ECHO Study Links Fast Growth During First Five Years of Life With Younger Onset of Puberty in Children

Author: Izzuddin M. Aris, et al.

Who sponsored this study?

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

What were the study results?

In male children, gaining weight or growing faster than their peers in the first five years of life was associated with entering puberty at a younger age. The researchers found similar results in female children, but only among those with faster weight gains during early childhood (two to five years of age). Female children with faster weight gains during infancy (six months to two years of age) and early childhood started their periods earlier and had more advanced pubic hair development.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study has a direct clinical impact. As pediatricians regularly measure weight and height during routine visits and use growth curves to identify abnormal growth predictions, they could closely monitor children who have faster weight and height gains in the first five years of life for earlier onset of puberty. These study results may also inform future studies that aim to develop and/or test interventions to potentially help prevent earlier onset of puberty, such as good nutrition, environmental exposures, physical activity, and other behaviors related to growth during the first five years of life.

Why was this study needed?

Puberty is a key stage during child development. Previous research indicates that children in the United States are entering puberty at younger ages. These children may be in danger of developing certain diseases, such as type 2 diabetes, later in life. A better understanding of how early life factors affect puberty development is important for combating earlier puberty onset.

Who was involved?

This study included almost 7,500 children from 36 birth cohorts. All participating cohorts had documented at least one measure of weight and height in the first five years of the child’s life and at least one measure of puberty development.

What happened during the study?

The researchers used participants’ weight and height data to look at the following signs of puberty: age when the child experienced the most growth due to puberty; age of their first period (in female children only); puberty development score; and pubic hair development. The team then examined how gains in weight, height, and body mass index at different stages between birth and age 5 were related to puberty development, controlling for maternal and child characteristics.

What happens next?

The team planned follow-up studies that will aim to identify the mechanisms behind these initial observations. They also aim to identify the role of puberty in explaining the relationship between early life factors and longer-term chronic diseases, such as type 2 diabetes.

Where can I learn more?

Access the full journal article, titled “Analysis of early life growth and age at pubertal onset in US children” in JAMA Network Open.

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

Published February 4, 2022

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ECHO Study Links Fast Growth During First Five Years of Life With Younger Onset of Puberty in Children

ECHO Researchers Explore How Maternal Stress During Pregnancy Relates to Infant Suck Patterns

Posted on January 3, 2022December 8, 2023 by Jodi Snare

Collaborative ECHO research led by Emily Zimmerman, PhD, CCC-SLP from Northeastern University and Andréa Aguiar, PhD from the University of Illinois at Urbana-Champaign found that a mother’ s level of stress during pregnancy was linked to changes in the way her infant sucked on a pacifier.

Infants’ sucking patterns can be used to measure brain function soon after birth, and this research investigated how maternal stress during pregnancy related to infant suck patterns. Zimmerman, Aguiar, and team found that mothers who felt more stressed late in their pregnancy had infants who sucked on their pacifiers less frequently, but when they did suck on their pacifier, they did so for a longer period of time compared with infants of mothers who felt less stressed in late pregnancy. It is important to note that the mother and infants participating in this study were from two different groups who had different maternal stress levels and infants’ sucking behaviors. These differences in stress and infants’ sucking behaviors could be due to other differences between the two groups in their culture, ethnicity, geographical location, and income, and education levels.

This research, titled “Examining the Association Between Prenatal Maternal Stress and Infant Non-Nutritive Suck,” was published in Pediatric Research.

To collect data, the researchers surveyed mothers from two ECHO cohorts—one from Urbana-Champaign, Illinois and the other from Manati, Puerto Rico—regarding their stress during late pregnancy using the Perceived Stress Scale. The researchers followed up with each mother within 8 weeks after giving birth and tested their baby’s sucking pattern on a pacifier connected to a pressure detector.

This research demonstrates that maternal mood and stress during pregnancy can affect infant behavior and development starting prenatally and through the first months of life. “This finding is important as it may allow for earlier awareness of stress exposure during pregnancy,” said Dr. Zimmerman, “and as a result, earlier treatment for stress-exposed infants.”

The next steps for this research include further investigation of the link between early infant sucking patterns and visual memory, attention, and speed processing in infants.

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

Author(s): Emily Zimmerman, Andréa Aguiar, et al.

Who sponsored this study?

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

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

What were the study results?

The researchers found that higher maternal stress during late pregnancy was associated with fewer but longer sucking bursts when the infants sucked on the special pacifier. It is important to note that the maternal stress levels and infants’ sucking behaviors between the two cohorts were different. This could be due to differences between the two cohorts’ cultures, geographical locations, ethnicities, incomes, and education levels.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This is the first study investigating the link between maternal stress and infants’ sucking patterns. The results of this study may help promote awareness and earlier detection of stress exposure during pregnancy and, as a result, improve the treatment of stress-exposed infants. This study also researched these outcomes in two groups of participants with different demographics and stress levels, which may allow for earlier detection of high maternal stress exposure in lower SES populations.

Why was this study needed?

Previous studies show that a mother’s stress during pregnancy can affect her baby’s development. But less is known about how a mother’s stress during pregnancy relates to their infant’s brain function early in life. Infants’ sucking patterns have been used to measure brain function soon after birth. This study investigated whether there was any relationship between mothers’ stress in pregnancy and their young infants’ sucking patterns.

Who was involved?

The study included participants from two ECHO cohorts—one from Urbana-Champaign, Illinois and the other from Manati, Puerto Rico.

What happened during the study?

The researchers surveyed mothers regarding their stress during late pregnancy using the Perceived Stress Scale, which has 10 questions. Next, between one and eight weeks after the mothers gave birth, the researchers measured the infants’ sucking behaviors by having them suck on a pacifier connected to a pressure detector for approximately five minutes.

What happens next?

Future studies will look at the question of how early sucking behaviors relate to a child’s growth and development, in particular their brain function and cognitive development.

Where can I learn more?

Access the full journal article, titled “Examining the Association Between Prenatal Maternal Stress and Infant Non-Nutritive Suck” 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 December 16, 2021

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ECHO Study Suggests Link Between Maternal Stress During Late Pregnancy and Infant Pacifier Sucking Patterns

ECHO Director, Researchers Featured in Article on the Effects of Perinatal Stress on Babies

Posted on December 10, 2021June 7, 2023 by Jodi Snare

ECHO researchers Catherine Monk, PhD and Johnnye Lewis, PhD, as well as Program Director Matt Gillman, MD, were recently featured in an article regarding perinatal stress during the pandemic and its effects on babies. Featured in Undark.org, a non-profit digital magazine that explores the intersection of society and science, the article references previous studies regarding in-utero stress, including Dr. Monk’s 2016 study on stress and the effect of excess cortisol being passed via the placenta to the fetus.

Monk and her team hypothesized that high levels of stress passed on to the fetus would cause changes to the expression of a fetal gene responsible for deactivating, or neutralizing, cortisol in the body. This was the first study to link pregnant women’s stress with changes in placental genes.

In addition to extreme stress during pregnancy, Monk notes that another factor that may affect the fetus is climate change, which “is affecting the air their mothers breathe while they’re pregnant, and it’s going to be affecting their development in so many ways, and the quality of their lives in the future,” Dr. Monk said.

Additionally, the article highlights Dr. Lewis’s efforts as founder and director of the Community Environmental Health Program at University of New Mexico’s College of Pharmacy, as well as her collaborative ECHO work comparing how stressors related to the COVID-19 pandemic may affect mental health and neurodevelopment among Indigenous, Black, and White communities.

“The beauty of ECHO is it lets us compare across several different populations,” Dr. Lewis said. Based on a preliminary review of Lewis’s data, Black and Indigenous communities surveyed reported more pandemic-related stressors in comparison to a rural white community. This may suggest poorer outcomes for these populations due to the complex relationship linking stress to disease, behavioral health, and neurodevelopmental problems.

Regarding the news that stress plays a large role in the development of fetuses and newborns, Gillman stresses the importance of early intervention. “If you can do interventions early when systems and organs are most plastic, then it’s easier,” he said.

How Does Maternal PFAS Exposure Affect Prenatal Development?

Posted on November 18, 2021December 8, 2023 by Jodi Snare

Per- and polyfluoroalkyl substances (PFAS) are long-lasting chemicals that can be found in many household materials, but not enough is known about pre- and perinatal negative health outcomes associated with PFAS exposure. Additionally, socioeconomically disadvantaged groups, such as African American women and children, may be at more risk for PFAS exposure, worsening health disparities. Previous studies have linked PFAS exposure with negative infant health outcomes, such as lower birth weight, but little is known about the specific biological mechanisms that PFAS exposures disrupt during prenatal development.

Che-Jung Chang, PhD (left) and Donghai Liang, PhD (right) served as first and corresponding authors for this publication.

To investigate these mechanisms, Che-Jung Chang, PhD, Donghai Liang, PhD, and their team of ECHO researchers at Emory University looked at pregnancy and exposure data from more than 300 African American women enrolled in the Atlanta ECHO cohort from 2014-2018. Their research, titled “Per- and polyfluoroalkyl substance (PFAS) exposure, maternal metabolomic perturbation, and fetal growth in African American women: A meet-in-the-middle approach,” is published in Environment International.

As part of this study, the researchers analyzed the levels of PFAS in the participants’ blood samples along with the levels of a variety of small molecules that are known to be essential to prenatal development. The researchers then used statistical methods to look at how these chemical differences affected birth weights. The analysis found that PFAS exposures were linked with lower birth weights in babies that African American women delivered. These lower birth weights may have been associated with changes in the levels of a variety of essential metabolites and molecules, including amino acids, lipid/fatty acid, bile acids, and sex hormones.

The results of this study reveal some of the key chemical mechanisms that may be responsible for the effects of PFAS exposure on prenatal development. “The molecular mechanisms and biomarkers presented in this study warrant future investigation in targeted studies,” said Dr. Liang. “These investigations may help develop early detection and intervention strategies in both public health and clinical settings.”

Going forward, the team will take a closer look at how PFAS exposures are reflected in the levels of key small molecules in newborn babies. Additionally, team members hope to expand their chemical analysis in order to get a more holistic view of how PFAS exposures affect prenatal development.

Access the brief flash talk from the authors in the following video:

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Recent ECHO Publication Uses New Tools to Explore the Impact of Chemical Exposures on Pregnancy

Posted on November 18, 2021December 5, 2023 by Jodi Snare

Chemical exposures from the environment can have a profound effect on health outcomes, especially for pregnant mothers and their babies. Prenatal development is a carefully controlled biological process that is sensitive to environmental chemicals and maternal health.

In order to better understand the impact of chemical exposures on prenatal development, ECHO researchers Brett Doherty, PhD, MSPH, and Megan Romano, PhD, MPH of Dartmouth College used emerging technologies to investigate the link between chemical exposures and prenatal chemical processes. Their research, titled “Chemical co-exposures assessed via silicone wristbands and endogenous plasma metabolomics during pregnancy” is published in the Journal of Exposure Science and Environmental Epidemiology.

During this investigation, 177 pregnant women enrolled in the New Hampshire Birth Cohort Study (NHBCS) were given silicone wristbands to wear for a week in the early stages of their pregnancy. These wristbands captured snapshots of the chemical exposures the mothers experienced during pregnancy. Three months later, the researchers collected blood samples from the mothers for further analysis.

This analysis utilized metabolomics, a relatively new technology that involves the quantification of all the small molecule building blocks in a sample as a way to determine what chemical processes are occurring in the system.

“We used new tools to investigate how chemicals can affect important small molecules during pregnancy,” said Doherty, “which provided clues to the impacts of those chemicals on the health of the mother and the baby.”

The researchers found that several of the chemical exposures experienced by women in the study were associated with changes in the relative amounts of different important chemical building blocks. Specifically, many of the exposures, including exposures to the insecticide DEET, were associated with changes in the amounts of various amino acids that make up many of the proteins vital to prenatal development.

These results may provide a useful framework for further investigations into the effects of prenatal chemical exposures. “Future investigations may find it helpful to link the impacts we observed to related health processes and outcomes,” Romano noted.

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ECHO Study Links PFAS Exposure During Pregnancy to Lower Birth Weight for Black Mothers

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ECHO Study Links PFAS Exposure During Pregnancy to Lower Birth Weight for Black Mothers

Authors: Che-Jung Chang, Donghai Liang, et al.

Who sponsored this study?

This work was supported by the Environmental Influences on Child Health Outcomes (ECHO) program Opportunities and Infrastructure Fund, Office of the Director, National Institutes of Health, and the Environmental Protection Agency (USEPA).

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

What were the study results?

Some PFAS exposures were linked to a greater risk of low birth weight for babies that African American women delivered. PFAS exposures were also associated with the changes in the levels of small molecules needed for the baby’s development. These molecules included amino acids, lipid/fatty acids, bile acids, and sex hormones.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This is one of the first studies researching the connections and relationships between exposures to PFAS, metabolomic changes during the baby’s development, and the baby’s growth. The chemical analysis showed that changes in the levels of the molecules may be responsible for the effects on birth weight. Future studies may target the important chemical mechanisms of the molecules, which may help develop early detection and intervention strategies for babies with low birth weight due to PFAS.

Why was this study needed?

Per- and polyfluoroalkyl substances (PFAS) are called “forever chemicals” because they stay in the environment a long time. PFAS exposures have been linked to adverse pregnancy and birth outcomes, such as lower birth weights, but there is little information on why this relationship exists and how PFAS exposures affect the body. Also, African American women and children are exposed to higher levels of environmental pollutants and have a higher risk of negative birth outcomes, so studies focusing on this population are very important for reducing heath disparities.

Who was involved?

This study included 313 participants enrolled in the Atlanta African American Maternal-Child ECHO cohort between March 2014 and May 2018.

What happened during the study?

Researchers collected blood samples from participants and measured the levels of PFAS and small molecules essential to a baby’s development. Using this information, the researchers calculated how the levels of the molecules changed in response to PFAS exposures and how these exposures affected the birth weight of babies.

What happens next?

The research team is working on additional analyses on the impact of exposures to PFAS before birth and the levels of essential small molecules in newborns. They are also planning to conduct larger analyses in order to get a more holistic view of the connection between PFAS exposures and adverse birth outcomes.

Where can I learn more?

For research updates, follow them on Twitter @donghai_liang, @chejung_chang, @EmoryRollins, and @EmoryHERCULES, and check out the Environmental Metabolomics Research Group’s website.

Access the full journal article, titled “Per- and polyfluoroalkyl substance (PFAS) exposure, maternal metabolomic perturbation, and fetal growth in African American women: A meet-in-the-middle approach” 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 November 1, 2021

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See ECHO's PFAS research.

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ECHO Study Links PFAS Exposure During Pregnancy to Lower Birth Weight for Black Mothers

ECHO Study Maps Environmental Exposures During Pregnancy to Molecular Changes Associated with Key Health Processes

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ECHO Study Maps Environmental Exposures During Pregnancy to Molecular Changes Associated with Key Health Processes

Authors: Brett T. Doherty, Megan E. Romano, 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, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3 OD023275, and NIH NIEHS P42ES007373. Additional supporting entities include the Dartmouth Center for Molecular Epidemiology NIGMS, P20 GM104416) and the RTI Children’s Health Exposure Analysis Resource (CHEAR) Exposure Assessment Hub (NIEHS, U2CES026544, Fennell PI), among others

What were the study results?

Some of the chemical exposures were related to changes in the amounts of certain small molecules in the blood. Specifically, chemical exposures had the most impact on the amounts of a certain amino acids, which are the building blocks of many proteins that are important to both mother and child. When considered together, these molecule changes suggest that some of the chemical exposures may impact key health processes.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study used new tools to study how chemical exposures can affect important small molecules during pregnancy. The study results provide clues to the potential impact of these chemical exposures on the health of both mother and baby. In the future, further investigation of these chemical exposures may reveal more about their link to specific health endpoints.

Why was this study needed?

Pregnant women are exposed to chemicals in their environment. It is important to know how these chemicals might impact their health and the health of their babies. New tools can help us study how these chemicals affect health.

Who was involved?

This study included pregnant women in the New Hampshire Birth Cohort Study (NHBCS), who lived in north-central New England. A total of 177 women participated in this specific study within NHBCS.

What happened during the study?

During early pregnancy, women wore silicone wristbands for one week that captured chemicals in their environment. About three months later, the same women provided a blood sample, which was used to measure important molecules in their blood. Researchers looked at the link between environmental chemicals and the amounts of different molecules in the blood in order to better understand the health effects of these chemical exposures.

What happens next?

Going forward, it may be helpful to look for a link between the changes in molecules and related health processes and outcomes. Researchers may also want to reproduce these findings in other cohorts to better understand these environmental effects.

Where can I learn more?

Access the full journal article, titled “Chemical co-exposures assessed via silicone wristbands and endogenous plasma metabolomics during pregnancy,” is published in the Journal of Exposure Analysis and Environmental Epidemiology.

Learn about silicone wristbands at the MyExposome website.

Learn about small molecules and the methods to measure them through The UNC Nutrition Obesity Research Center (NORC) Metabolism and Metabolomics Core.

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

Published October 26, 2021

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ECHO Study Maps Environmental Exposures During Pregnancy to Molecular Changes Associated with Key Health Processes

Too Much or Too Little: Exploring Micronutrient Intake in Pregnant Women

Posted on September 14, 2021April 8, 2025 by Jodi Snare

Good nutrition during pregnancy is important for a baby’s health. Too few vitamins and minerals, such as folic acid and vitamin A, can result in neural tube defects and alterations in heart structure. On the other hand, excessive intake of certain micronutrients may increase chronic disease risk. Although previously associated with lower income countries, meta-analyses and nationally representative samples have shown that at least one in every three pregnant women in the US aged 20-40 were at risk for inadequate intake of various vitamins while nearly one third of pregnant women exceeded the upper intake level of certain micronutrients by up to 5-10 times their required amount.

To explore the disparities in nutrient intake among pregnant women, Katherine Sauder of CU Anschutz and her writing team collected data from nearly 10,000 women in 15 ECHO cohorts across 14 states. Participants in all of these cohorts reported sociodemographic data, weight, age, race/ethnicity, education status, and pre-pregnancy body mass index. Participants were women aged 14-50 who provided either 24-hour dietary recalls or food frequency questionnaires during their pregnancy between 1999-2019.

The team compared the intake of 19 micronutrients from food alone versus food plus dietary supplements to estimate the proportion of the micronutrients consumed above and below their recommended amounts among the different sociodemographic and physical subgroups.

The study found that more than one in five pregnant women did not eat enough of the vitamins D, E, K, and choline and the minerals magnesium and potassium, even when taking dietary supplements. The women most likely to not get enough of these vitamins and minerals were those aged 14-18 years, those who were Hispanic or Black, those who had less than a high school education, and those with obesity. Also, non-Hispanic women were most likely to eat too much folic acid, potentially putting their child at an increased risk for chronic illness.

“This study shows that the dietary supplements women use today do not help them get all the nutrients they need in the right amounts. Personalized approaches for dietary counseling and dietary supplement recommendations are needed. Reformulation of supplements would likely benefit pregnant women as well,” said Sauder. “Choosing a prenatal vitamin can be hard because there are so many products at the store. Ask your doctor to help you choose the best one for you.”

In the future, the team will study how much vitamins and minerals women are getting from foods and compare this value to the recommended amounts for pregnant women. This will help doctors identify which dietary supplements on the market will give women the vitamins and minerals they need.

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The Effect of Phthalate Exposure on Placental Function and Gene Expression

Posted on September 13, 2021December 5, 2023 by Jodi Snare

Phthalates are man-made chemicals that are commonly found in plastics, solvents, and personal care products like perfumes, nail polishes, soaps, and hair sprays. Because they are found in so many household products, people can be exposed to them often. Unfortunately, there is little research on how exposure to phthalates can affect a pregnant woman’s health and the health of the developing baby. Investigating how exposures to phthalates affect the placenta, an organ that delivers oxygen and nutrients to the baby, can reveal more about the relationship between these chemical exposures and infant health.

To explore this research gap, Alison Paquette, PhD of Seattle Children’s Research Institute and the ECHO Pathways research team examined the association between phthalate exposure in the second and third trimester and gene expression in the placenta. This information provides insight into how phthalates may affect different placental functions.

To conduct this research, the team gathered urine samples from 760 women enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study in Shelby County, TN. Their placentas were also collected after giving birth. Participants were between 16-40 years old, with relatively healthy pregnancies, and a majority were Black.

The team measured the levels of 16 different phthalates in each urine sample provided during the mother’s second and third trimesters and analyzed the levels of expression for every gene in the placenta after giving birth. Gene expression is a measure of how DNA is converted into proteins, which perform a variety of important cellular functions and play critical roles in development. For each gene, the researchers investigated the link between that gene’s expression and phthalate levels during pregnancy. The researchers used this information to analyze which biological pathways in the placenta are potentially affected by phthalate exposure.

The study found that several phthalates were associated with higher or lower placental gene expression for 38 genes. The team also identified some changes in gene expression that were only significant in male or female infants, indicating that phthalates may alter placental function differently for the different sexes. The team also found 27 specific biological pathways that may have been affected by phthalate exposure, including pathways essential to infant development. For example, the team found phthalate exposure was linked with decreased expression of the genes involved in the generation of fatty acids, which are essential building blocks for organ development. Changes in generating these fatty acids may impact how the fetus grows, particularly the brain, which may have a long-term impact on the child’s health.

“Placental gene expression is an important marker that can tell us if the placenta is performing all its normal jobs correctly. If the placenta is not functioning correctly, it may lead to pregnancy complications that threaten the health of both the mother and baby, or cause changes in fetal growth and development,” said Paquette. “By identifying how chemicals like phthalates alter placental function, it may help us understand the associations between phthalate exposure and some pregnancy complications.”

Moving forward, the research team will study how changes in the placenta are associated with other pregnancy complications, such as preterm birth, within the same population of women. Additional research, paired with new tools and technology, will also help them map out how phthalates may cause these changes in gene expression.

Read the research summary.