. However, researchers did not find any associations of individual food insecurity with birth outcomes.

To conduct this study, researchers matched pregnant individuals' home addresses with information about nearby food availability from the U.S. Food Access Research Atlas, which provided data on household income, the availability of a household vehicle, and where people can access food in different neighborhoods.

“In future studies, we want to look at health habits and chemical exposures to understand what else could be affecting birth outcomes,” said Dr. Aris.

Dr. Aris led a team of ECHO Cohort researchers from across the country who collaborated on the data analysis and writing for this research article.

###

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.

Read the research summary.

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 (formerly known as Twitter).

ECHO Researchers Examine Fish Consumption and Supplement Use Among Pregnant Women

Posted on March 21, 2024April 1, 2025 by Jodi Snare

Collaborative ECHO research led by Emily Oken, MD, MPH of Harvard Medical School and the Harvard Pilgrim Health Care Institute, and Kristen Lyall, ScD of Drexel University, investigates fish consumption and the use of omega-3 supplements among pregnant women.

This research, titled “Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO program,” is published in Public Health Nutrition.

Omega-3 fatty acids, also known as n-3 fatty acids, are essential nutrients during pregnancy for supporting child health and neurodevelopment and may also improve other pregnancy outcomes. Fish intake is the primary source of these nutrients in the diet. Prior research on who eats fish and uses supplements during pregnancy has been limited, involving fewer participants and older data that may not represent current consumption.

This study included 10,800 pregnant participants enrolled by 23 ECHO Cohort study sites that collected information on fish consumption, and 12,646 participants at 35 sites that collected information on omega-3 supplement use. While the ECHO Program began 2016, some study sites had been collecting participant data for many years before. In this study, information on fish consumption and omega-3 supplement use was collected from pregnant participants from 1999 to 2020.

After collecting this information, the researchers sorted participant data based on how often they ate fish: never or less than once per month, once per month to less than once per week, one to two times per week, or more than twice per week. They then compared participant fish consumption and supplement use across various demographic and lifestyle factors, including age, race, ethnicity, education, weight, and smoking status.

The research team observed that about 25% of pregnant participants did not eat any fish or ate fish less than once per month, but older participants were more likely to eat fish. Participants who were non-Hispanic Black, non-Hispanic Asian, or Hispanic ate less fish on average than those who identified as non-Hispanic White. Participants categorized as overweight were also less likely to eat fish.

Omega-3 supplement use was also rare—with only 1 in 6 study participants reporting taking omega-3 supplements. Supplement use was more common in participants who were older and had more education, a lower body mass index (BMI), and a diet that included fish.

“This study observed that one-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and omega-3 supplement use was uncommon, even among those who did not consume fish,” Dr. Oken said.

Experts recommend that people need additional omega-3 fatty acids during pregnancy. Ongoing effective public health advice and resources to support clinicians are needed to encourage consumption of low-mercury fish during pregnancy and intake of omega-3 supplements among those who do not consume fish.

Read the research summary.

Study Finds Link Between Phthalate Exposure During Pregnancy and Development of Multiple Health Outcomes in Children

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Study Finds Link Between Phthalate Exposure During Pregnancy and Development of Multiple Health Outcomes in Children

Authors: Drew Day, Kaja Z. LeWinn, 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?

Chronic health conditions, such as asthma and obesity, can develop together during childhood but are usually studied separately. ECHO researchers used new machine learning tools to explore patterns of health outcomes in children and then looked at how common exposures are associated with multiple health conditions.

The goal of this study was to use data from ECHO Cohort research sites across six U.S. cities to characterize “clusters,” or patterns of obesity-related, lung health, and brain development outcomes in children and to investigate how these patterns relate to mothers’ exposures to chemicals called phthalates during pregnancy. Phthalates are chemicals widely used in plastics, and maternal exposure to certain phthalates have been linked to preterm birth.

What were the study results?

The researchers identified three groups of children with a pattern of health outcomes that occurred together:

A group of relatively healthy children;
A group of children with lower IQ, elevated obesity,
and slightly elevated asthma-related outcomes such as asthma, wheezing, and allergies; and
Another group of children with high asthma-related outcomes along with elevated obesity and some increase in anxiety- and depression-related outcomes.

Compared to children in the healthy group, other groups had more male children, mothers with higher BMI and lower education attainment, and lower household incomes. The researchers found that children—particularly boys—were more likely to be in the third group if their mothers were exposed to phthalates during pregnancy.

What was this study's impact?

These findings suggest that exposure to phthalates during pregnancy might be associated with an increased risk of developing not only asthma and related lung outcomes, but also obesity and mental health issues such as anxiety and depression. This study also suggests that low-income households are at higher risk for worse childhood health outcomes.

The three patterns of health outcomes seen in this study also reveal more about how pediatric diseases might arise together, which could help inform future research on what biological processes contribute to those health outcome patterns as well as better treatments and interventions to enhance child health.

Who was involved?

Researchers looked at health outcomes in 1,092 children across six U.S. cities. Researchers were able to collect measurements of phthalate exposure during pregnancy from 856 of these children’s mothers.

What happened during the study?

The researchers measured 15 health outcomes in children between the ages of 4 and 9 years—including body mass index (BMI), IQ, anxiety, depression, irritability, learning disabilities, speech problems, asthma, wheeze, and nasal allergies. The researchers evaluated how children developed multiple outcomes and investigated how the probability of being in a particular group was affected by exposure to 15 plastic-associated phthalate chemicals during pregnancy. The researchers measured phthalate exposure during pregnancy using urine samples collected from 2007–2014 from mothers during late pregnancy.

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.

What happens next?

This study’s multi-outcome approach can be used in future studies to identify public health risks that may affect central biological processes that result in multiple negative health outcomes. ECHO Cohort researchers are working to extend this method to include several additional U.S. research sites, which will allow them to evaluate whether similar patterns are observed in a larger dataset. Larger studies will also help researchers characterize how demographic differences like income and sex may influence the development of multiple health outcomes during childhood.

Where can I learn more?

Find the full research article, titled “Subpopulations of children with multiple chronic health outcomes in relation to chemical exposures in the ECHO-PATHWAYS consortium,” in the journal Environment International.

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

Published March, 2024

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Study Finds Link Between Phthalate Exposure During Pregnancy and Development of Multiple Health Outcomes in Children