ECHO Study Evaluates Influence of Neighborhood-Level Poverty and Food Insecurity During Pregnancy on Birthweight

Authors: Izzuddin Aris, Emily Oken, 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?

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

What were the study results?

The study found that living in neighborhoods where residents have lower incomes, limited food access, or limited vehicle access was associated with lower birthweights and an increased risk of babies born small for gestational age. However, researchers didn’t find any association between individual experiences of food insecurity and birth outcomes.

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

What was this study's impact?

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. A variety of strategies could be effective at improving birth outcomes, including strategies to increase neighborhood food access, improve food affordability in neighborhoods with low food access, or directly provide healthy foods to individuals during pregnancy.

Who was involved?

This study included 22,206 pregnant participants enrolled in 53 ECHO research sites that collected information on neighborhood-level food access data and birth outcomes. Of these participants, 24% 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). About 14% of the participants in this study lived in neighborhoods with high poverty rates where more than 100 households had no access to a vehicle and lived more than half a mile from the nearest grocery store.

What happened during the study?

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. Researchers also assessed individual-level food insecurity during pregnancy using the Crisis in Family Systems-Revised questionnaire.

What happens next?

Additional studies are needed to examine how health habits, chemical exposures, and other related factors may also influence birth outcomes.

Where can I learn more?

Access the full journal article, titled “Birth Outcomes in Relation to Neighborhood Food Access and Individual Food Insecurity During Pregnancy in the Environmental influences on Child Health Outcomes (ECHO)-Wide Cohort Study,” in American Journal of Clinical Nutrition.

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

Published March 1, 2024

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ECHO Study Evaluates Influence of Neighborhood-Level Poverty and Food Insecurity During Pregnancy on Birthweight

ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

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ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

Authors: Emily Oken, Kristen Lyall, 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?

Omega-3 fatty acids are essential nutrients for supporting positive health outcomes. Getting enough of these nutrients during pregnancy is vital for child health and neurodevelopment and may also improve other pregnancy outcomes. Prior research on the demographic characteristics associated with fish and supplement use during pregnancy has been limited, involving fewer participants and older data that may not represent current intake.

What were the study results?

During the study, about 25% of pregnant participants did not eat any fish or ate it less than once per month. Older participants were more likely to eat fish. Participants who were non-Hispanic Black, non-Hispanic Asian, or Hispanic ate less fish on average when compared to those who identified as non-Hispanic White. Participants categorized as overweight were also less likely to eat fish. Only about 1 in 6 pregnant participants reported taking omega-3 supplements. Supplement use was more common in participants who were older and had more education, had a lower body mass index (BMI), and ate fish.

What was the study's impact?

One-quarter of participants in this large, nationwide study rarely or never consumed fish during pregnancy, and omega-3 supplement use was uncommon, even among those who did not consume fish. Given the role of omega-3 fatty acids in preventing preterm birth and supporting child health and neurodevelopment, experts recommend pregnant women get at least 500 mg of omega-3 fatty acids per day through supplements or consuming fish that is low in mercury.

Learn more about the FDA’s and EPA’s current recommendations for eating fish during pregnancy here.

Who was involved?

This study included 10,800 pregnant participants enrolled in 23 ECHO research sites that collected information on fish consumption and 12,646 participants at 35 ECHO research sites that collected information on omega-3 supplement use. Information on fish consumption and omega-3 supplement use was collected from pregnant participants from 1999 to 2020.

What happened during the study?

The researchers collected information on fish intake during pregnancy and grouped participants based on the frequency of their fish consumption: 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. The researchers also collected information on participants’ omega-3 supplement intake. They then compared participant fish consumption and supplement use information across various demographic and lifestyle characteristics, including age, race, ethnicity, education, weight, and smoking status.

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 diet without first consulting your healthcare professional.

What happens next?

Future research may examine how fish consumption during pregnancy relates to childhood developmental outcomes such as autism-related traits.

Where can I learn more?

Access the full journal article 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” in Public Health Nutrition.

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

Published February 27, 2024

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ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

ECHO Researchers Find Link Between Phthalate Exposure and Preterm Birth, Estimate Potential Costs

Posted on February 19, 2024April 11, 2024 by Jodi Snare

Collaborative ECHO research led by Leonardo Trasande, MD, MPP of NYU Langone Health investigates the potential connections between phthalates, their metabolites in the urine of pregnant individuals, and birth outcomes. This research, titled “Prenatal phthalate exposure and adverse birth outcomes in the USA: a prospective analysis of births and estimates of attributable burden and costs,” is published in The Lancet Planetary Health.

Phthalates are widely used chemicals found in some consumer products, and previous research has linked phthalate exposure to preterm birth. In response, the use of di-2-ethylhexyl phthalate (DEHP), a common type of phthalate, has decreased in recent years. However, there is limited research on the effects of the replacement phthalates, and the costs associated with phthalate exposure remain unquantified.

The study included 5,006 mother-child pairs from 13 ECHO Cohort Study Sites across the U.S. Researchers analyzed levels of 20 phthalate metabolites in urine samples collected at three different points during each participant’s pregnancy. Then, the team looked for associations between these metabolite levels and preterm birth. The team also investigated the differences between specific types of phthalates, comparing di-2-ethylhexyl phthalate (DEHP), a common type of phthalate, with several newer alternatives developed to replace it.

When the researchers grouped mothers based on the amount of DEHP metabolites (substances produced when the body breaks down DEHP) found in their urine, they found that the 10% with the highest levels had a 50% higher chance of giving birth before the 37th week of pregnancy compared to the 10% with the lowest levels.

Some common alternatives to DEHP were associated with an even higher risk of preterm birth. Women exposed to the highest amounts of these alternative chemicals—phthalic acid, di-isodecyl phthalate (DIDP), di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP)—had twice the risk of preterm birth compared to those with little to no exposure to these alternatives. The team also calculated the costs associated with phthalate exposure.

“The number of premature births in the U.S. that could be linked to phthalate exposure in 2018 was between 24,000 and 120,000, potentially costing between $1.6 billion and $8.1 billion in medical expenses over the lifetime of the children,” Dr. Trasande said.

Future research could look at how exposure to replacement phthalates affects child development after birth. The European Union has prohibited the use of certain phthalates in some consumer products—as have California and a few other U.S. states.

Read the research summary here.

ECHO Study Finds Link Between Phthalate Exposure and Preterm Birth, Estimates Potential Costs

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ECHO Study Finds Link Between Phthalate Exposure and Preterm Birth, Estimates Potential Costs

Authors: Leonardo Trasande, 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?

Phthalates are widely used chemicals found in some consumer products, and previous research has linked phthalate exposure to preterm birth. In response, the use of di-2-ethylhexyl phthalate (DEHP), a common type of phthalate, has decreased in recent years. However, there is limited research on the effects of the replacement phthalates, and the costs associated with phthalate exposure remain unquantified. ECHO Cohort researchers wanted to learn about the potential connections between phthalates, their metabolites in the urine of pregnant individuals, and birth outcomes—including birth weight and length of pregnancy. The study also sought to estimate the potential costs associated with adverse birth outcomes.

What were the study results?

When the researchers grouped mothers based on the amount of DEHP metabolites (substances produced when the body breaks down DEHP) found in their urine, they found that the 10 percent with the highest levels had a 50 percent higher chance of giving birth before the 37th week of pregnancy compared to the 10 percent with the lowest levels.

Some common alternatives to DEHP were associated with even higher risk of preterm birth. Women exposed to the highest amounts of these alternative chemicals—phthalic acid, di-isodecyl phthalate (DIDP), di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP)—had twice the risk of preterm birth compared to those with little to no exposure to these alternatives.

Researchers estimated that the number of premature births in the U.S. that could be linked to phthalate exposure in 2018 was between 24,000 and 120,000, potentially costing between $1.6 billion and $8.1 billion in medical expenses over the lifetime of the children.

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

What was this study's impact?

This ECHO Cohort research examines the effect of phthalates on birth outcomes such as preterm birth and birth weight. These findings associated adverse birth outcomes with exposure to DEHP and its chemically similar substitutes, which can inform the development of policies, programs, and practices that can help prevent or lessen potentially harmful exposures during pregnancy.

Who was involved?

The study included 5,006 mother-child pairs from 13 ECHO Cohort Study Sites across the U.S. Researchers included individuals with information on up to 20 urinary phthalate metabolites. The pregnant participants were aged 25 to 34 at the time they gave birth.

What happened during the study?

The researchers analyzed levels of 20 phthalate metabolites in urine samples collected at three points during each participant’s pregnancy. They also investigated the differences between specific types of phthalates, comparing DEHP with several newer alternatives developed to replace it. Then, the team looked for associations between these metabolite levels and preterm births. They also calculated the number of premature births that could be linked to phthalate exposure and the possible associated costs over the lifetime of the child.

What happens next?

Future research could look at how exposure to replacement phthalates affects child development after birth. The European Union has prohibited the use of certain phthalates in some consumer products—as have California and a few other U.S. states.

Where can I learn more?

Access the full journal article, titled “Prenatal phthalate exposure and adverse birth outcomes in the USA: a prospective analysis of births and estimates of attributable burden and costs,” in The Lancet Planetary Health.

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

Published February, 2024

Access the associated article.

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ECHO Study Finds Link Between Phthalate Exposure and Preterm Birth, Estimates Potential Costs

NIH Study Finds Flame-Retardant Chemicals May Increase Risk Of Preterm Birth, Higher Birth Weight

Posted on January 25, 2024August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

An NIH Environmental influences on Child Health Outcomes (ECHO) Cohort study finds that certain organophosphate esters (OPEs) were linked to increased odds of preterm birth, especially in girls.

Pregnant individuals exposed to specific classes of flame-retardant chemicals known as organophosphate esters (OPEs) may face an increased risk of preterm birth, especially for baby girls, or higher birth weights for girls and boys, according to a recently published study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Manufacturers commonly use OPEs in products such as furniture, baby items, electronics, clothes, and building materials to prevent fires and make plastics more flexible. People can come into contact with OPEs in various ways, including swallowing or breathing indoor dust or absorbing it through the skin.

In the past decade, OPEs have been increasingly used as flame retardants after polybrominated diphenyl ether (PBDE) flame retardants were phased out due to health risks. ECHO researchers wanted to learn how these now more widespread OPE chemicals might affect pregnancy outcomes such as preterm birth and birth weight.

"The widespread use of products with new flame retardants among pregnant women in the U.S. means that a significant number of births could be affected by these compounds," said Deborah Bennett, PhD, of the University of California, Davis. “In fact, ECHO researchers learned that more than 85% of the study participants had three specific markers of OPE exposure in their bodies.”

Those three substances—diphenyl phosphate (DPHP), a combination of dibutyl phosphate and di-isobutyl phosphate (DBUP/DIBP), and bis(1,3-dichloro-2-propyl) phosphate—were associated with shorter pregnancies and higher risks of preterm birth only among female infants. Among male infants, higher concentrations of DPHP were associated with longer pregnancies.

Babies born to mothers with detectable levels of three other OPE markers—bis(1-chloro-2-propyl) phosphate, bis(2-methylphenyl) phosphate, and dipropyl phosphate—tended to have higher birth weights compared to those whose mothers had no detectable levels of these substances. Babies with a higher birth weight might be more likely to have jaundice, breathing problems, or congenital disorders.

Researchers measured a total of nine OPE markers in urine samples collected from 6,646 pregnant participants across 16 ECHO Cohort Study Sites—often during their third or second trimesters. The researchers assessed birth outcomes, including the length of pregnancy and birth weight, using medical records or parent reports.

“These substances tend to stay in the body for short periods, usually just hours to days,” said Dr. Bennett. “Conducting more thorough studies with various urine tests can help us figure out how they might be linked to birth outcomes.”

Dr. Bennett led this collaborative research published in Environmental Health Perspectives.

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

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If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

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ECHO Study Finds Flame-Retardant Chemicals May Increase Risk Of Preterm Birth and Higher Birth Weight

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ECHO Study Finds Flame-Retardant Chemicals May Increase Risk Of Preterm Birth and Higher Birth Weight

Authors: Deborah Bennett, Jiwon Oh, 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?

Manufacturers commonly use flame-retardant chemicals known as organophosphate esters (OPEs) in products such as furniture, baby items, electronics, clothes, and building materials to prevent fires and make plastics more flexible. People can come into contact with OPEs in various ways, including swallowing or breathing indoor dust or absorbing it through the skin. Animal studies have revealed that OPEs can harm the growth and development of offspring. However, the connection between OPE exposure during pregnancy and birth outcomes has been unclear. ECHO researchers wanted to learn if there was a link between OPE levels in the urine of pregnant individuals and specific birth outcomes.

What were the study results?

Pregnant individuals exposed to specific classes of OPEs may face an increased risk of preterm birth, especially for baby girls and babies with higher birth weights. Three of these substances—diphenyl phosphate (DPHP), a combination of dibutyl phosphate and di-isobutyl phosphate (DBUP/DIBP), and bis(1,3-dichloro-2-propyl) phosphate—were associated with shorter pregnancies and higher risks of preterm birth only among female infants. Among male infants, higher concentrations of DPHP were associated with longer pregnancies.

Babies born to mothers with detectable levels of three other OPE markers—bis(1-chloro-2-propyl) phosphate, bis(2-methylphenyl) phosphate, and dipropyl phosphate—tended to have higher birth weights compared to those whose mothers had no detectable levels of these substances.

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 was this study's impact?

In the past decade, OPEs have been increasingly used as flame retardants after polybrominated diphenyl ether (PBDE) flame retardants were phased out due to health risks. ECHO research examines the potential impact of these now more widespread OPE chemicals on pregnancy outcomes such as preterm birth and birth weight. The findings can inform policies, programs, and practices to help decrease exposure.

Who was involved?

The study included 6,646 pregnant participants at 16 ECHO Cohort Study Sites across the U.S. and Puerto Rico.

What happened during the study?

Researchers measured a total of nine OPE markers in urine samples collected from 6,646 pregnant participants across 16 ECHO Cohort Study Sites—often during their third or second trimesters. The researchers then assessed birth outcomes, including the length of pregnancy and birth weight, using medical records or parent reports.

What happens next?

OPEs tend to stay in the human body for short periods, usually hours to days. To better understand how these chemicals might affect birth outcomes, researchers can use multiple measurements of urinary OPE biomarkers. This could help identify when the body might be more sensitive to these chemicals. Additionally, learning more about how people are exposed to these chemicals can help identify ways to reduce exposure, especially during pregnancy.

Where can I learn more?

Access the full journal article, titled “Associations of Organophosphate Ester Flame Retardant Exposures during Pregnancy with Gestational Duration and Fetal Growth: The Environmental influences on Child Health Outcomes (ECHO) Program,” 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 January 24, 2024

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ECHO Study Finds Flame-Retardant Chemicals May Increase Risk Of Preterm Birth and Higher Birth Weight

New ECHO Research Finds No Association Between Arsenic Exposure and Birth Outcomes

Posted on December 15, 2023June 5, 2024 by Jodi Snare

Collaborative ECHO research led by Jonathan Lewis, MHS, Emily Knapp, PhD, MHS, and Amii Kress, PhD, MPH of Johns Hopkins Bloomberg School of Public Health investigates the relationship between arsenic exposure and certain birth outcomes. This research, titled “Associations Between Area-Level Arsenic Exposure and Adverse Birth Outcomes: An ECHO-Wide Cohort Analysis,” is published in Environmental Research.

Researchers captured proxy exposure to arsenic using a residential history of arsenic violations from the preconception period throughout pregnancy, a time when environmental influences could disrupt fetal growth. Violations were used as a proxy for arsenic exposure. The study used data from 15,000 mother-child pairs at 51 research sites across the U.S., focusing on children born in 2006 or later. In 2006, the Environmental Protection Agency (EPA) revised the enforceable standard for arsenic concentrations in drinking water to 10 parts per billion.

Low birth weight, gestational age at birth, preterm birth, and birth size were not found to be associated with potential arsenic exposure in areas with violations. However, infants whose mothers experienced continuous exposure to arsenic from three months before conception through birth exhibited a statistically significant increase in birth weight compared to those born in areas without violations.

In future studies, researchers aim to improve the identification of the community water systems that serve ECHO participants. Future research could also consider ECHO participants’ exposure to arsenic in foods and from other sources of drinking water.

Read the research summary.

ECHO Research Explores Potential Value of Nutrition Data Collected from Pregnancy Through Adolescence for Understanding Child Health

Posted on December 1, 2023April 11, 2024 by Jodi Snare

Collaborative ECHO research led by Megan Bragg, PhD, RD and Kristen Lyall, ScD of the A.J. Drexel Autism Institute highlights the opportunity for researchers to access the large amount of diet information already collected from the ECHO Cohort. This research, titled “Opportunities for examining child health impacts of early-life nutrition in the ECHO Program: Maternal and child dietary intake data from pregnancy to adolescence”, is published in Current Developments in Nutrition.

This study aimed to describe dietary intake data available in the ECHO Program as of August 2022, from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health. As of that date, 66 ECHO Cohort Study Sites across the country had collected diet information using a variety of methods, including dietary recalls, food frequency questionnaires, and questionnaires about supplement use. Diet information from these study sites is especially useful because it has been collected from a large group of diverse people, and because many families provided information more than once over the course of pregnancy and childhood.

Often, data collected on diet provide only a snapshot that can’t address how early-life diet affects later child health outcomes. The ECHO Cohort Consortium is addressing these challenges by gathering information over time about the dietary habits of individuals during pregnancy and childhood from a large, diverse group of participants.

“Researchers need information about what people eat during pregnancy and childhood from a large, diverse group of people in order to answer questions about nutrition,” said Dr. Bragg. “ECHO is unique because study sites have collected and continue to collect this information.”

Information from over 33,000 pregnancies and more than 31,000 children in the ECHO Program is now accessible to researchers. This de-identified data is publicly available to researchers through the National Institute of Child Health and Human Development Data and Specimen Hub (DASH) to encourage broad use to answer important questions about nutrition and child health.

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

Read the research summary.

ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

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ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

Authors: Catherine Bulka, Rebecca Fry, 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?

This study found that gene activity in the placenta might differ based on the infant’s sex, suggesting that the placentas of males and females develop differently. The placenta is an organ formed during pregnancy to nourish the fetus that goes through many changes during the length of the pregnancy to support the development of the infant.

Previous studies have found that a number of changes occur in the genetic make-up of the placental tissue throughout pregnancy. The current study suggests that some of these genetic changes may differ based on whether the baby is male or female. The researchers looked at gestational age (the amount time the baby spent in-utero) to compare placentas among males and female fetuses at different points in time. Among females, the researchers saw modifications in genes related to the immune system. Among males, there was modifications in genes related to the transport of molecules into the placenta.

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 identified differences in the location of modifications of placental DNA between male and female infants at different gestational ages. The most prominent differences were linked to genes that play significant roles in immunity, inflammation, and pregnancy complications. These differences seen between male and female infants may be important when looking at sex-specific health and developmental outcomes.

Why was this study needed?

The placenta is crucial for fetal growth and development. No previous study had considered the role of infant sex in placental development, despite accumulating evidence that females and males develop differently in utero.

Who was involved?

This study included 774 infants from 4 ECHO research sites. In total, the study included 355 female and 419 male infants. One of the research sites enrolled infants born at less than 28 weeks, which provided samples from the earliest viable births.

What happened during the study?

Research sites compared the placental tissue of male and female infants to determine associations between gestational age and modifications of placental DNA. Researchers then located the modifications and identified the closest genes, allowing them to analyze the biological significance of the modifications.

What happens next?

Researchers are now using this data to estimate an infant’s “biological” rather than “chronological” gestational age based on the modification of placental DNA. The findings of this study suggest that it may be important to consider the infant’s sex when calculating “biological” gestational age.

Where can I learn more?

Access the full journal article, titled “Sex-based differences in placental DNA methylation profiles related to gestational age: an NIH ECHO meta-analysis,” in Epigenetics.

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

Published December 2023

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ECHO Study Suggests Placenta Development for Male, Female Infants May Differ

New ECHO Research Characterizes Children Born Preterm into Four Neurobehavioral Profiles Based on a Combination of Health Outcomes

Posted on November 10, 2023November 10, 2023 by Jodi Snare

Collaborative ECHO research led by Marie Camerota, PhD of the Warren Alpert Medical School of Brown University studies the health outcomes of children born preterm and characterizes them into four neurobehavioral profiles. This research, titled “Neurodevelopmental and behavioral outcomes of very preterm infants: latent profile analysis in the Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Pediatric Research.

Birth outcomes for infants born very preterm have steadily improved over the past several decades. More children born at earlier gestational ages are surviving into childhood, however, it is unclear how being born very preterm may influence neurodevelopmental or behavioral problems.

Outcomes of children born at a gestational age of less than 33 weeks (“very pre-term”) vary significantly, with some children showing few neurodevelopmental concerns and others showing significant impairment. Most prior research has looked at single outcomes—for example, whether a child born preterm had a lower neurodevelopmental score or higher levels of behavior problems. Understanding how these different outcomes may group together can help researchers and healthcare providers provide more comprehensive treatment plans for children born very preterm.

This study included more than 2,000 babies who were born at less than 33 weeks gestational age from three ECHO Cohort Study Sites. When these children reached the age of two years, researchers conducted a neurodevelopmental assessment and a motor exam on the children while parents completed questionnaires about their children’s behavior. ECHO researchers looked for patterns in these data to understand whether there were groups of children with similar strengths and weaknesses.

Researchers found evidence for four different neurobehavioral profiles based on different combinations of cognitive, motor, and behavioral outcomes of children at the age of two. These profiles range from few or no developmental concerns to severe impairment in one or more domains. The study placed about 85% of children into one of two groups with no/mild developmental delay and a low prevalence of behavioral problems. The remaining 15% fell into one of two profiles with more serious neurodevelopmental problems with (5%) or without (10%) co-occurring behavior problems.

“This study helps us better understand outcomes for children following a very pre-term birth and shows that it is important to measure both neurodevelopmental and behavioral outcomes for children born preterm,” Dr. Camerota said. “The different groups of children we described might require different types of follow-up services or interventions. Therefore, the results of this study could potentially be used to develop personalized interventions for children following a very pre-term birth.”

More research is needed to understand why some preterm children develop neurodevelopmental and/or behavioral problems and others do not. To do this, future studies may study risk factors in pregnancy, the perinatal period, and in early infancy.

Read the research summary.