ECHO Study Identifies Demographics of Pregnant Women Least Likely to Get the Nutrients They Need

Author(s): Katherine Sauder, et al.

Who sponsored this study?

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

What were the study results?

More than one in every 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 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. Non-Hispanic women were the most likely to eat too much folic acid.

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

What was the study's impact?

The study showed that many pregnant women are at a high risk of not getting enough nutrients from food alone, so it is important for pregnant women to improve their diet quality and take dietary supplements when needed. The risk of not getting enough vitamins or minerals for women of various ages, races/ethnicities, education levels, or weights is often a problem, even when using dietary supplements.

This study shows that the dietary supplements women use today do not help them get all the nutrients they need in the right amounts. Pregnant women need guidance specific to their bodies to manage the vitamins and supplements they need. Different combinations and formulas of dietary supplements taken before getting pregnant may also help this problem and make sure women do not receive too much folic acid, iron, and zinc.

Why was this study needed?

One in three pregnant women in the United States eats too little or too many key vitamins and minerals. Prior studies do not tell us what groups are at the most risk for poor nutrition during pregnancy. Knowing who is at risk for poor nutrition can make it easier for doctors and public health workers to help pregnant women manage their nutrition.

Who was involved?

The researchers studied 9,801 women aged 14-50 years living across the United States who were pregnant between 1999 and 2019.

What happened during the study?

Pregnant women reported their daily food and dietary supplement intake during pregnancy. Researchers compared their daily intake of 19 vitamins and minerals to the Institute of Medicine recommendations for pregnant women.

What happens next?

The researchers will study how much vitamins and minerals women are getting from foods and compare this amount to the amount pregnant women should get. They will identify dietary supplements that can give women the right amounts of the vitamins and minerals they need.

Where can I learn more?

Access the full journal article, titled “Disparities in risks of inadequate and excessive intake of micronutrients during pregnancy” in Journal of Nutrition.

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

Published September 7, 2021

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ECHO Study Identifies Demographics of Pregnant Women Least Likely to Get the Nutrients They Need

ECHO Study Links Phthalate Exposure During Pregnancy With Genetic Changes in the Placenta

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ECHO Study Links Phthalate Exposure During Pregnancy With Genetic Changes in the Placenta

Authors: Alison Paquette, Sheela Sathyanarayana, et al.

Who sponsored this study?

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

What were the study results?

Researchers found that several phthalates were associated with changes in the expression of 38 genes within the placenta. Some of these changes in gene expression were only significant in male or female infants. This shows that phthalates may change how the placenta works in different ways for the two sexes. The team also studied which biological pathways were connected to these changes in gene expression. They found 27 specific pathways that may have been affected by phthalate exposure. These pathways involved important building blocks for the developing infant.

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?

Exposure to phthalate chemicals is related to changes in gene expression in placentas. This is important because these changes in gene expression may affect the growing baby.

Why was this study needed?

There is a lot we still don’t know about how phthalates affect the placenta. Phthalates are a group of chemicals used in plastics and household products. The placenta is an organ in pregnant women that provides their growing baby with oxygen and nutrients. It also helps mothers and babies share information. Exposure to phthalates during pregnancy may harm the placenta and affect how the baby develops. Looking at changes in how genes are expressed when exposed to phthalates during pregnancy can help researchers measure the effect on how the placenta works. Genes are expressed when DNA is converted into proteins, which perform a variety of important functions and play critical roles in development.

Who was involved?

The study involved pregnant women from Memphis, Tennessee who enrolled in the CANDLE study during their pregnancy. Researchers collected urine and placentas from mothers just after their babies were born. These participants were between 16-40 years old, mostly Black, and had relatively healthy pregnancies.

What happened during the study?

Researchers measured the amount of 16 phthalates in urine collected from the participants during the 2nd and 3rd trimester of pregnancy.

Researchers collected the placenta from the mother after having the baby and measured the expression of each gene in the placenta. For each gene, the researchers tried to figure out if higher phthalate concentrations were related to more or less gene expression in the placenta. This information was used to understand how phthalates may have affected how the placenta worked.

What happens next?

This research team will study how changes in the placenta are related to pregnancy complications like preterm birth within this same group of pregnant women. They will also use new tools and technologies to study how phthalates may cause these changes in gene expression.

It is also important to look at the effect of phthalates on other groups of women and see how these changes in placental function impact infant and childhood health.

Where can I learn more?

Read more information about how people are exposed to phthalates and how to decrease exposures.

Access the full journal article, titled “A Comprehensive Assessment of Associations between Prenatal Phthalate Exposure and The Placental Transcriptomic Landscape” in Environmental Health Perspectives.

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

Published September 3, 2021

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ECHO Study Links Phthalate Exposure During Pregnancy With Genetic Changes in the Placenta

Series Highlighting ECHO Program Now Available in Pediatric Research

Posted on July 6, 2021June 7, 2023 by Jodi Snare

Pediatric Research recently published a series of articles highlighting the ECHO Program’s progress. In the introductory article, titled “The NIH ECHO Program: investigating how early environmental influences affect child health,” the NIH Program Office provides a broad overview of the program and its achievements to date. The second and third articles, written by members of the ECHO Coordinating Center (CC) and various ECHO investigators, focus on the program’s construction, challenges overcome during development, and the scientific opportunities that have already resulted from ECHO’s uniquely broad dataset.

The introductory article highlights the origins of the ECHO Program, dating back to September 2016. Authored by members of the NIH Program Office, this article details the breadth of the ECHO Program’s national network of cohorts, which includes 57,000 children and over 1,200 researchers participating through observational and interventional research. This piece also outlines program goals, including ECHO’s commitment “to enable high-impact research evidence that will inform clinical practices, policies, and programs for child health; and establish a national data platform and biorepository for the scientific community.”

Given its size and span, the program faced unique challenges. To tackle these head-on, governing committees facilitated the establishment of several specialized working groups to address challenges and direct the program in pursuing its goals. For example, the purpose of the Team Science Working Group was to “maximize ECHO’s scientific excellence and productivity by fostering team building and collaboration through effective communication.”

Another logistical challenge that ECHO faced from the beginning was the coordination of a dispersed set of established pediatric cohorts and the harmonization of their existing data to create a nationwide standardized dataset. As many of these individual cohorts had their own research focal points and routine sets of measurements, building a consistent dataset required ECHO to develop a unified set of required measurements and standard protocols. From this problem came the Protocol Working Group.

ECHO aims to enhance the health of children and adolescents through research that may help inform healthcare practices, programs, and policies. The third article details program strategies for fostering solution-oriented research that helps accomplish this goal, some of which include promoting ECHO research through publications and Opportunities and Infrastructure Fund (OIF) grants.

In the five years since its inception, the ECHO Program has made great strides in the development of a diverse, nationwide pediatric research framework with the power to inform children’s health policies and practices. Its large, varied population of participants, emphasis on multidisciplinary science, and capacity for pioneering innovative methods and technologies have shaped the program into an unprecedented resource in pediatric research.

“ECHO represents exciting new opportunities for pediatric research,” the third article concludes, “allowing for the investigation of scientific questions related to less common childhood outcomes and increasing inclusiveness of children participating in research in the United States.”

ECHO Study Finds Pregnant Women Exposed to Variety of Chemicals—Some May Affect Birth Weights

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ECHO Study Finds Pregnant Women Exposed to Variety of Chemicals—Some May Affect Birth Weights

Author(s): John L. Pearce, Brian Neelon, Michael S. Bloom, Jessie P. Buckley, Cande V. Ananth, Frederica Perera, John Vena, and Kelly Hunt

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

Findings from the study revealed that moms experienced a broad range of chemical exposure profiles with marked variability in exposure magnitudes across chemical classes and exposure frequencies. Evaluation of health effects found that maternal exposure profiles dominated by higher levels of flame-retardants (i.e., polybrominated diphenyl ethers, PBDEs) were associated to lower birth weights. Exposure profiles with higher levels of polychlorinated biphenyls (PCBs) and perfluoroakyl (PFAS) substances were associated with increased birth weights. PCBs are man-made chemicals that are often found in industrial and commercial products, such as electrical and hydraulic equipment and plasticizers in paints, plastics, and rubber products. PFAS substances can often be found in food packaging, commercial household products, drinking water, and living organisms.

What was the study's impact?

ECM provides a promising framework for supporting studies of other exposure mixtures as the resulting mapping benefits visualization and assessment of relationships in complex data.

Why was this study needed?

Pregnant women often encounter numerous chemicals that may pose a risk to them and their baby. Studies seeking to identify health effects in populations that experience such complex exposure scenarios remains difficult. With this study, the researchers tried to improve research of multiple exposures by presenting a mixtures methodology, defined as exposure continuum mapping (ECM), that allows investigators to identify complex exposure patterns (i.e., mixtures) within their study population and evaluate complex health effects.

Who was involved?

The team involved a diverse mother-child cohort over 600 women participating in ECHO that also enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's (NICHD) Fetal Growth Studies from 2009-2012.

What happened during the study?

To begin, the team obtained data previously collected from the study population during their participation in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's (NICHD) Fetal Growth Studies. These data included concentrations of endocrine disrupting chemicals (EDCs) measured in blood samples collected from mothers 8-12 weeks into their pregnancy and their infant’s weight at birth. Then, the team analyzed these data with ECM in order to identify the range of EDC exposure profiles experienced by moms during their pregnancy and to examine the relationship to the birth weight of their children.

What happens next?

The team will apply ECM to assist investigations of exposure mixtures and other child health outcomes, with particular interest on obesity.

Where can I learn more?

For access to software tools see: https://github.com/johnlpearce/

Access the full journal article, titled “Exploring associations between prenatal exposure to multiple endocrine disruptors and birth weight with exposure continuum mapping.”

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

Published June 2, 2021

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ECHO Study Finds Pregnant Women Exposed to Variety of Chemicals—Some May Affect Birth Weights

ECHO Review Finds Air Pollution May Be Associated with Child Brain Development, Behavior

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ECHO Review Finds Air Pollution May Be Associated with Child Brain Development, Behavior

Author(s): Heather E. Volk, Frederica Perera, Joseph M. Braun, Samantha L. Kingsley, Kim Gray, Jessie Buckley, Jane E. Clougherty, Lisa A. Croen, Brenda Eskenazi, Megan Herting, Allan C. Just, Itai Kloog, Amy Margolis, Leslie A. McClure, Rachel Miller, Sarah Levine, Rosalind Wright

Who sponsored this study?

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

What were the study results?

ECHO provides a unique opportunity to study how air pollution can affect children’s brain development and behavior in a large, diverse study population. It also has the ability to study pollutant exposures by geographic area, which has been a limitation in previous research.

What was the study's impact?

This study sets up the possibility of future work in ECHO on the effect of prenatal air pollution exposure on brain development in children.

Why was this study needed?

This study summarized information on different ways to measure prenatal air pollution exposure and what we know about how air pollution affects children’s behavior and brain development. It also helps create a plan for ECHO to study how being exposed to air pollution in the womb may affect children’s behavior.

Who was involved?

This paper uses summary data from ECHO to learn if there may be enough participants in the future to study how air pollution can affect children’s brain development and behavior.

What happened during the study?

Researchers reviewed earlier papers on air pollution and child development to summarize what those studies found. Then, they used that information to develop a plan that ECHO might use to fill gaps in that earlier work to advance children’s health.

What happens next?

Future studies will do the work described here – to examine air pollution exposure in ECHO participants by geographic area to determine how air pollution can affect the brain.

Where can I learn more?

Access the full journal article , titled “Prenatal air pollution exposure and neurodevelopment: A review and blueprint for a harmonized approach within ECHO.”

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

Published: May 2021

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ECHO Review Finds Air Pollution May Be Associated with Child Brain Development, Behavior

Exploring Gaps in Factors that Affect Pre-Term Birth

Posted on March 23, 2021June 7, 2023 by Jodi Snare

Although previous studies show the rates of pre-term birth (PTB) vary based on race and location, little is known about the origin of these differences. Therefore, ECHO researchers Anne Dunlop, MD, MPH, of Emory University, and Alicynne Glazier-Essalmi, of Michigan State University, sought to explore the link between the mother’s socioeconomic status (SES), race, location, and pre-term birth (PTB). Their research, titled “Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts,” is now published in PLoS One.

The participants involved in this study included women enrolled in the ECHO Program who delivered a baby, totaling more than 20,000 mother-infant pairs. These women provided all of the required information about themselves and their infant, including the mother’s age at delivery, education, physical address or region, alcohol use, prenatal care, and the child’s birth sex and gestational age. The research team then took this data and looked for patterns and connections between the given information and factors that affect PTB.

The study found race and ethnicity played a role in how early the child was born. Additionally, compared to non-Hispanic white women, women of all other races had a higher chance of PTB. “Education also played a role,” said Dunlop. “For women overall, a bachelor’s degree or above was linked to less chances of PTB, and a high school education or less led to higher chances of PTB.” This connection between education level and PTB was seen in women who lived in the South and Midwest regions of the United States. Lastly, non-Hispanic white women living in rural areas had a higher chance of PTB delivery compared to women living in urban areas.

“This study explored an important gap in the field of children’s health, as it gathered information on several factors that affect when and if a child is born prematurely,” said Glazier-Essalmi. “Given our findings on education, it is possible that higher education among women could decrease the chances of PTB in the county, especially in the South and Midwest regions.”

Because non-Hispanic Black women, Native American, and Alaskan Native women have the highest rates of PTB, future studies can help identify the causes for this difference and determine ways to prevent PTB in these populations.

Read the research summary here.

Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

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Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

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

What was done?

We reviewed medical records from 30 U.S. hospitals. There were 180 babies with NOWS treated with morphine (M) and a secondary drug [phenobarbital (P) or clonidine (C)]. We compared the two groups (M + P and M + C) and calculated the number of days spent in the hospital and the number of days they received morphine.

What was found?

Babies in the M + P group had fewer days of morphine treatment compared to babies in the M + C group. They also spent fewer days in the hospital than the M + C group. However, babies in the M + P group were more likely to continue taking phenobarbital at home.

What do the results mean?

In this study, babies treated with M + P had shorter hospital stays, and in some cases, fewer days of morphine treatment. But, some studies show that long-term use of phenobarbital could cause problems with the development of the nervous system. More research is needed on the benefits and risks of using this drug to treat NOWS symptoms.

Why was this study conducted?

Babies exposed to opioids (e.g., morphine, methadone, etc.) in the womb may have drug withdrawal symptoms called neonatal opioid withdrawal syndrome (NOWS) after birth. Some are given medicine for their symptoms. If the medicine doesn’t work, doctors may add other (secondary) medicine to the treatment. This study looked at two secondary drugs used most often to see if one was better than the other in NOWS treatment.

Appreciation:

We deeply appreciate the doctors, nurses, and hospitals that participated in the study and helped identify and extract information from the required medical records. Their enthusiastic collaboration made this study possible. The authors thank the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health for supporting this research.

Access the full journal article, titled "Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome," published in Pediatrics.

Published March, 2021

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

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Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Resources

Centers for Disease Control and Prevention (CDC)

About Opioid Use During Pregnancy

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Silicone Wristbands Capture Chemical Exposures in Early Pregnancy

Posted on January 15, 2021June 7, 2023 by Jodi Snare

Pregnant women are exposed to chemicals that may pose risks to their health or their babies’ health. However, the types of chemicals and the patterns of exposure are not well known. Therefore, ECHO researchers and Opportunities & Infrastructure Fund (OIF) investigators Brett Doherty, PhD, MSPH, and Megan Romano, PhD, MPH of Dartmouth College used silicone wristbands to collect data on chemical exposures during pregnancy. Their research, titled “Assessment of Multipollutant Exposures During Pregnancy Using Silicone Wristbands” is published in Frontiers in Public Health.

During this study, 255 women from the New Hampshire Birth Cohort Study (NHBCS) wore silicone wristbands for one week during early pregnancy. The women went about their normal activities while chemicals in their environment became trapped in the wristbands. At the end of the week, the participants returned the wristbands and the research team measured the captured chemicals.
The study found 199 unique chemicals in the wristbands worn by women in the study. A group of 16 chemicals, including chemicals in personal care products and consumer goods, was identified most often. Most women had relatively low amounts of these chemicals in their wristbands, but others had more unique combinations of chemical exposures. Education and behaviors, such as nail polish use, were predictive of the chemical exposures.

“We identified common exposures and exposure patterns in our study population, which may be studied in future research,” said Romano. The team will compare the wristband measurements to traditional measurements of chemical exposures to better understand the strengths and weaknesses of this new technology.
Additionally, the research team plans to link the chemical exposure data from the silicone wristbands to maternal and infant health outcomes and other biological data. “This linkage may indicate how chemicals influence human health and provide clues to prevent adverse health outcomes,” said Doherty.

ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

Author(s): Anne L. Dunlop, Alicynne Glazier-Essalmi, et al.

Who sponsored this study?

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

What were the study results?

There were differences in how early the baby was born based on the mother’s race and ethnicity. Compared to non-Hispanic white women, women of all other races had a higher chance of PTB. For women overall, a bachelor’s degree or above was linked to less chances of PTB, and a high school education or less led to higher chances of PTB. This link between education level and PTB was mostly seen in non-Hispanic white women and those who lived in the South and Midwest regions of the US. This study also collected data on neighborhood factors; non-Hispanic white women living in a rural area had a higher chance of PTB delivery compared to women living in an urban area.

What was the study's impact?

This study explored an important gap in the field of children’s health. It gathered information on how factors such as the mother’s race/ethnicity, location, education level, and SES affect if a baby is born early. The results show that higher education among women could help decrease the chances of PTB in the US, especially in the South and Midwest regions.

Why was this study needed?

There are high rates of preterm birth (PTB) in the US. Previous studies show that the rates of PTB are different based on race and location, but there is not much information available on what causes these differences. This study also explored the link between the mother’s SES, race, and location and how they affect the baby’s age at birth. Socioeconomic status (SES) is a combination of factors such as education, income, and occupation.

Who was involved?

Women enrolled in the ECHO Program who delivered a baby were included in this study. They provided all of the required information about themselves and their infant. More than 20,000 mother-infant pairs participated.

What happened during the study?

Researchers studied a variety of information including the mother’s age at delivery, education, physical address or region, alcohol use, prenatal care, and the child’s birth sex and how many weeks they were at birth. They took this information and looked for patterns and connections between factors that affect PTB.

What happens next?

Non-Hispanic Black women, Native American, and Alaskan Native women have the highest rates of PTB. Future studies in these populations will help explore the causes for these differences and figure out ways to prevent PTB.

Where can I learn more?

View the full journal article, titled “Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts” in PLOS One.

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

Published: January 8, 2021

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

Literature Review Finds Connection between Chemical Exposure and Time to Pregnancy

Posted on November 12, 2020June 7, 2023 by Jodi Snare

Some human-made chemicals can cause problems with the reproductive system, and several studies have looked at whether these chemicals affect how long it takes to get pregnant.

*Linda Kahn, PhD, MPH*
*NYU Langone Health*

In a literature review recently published in Human Reproduction Update, ECHO researcher Linda Kahn, PhD, MPH, of NYU Langone Health, and her research team compared the results of past studies on human-made chemicals and their impact on pregnancy. The research found a connection between certain chemicals and time to pregnancy, and also identified chemicals that need further research.

To conduct this research, the team reviewed all papers published in English on this topic from January 1, 2007 to August 6, 2019. After searching five science libraries and finding more than 4,500 articles, they narrowed it down to 28 articles with information from 19 studies that took place in North America, Europe, and East Asia.

The review found a strong connection between a chemical group called polychlorinated biphenyls, formerly used in electrical and hydraulic equipment, and longer time to pregnancy. Even though production of these chemicals stopped in the late 1970s, individuals are still exposed to them through soil, water, and building materials. More research needs to be done on brominated flame retardants, found in furniture, clothing, and other household products, and per- and polyfluoroalkyl substances, found in non-stick cookware and stain-resistant fabrics, to determine their impact on time to pregnancy.

“This review is especially important because it shows that certain long-lasting chemicals may increase the time it takes for couples to become pregnant, which can be stressful and lead couples to seek expensive fertility treatment,” Dr. Kahn said. “Although many of the chemicals covered in the review are no longer produced or used in the United States, they can last for years—even decades—in the environment and our bodies, affecting our health.”

The team believes we need more research on newer chemicals that have been invented to replace dangerous ones to figure out exactly how these chemicals interfere with healthy reproduction. For example, there may be certain life stages such as puberty when being exposed to them may be especially damaging.