pregnancy and birth

ECHO Participants and Investigators Featured in The Washington Post

Posted on by Jodi Snare

The Washington Post recently featured the Environmental influences on Child Health Outcomes (ECHO) Program in a story on phthalates—chemicals commonly found in plastics and personal care products—and how they may affect babies’ development during pregnancy.

The article highlighted ECHO participants who are helping researchers understand how chemical exposures during pregnancy and throughout the life course may influence pregnancy outcomes and child health. ECHO participants Arica Nyamsi and Cassondra Perez shared a range of experiences with chemical exposures, from making significant lifestyle changes to expressing uncertainty and a need for clearer guidance.

Sheela Sathyanarayana, a professor of pediatrics at the University of Washington, explained that determining safe levels of phthalate exposure is challenging because individual health risks vary based on genetics and susceptibility.

The story also featured ECHO investigator Dr. Leonardo Trasande of NYU Grossman School of Medicine, who noted in the article:

“Endocrine-disrupting chemicals are one of the biggest global health threats of our time. And 2 percent of us know about it — but 99 percent of us are affected by it.”

Chemical exposures will be a focus at the ECHO Symposium: Translating Science to Action on September 15, 2025. During the first session, Dr. Trasande will discuss phthalate exposure in pregnancy and early childhood, focusing on the evidence, knowledge gaps, and opportunities to inform policies, practices, and programs. Mrs. Perez will also speak during the third session on her experience as an ECHO participant.

Learn more about ECHO’s ongoing research on chemical exposures. Also, review the full symposium agenda for details and register to attend this free event either in-person or virtually.

Exposure to Low Levels of Arsenic in Public Drinking Water Linked to Lower Birthweight, Preterm Birth, Study Finds

Posted on by Jodi Snare

Babies born to mothers potentially exposed to low levels of arsenic in public drinking water—even at levels below the federal safety standard—were more likely to be born preterm, with lower birthweight, or be smaller than expected, according to a study funded by the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program.

While the U.S. Environmental Protection Agency sets a maximum contaminant level of 10 micrograms per liter for arsenic in public water systems, this study examines how even lower-level arsenic exposures may still affect pregnancy outcomes in a large population. Previous research largely focused on private wells or smaller study groups.

Because arsenic occurs naturally, water that comes in contact with certain rocks and soils may contain it. Contamination from various industrial processes also contributes to increased levels of arsenic in some areas.

“Most U.S. residents rely on public drinking water, and our findings suggest that further reducing arsenic in public water systems could be an important step to improve infant health across the U.S.,” said Anne Nigra, PhD, of Columbia University’s Mailman School of Public Health. “Even low levels of arsenic in public drinking water were associated with low birthweight and other adverse birth outcomes in U.S. infants.”

Key takeaways include:

  • Potential arsenic exposure during pregnancy—even at levels below the current federal safety standard—may be linked to adverse birth outcomes.
  • Mothers exposed to higher levels of arsenic in public drinking water were more likely to have babies born with low birthweight or smaller than expected for the number of weeks of pregnancy.
  • These patterns were seen across several racial and ethnic groups, including White, Black, and Hispanic/Latino families. Similar risks were also observed among babies born to American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander parents.
  • Babies born to Black parents faced higher risks of being born early, having low birthweight, or being smaller than expected.

Researchers analyzed data from nearly 14,000 mother-infant pairs from the ECHO Cohort. Arsenic exposures during pregnancy were estimated by combining water quality data with the residential histories of participants. No actual arsenic levels were tested for these participants.

This collaborative research was published in JAMA Network Open.

Nigra, A., et al. (2025) Public water arsenic and birth outcomes in the Environmental influences on Child Health Outcomes Cohort. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.14084

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About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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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

 

Access the associated article.

Download this summary

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

Read More Research Summaries about Chemical Exposures and Pregnancy

Do chemicals that break down slowly in the environment affect how long it takes to become pregnant?  

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

A review of studies that look at whether exposure to common non-persistent chemicals in consumer products delays the time it takes to become pregnant

Author(s): Alison E. Hipwell, Linda G. Kahn, Pam Factor-Litvak, et al

Exploring Gaps in Factors that Affect Pre-Term Birth

Posted on 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.

Silicone Wristbands Capture Chemical Exposures in Early Pregnancy

Posted on 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.

Literature Review Finds Connection between Chemical Exposure and Time to Pregnancy

Posted on 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.

ECHO Researchers Identify Gaps in Prenatal Opioid Exposure Research

Posted on by Jodi Snare

Elisabeth Conradt, PhD

This week, Pediatrics published results from ECHO researcher Elisabeth Conradt and her team’s efforts to learn more about prenatal opioid exposure and its effects on child development. Conradt and her team reviewed 52 publications to summarize what is known and make suggestions on how to expand knowledge in this area. The resulting article includes perspectives on how the ECHO Program can help learn more about this important topic.

“The number one question mothers, fathers, and clinicians have when they see that a mother is using opioids while pregnant is ‘how will this opioid exposure affect the child’s health?’ We cannot answer that question right now with the existing data,” Conradt said.

The team analyzed existing publications on three age groups: birth, infancy, and 2 years and older. Because of inconsistent and limited data, Condradt’s team was not able to understand a connection between prenatal opioid exposure and how children’s minds develop throughout life. However, they predict that the effects of the exposure at birth and infancy are small and subtle, but may increase as children age and have more demands on their attention at home and school.

Current studies were limited because of small sample sizes and difficulty controlling for confounding factors such as where a person lives or how much money their family makes.

Moving forward, the team will use ECHO data to test how prenatal opioid exposure affects learning, understanding, behavior, and attention span in middle childhood. They will also consider other possible factors such as poverty. Conradt noted that the team will also look at whether newborns who have neonatal opioid withdrawal syndrome (NOWS) have worse effects compared with newborns exposed to opioids who do not have NAS/NOWS.

Read the study summary and full media release.