Smoking During Pregnancy Linked to Mental Health Challenges in Children, ECHO Study Finds

Authors: Kristine Marceau, 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 research has shown that children whose mothers smoked during pregnancy are more likely to develop behavior problems, particularly difficulties with acting out or following rules. However, it has been less clear whether prenatal smoking also increases the risk of mental health problems generally, or if it’s a specific risk for difficulties with acting out or following rules alone. Researchers from this study wanted to understand whether prenatal smoking contributes to co-occurring emotional and behavioral symptoms or specifically behavioral symptoms, and whether its effects differ by age or sex. This study helps address these gaps by examining which developmental periods may be especially sensitive to prenatal smoking effects and whether boys or girls are more vulnerable.

What were the study results?

Children exposed to smoking before birth were more likely experience multiple co‑occurring emotional and behavioral symptoms, and also to show more externalizing problems—such as attention problems, aggressive behavior, and rule‑breaking. These associations were observed across nearly all age groups and remained even after accounting for family history, background, and other exposures.

The strongest effects on mental health symptoms were seen in early childhood (under age 7) and early puberty (ages 9 to 12). There were very few differences between boys and girls. Only at ages 13-14 did boys seem to have more co‑occurring emotional and behavioral symptoms and externalizing-specific problems than girls. In general, both boys and girls were affected in similar ways.

What was the study's impact?

These results suggest that prenatal exposure to nicotine may increase the risk of mental health and behavioral problems. Because this study included a large number of children from different backgrounds, it helps clarify past research and contributes new insight about when certain problems tend to appear and how different symptoms may occur together.

Who was involved?

The study included 16,335 children and adolescents ages 1 to 18 from 55 U.S. ECHO Cohort Study Sites. All participants completed Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ) behavioral assessments.

What happened during the study?

Researchers gathered standardized information about children’s behavior and created a simple score to show how many symptoms a child had and whether those symptoms were more emotional (such as sadness, anxiety) or behavioral (such as acting out, rule breaking). They then looked at these patterns across different age groups, while taking into account important factors such as the mother’s age and education, family mental health history, and exposure to smoke or other substances during and after pregnancy.

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

What happens next?

Future work could help researchers understand how timing, dose, and frequency of smoking during pregnancy correlates with child mental health. Future research could also use methods to separate the effects of family background from the effects of smoking itself and look more closely at how nicotine and other chemicals in smoke might affect children’s development.

Where can I learn more?

Access the full journal article, titled “Prenatal Smoking and Child Psychopathology Associations by Age and Sex in the ECHO Cohort,” in Development and Psychopathology.

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

Published April 6, 2026

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Smoking During Pregnancy Linked to Mental Health Challenges in Children, ECHO Study Finds

Prenatal Smoking Associated with Higher Risk of Mental Health Challenges in Children

Posted on April 6, 2026April 6, 2026 by Jodi Snare

Mother and toddler laughing Children exposed to maternal smoking before birth are more likely to experience behavioral and mental health challenges, according to a large study funded by the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program.

While previous research had linked prenatal smoking to acting out or rule-breaking, it was less clear whether smoking during pregnancy also affects broader mental health outcomes and whether effects differ by sex. The new study sheds light on these questions, examining thousands of children across the U.S. and identifying periods when exposure may be most impactful.

“These findings show that prenatal nicotine exposure can affect more than just acting-out types of behavior problems—it can influence children’s overall mental health and experiences of both emotional and behavioral problems at the same time,” said Kristine Marceau, PhD, of Purdue University. “Understanding when kids are most vulnerable can help families and healthcare providers provide support at the right time.”

Researchers analyzed data from 16,335 children ages 1 to 18 from 55 ECHO Cohort Study Sites. Behavioral assessments measured emotional and behavioral symptoms using standardized questionnaires.

Key Findings

Widespread Impact: Children exposed to prenatal smoking were more likely to have multiple mental health or behavioral symptoms at the same time.
Critical Windows: The strongest effects appeared in early childhood (under age 7) and early puberty (ages 9–12).
Similar Effects for Boys and Girls: Both sexes were affected in comparable ways, with slightly higher symptom levels in boys only at ages 13–14.
Independent of Family Background: Associations persisted even after considering family history and other environmental factors, such as maternal age, education, and additional substance exposures.

Future studies could take a closer look at the timing, amount, and frequency of smoking during pregnancy. Researchers could also work to better understand which effects are due to smoking itself—rather than other family factors—and how nicotine and other chemicals in smoke may affect how children grow and develop.

This collaborative research, titled “Prenatal Smoking and Child Psychopathology Associations by Age and Sex in the ECHO Cohort,” is published in Development and Psychopathology.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

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

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Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

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Maternal Smoking During Pregnancy May Be Linked to Higher Blood Pressure in Children

Posted on February 17, 2026February 17, 2026 by Jodi Snare

Maternal smoking during pregnancy may be associated with higher blood pressure and increased risk of hypertension in children, according to a new ECHO Cohort study led by Lyndsey Shorey-Kendrick, PhD, of Oregon Health & Science University and Christine Ladd-Acosta, PhD, of Johns Hopkins University.

Blood pressure that is higher than normal in childhood, including diagnosed high blood pressure, can increase the risk of developing high blood pressure later in life, a major risk factor for heart disease. Previous studies examining prenatal smoking exposure and childhood blood pressure have produced mixed findings. Many relied on self-reported smoking or focused only on systolic blood pressure, the top number in a blood pressure reading that reflects pressure when the heart beats. Fewer studies examined diastolic blood pressure, the bottom number that reflects pressure when the heart rests between beats.

To address these gaps, researchers used data from the ECHO Cohort to examine how smoking during pregnancy was related to both systolic and diastolic blood pressure in children. The study included 13,120 children born between 1999 and 2020 from 52 ECHO Cohort Study Sites across the United States, including Puerto Rico. Researchers assessed smoking during pregnancy using self-reports, medical records, and urine samples collected during pregnancy, and measured children’s blood pressure between ages 3 and 18.

Children whose mothers smoked during pregnancy were more likely to have higher blood pressure and a greater risk of hypertension. The study distinguished between “any reported smoking,” which is based on what mothers shared in surveys or medical records, and “active smoking,” which is confirmed by a urine test for cotinine, a marker of recent tobacco use. Active smoking during pregnancy was linked to even higher blood pressure in children.

Key Takeaways include:

Self-reported smoking during pregnancy was associated with higher diastolic blood pressure and increased risk of childhood hypertension.
Associations were stronger among female children and tended to increase with age.
Active smoking during pregnancy, identified using urine samples, was associated with higher systolic and diastolic blood pressure and greater risk of hypertension.
Self-reported secondhand smoke exposure during pregnancy was not associated with higher blood pressure in children.

“These findings suggest that reducing maternal smoking during pregnancy could lower hypertension rates in children and adults,” said Dr. Ladd-Acosta.

This collaborative research, titled “Association of Maternal Smoking During Pregnancy with Childhood Blood Pressure and Hypertension in the ECHO Cohort,” is published in Circulation.

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.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

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

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow the ECHO Program on LinkedIn and X for the latest updates.

Maternal Smoking During Pregnancy May Be Associated with Increased Childhood Blood Pressure, ECHO Study Finds

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Maternal Smoking During Pregnancy May Be Associated with Increased Childhood Blood Pressure, ECHO Study Finds

Authors: Lyndsey E. Shorey-Kendrick, Christine Ladd-Acosta, 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?

Blood pressure that is higher than normal in childhood, including diagnosed high blood pressure, can increase the risk of developing high blood pressure as an adult, which is a major risk factor for heart disease. Past studies looking at smoking during pregnancy and children’s blood pressure have had mixed results. Many relied on parents’ self-reports of smoking or focused only on systolic blood pressure, the top number in a blood pressure reading that reflects pressure when the heart beats. Fewer studies examined diastolic blood pressure, the bottom number that reflects pressure when the heart rests between beats.

To better understand these links, researchers needed a large U.S. study that included objective lab measures of smoking during pregnancy. Using data from the ECHO Cohort, researchers examined how smoking during pregnancy was related to both systolic and diastolic blood pressure in children.

What were the study results?

Children whose mothers smoked during pregnancy—whether occasionally or regularly—were more likely to have higher blood pressure and a greater risk of hypertension (higher than normal blood pressure at three or more doctors’ visits). The study distinguished between “any reported smoking,” which is based on what mothers shared in surveys or medical records, and “active smoking,” which is confirmed by a urine test for cotinine, a marker of recent tobacco use. Active smoking, identified by these lab tests, was linked to even higher blood pressure in children.

What was the study's impact?

This study reinforces that smoking during pregnancy is a risk factor for increased childhood blood pressure and hypertension and underscores the importance of smoking reduction during pregnancy for children’s heart health. The use of objective laboratory measures strengthens these findings and more accurately identifies children at risk.

Who was involved?

The study included 13,120 children born between 1999 and 2020 from 52 ECHO Cohort Study Sites in the U.S. All children had at least one blood pressure measurement taken between the ages of 3 and 18 years. A nearly equal number of male and female children from a range of sociodemographic groups were included.

What happened during the study?

Researchers collected smoking data from pregnant women using self-report surveys, medical records, and/or urine specimens. Children’s blood pressure was measured when they were between 3 and 18 years of age. Using these measurements, the researchers performed a statistical analysis to compare blood pressure levels between children exposed to smoking during pregnancy and children not exposed. The researchers also assessed whether there were any differences in the relationships between smoking and blood pressure by child sex.

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

What happens next?

More studies could help researchers better understand how smoking during pregnancy may contribute to higher blood pressure in children. Future studies could use biological measures of prenatal smoke exposure, which may help capture individual differences in how children are affected and make it easier to identify those at higher risk

Where can I learn more?

Access the full journal article, titled “Association of Maternal Smoking During Pregnancy with Childhood Blood Pressure and Hypertension in the ECHO Cohort,” in Circulation.

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

Published February 16, 2026

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Maternal Smoking During Pregnancy May Be Associated with Increased Childhood Blood Pressure, ECHO Study Finds

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

Authors: Sarah Maylott, 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.

Why was this study needed?

Many studies in the past have been interested in how substance exposures during pregnancy affect childhood behavior. Most of these studies, however, have only focused on a single substance or have only assessed children aged 5 years or younger. The purpose of this study was to find out if types of substances affect a child’s behavior during middle childhood.

What were the study results?

Most children in the study were not exposed to any of the substances considered prior to birth, but those who were tended to be exposed to more than one. Children with substance exposures were more likely than their non-exposed peers to have certain behavior problems in middle childhood. Children exposed to tobacco and alcohol were more likely to display rule-breaking or aggressive behaviors, while children exposed to illegal drugs (cocaine, methamphetamine, heroin) were more likely to have higher rates of anxiety, depression, or withdrawn behaviors. However, not all children exposed to substances had behavioral problems, suggesting that some children may be more resilient than others.

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?

Two patterns of substance use during pregnancy were associated with childhood behavior problems. This finding is important because it suggests that researchers can identify children at risk for certain behavioral challenges based on the substances their mothers used during pregnancy. With more research, clinicians may be able to anticipate childhood behavior problems during or shortly after pregnancy based on the kinds of substances the child was exposed to and develop personalized interventions for these children.

Who was involved?

Researchers used data from approximately 2,000 women from 10 ECHO research sites which reported on their substance use during pregnancy. When their children were 6 to 11 years old, a caregiver reported on the child’s behavior. The average age of participating mothers at the time of pregnancy was 28 years old.

What happened during the study?

Using data from 2000 to 2020, the researchers grouped women based on the types of substances they used during pregnancy, including 1) low substance use, 2) mainly tobacco use (with moderate likelihood of using alcohol and marijuana), and 3) illicit use. They then compared children’s behaviors for each of these groups.

What happens next?

Similar large-scale studies are needed that look more closely at how the amount and timing of substance use during pregnancy affect the child’s risk for problem behavior, as well as how the child’s home environment contributes to that risk. Additionally, future studies are needed to identify factors that may increase resiliency in children with prenatal substance exposure.

Where can I learn more?

Access the full journal article, titled “Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes” in the Journal of Pediatrics.

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 12, 2023

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

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ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

Authors: Liz Conradt, 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.

Why was this study needed?

Little is known about how a pregnant mother’s exposure to multiple substances, like tobacco, alcohol, or opioids, during pregnancy may be associated with outcomes for their children when they reach middle childhood. Most research looks at the effects of single-substance exposures or focuses on the effects of prenatal exposures on the child’s health exclusively during birth or early childhood. In this study, the research team evaluated the effects of prenatal exposure to multiple substances (alcohol, tobacco, marijuana, and opioids) on children’s reasoning skills and behavior during middle childhood.

What were the study results?

The team identified two groups of children based on their reasoning skills and problem behavior scores. Group 1 had average verbal reasoning skills, average spatial reasoning skills, and normal levels of problem behavior. Children in this group were exposed to fewer substances before birth. Group 2 included children with multiple substance exposures before birth. This group had below average verbal reasoning skills, but average spatial reasoning skills, and higher levels of problem behavior. Children in Group 2 were significantly more likely to be exposed to tobacco before birth. The effects of tobacco exposure on problem behavior and reasoning skills were stronger than expected.

What was the study's impact?

This study suggests that children exposed to tobacco and other substances before birth may be at increased risk for problem behaviors and lower verbal reasoning skill scores during middle childhood. These findings will help pediatricians identify children who are at risk for behavior problems and poorer reasoning skill scores. If replicated, this information might help pregnant women and their doctors to recognize how prenatal tobacco, especially in the context of other substance exposure, might affect their child’s verbal reasoning and behavior in middle childhood.

Who was involved?

This study involved pairs of mothers and their biological children. There were 256 mother-child pairs from two ECHO research sites with locations in Rhode Island, Minnesota, Washington, California, and New York. Children were ages six to 11 at the time of the behavioral and reasoning skills assessments.

What happened during the study?

Researchers collected data on prenatal exposure to substances including alcohol, tobacco, marijuana, and opioids. When the children were between six and 11 years old, their caregivers reported on the presence of problem behaviors such as aggression and anxiety. The researchers also collected data on problem solving skills with words, pictures, and diagrams (verbal and nonverbal reasoning).

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

What happens next?

Moving forward, the team wants to improve their measures of prenatal substance exposure and expand their sample size to include more ECHO participants. Grouping children that have been exposed to substances prenatally can help identify subgroups of children at risk for problem behaviors and low reasoning skill scores.

Where can I learn more?

The Center for Parenting and Opioids and National Institute on Drug Abuse have additional helpful resources.

The full journal article, titled “Prenatal Substance Exposure: Associations with Neurodevelopment in Middle Childhood” is published in the American Journal of Perinatology.

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

Published May 10, 2023

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ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

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ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

Authors: Britt Snyder, Tina Hartert, James Gern, 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?

Few studies have looked at possible links between maternal health characteristics, including environmental stressors, and the metabolism of newborns. Metabolism refers to chemical reactions that take place within the cells to provide the body with the energy needed for growth and maintaining health. Researchers often study metabolism by measuring the blood levels of certain molecules—called metabolites—that are created during those chemical processes.

This study expanded previous findings that showed links between maternal characteristics (such as pre-pregnancy smoking, pre-pregnancy body mass index, education, occupation status, marital status, age at delivery, asthma diagnosis, diabetes during pregnancy, or type of delivery) and amounts of metabolites in newborns. The study also explored the link between these metabolites and child growth patterns. In addition, this study explores the maternal factors and potential series of chemical changes in utero (in the womb) that may contribute to the link between newborn metabolism and childhood BMI*.

*Body Mass Index (BMI) is a common health screening tool that considers both height and weight.

What were the study results?

The researchers identified links between maternal health characteristics and the concentration of various metabolites in newborns. Additionally, this study showed that some metabolites were also linked to childhood BMI at ages 1–3 years.

The study found that factors like higher BMI before pregnancy or maternal age at delivery seemed to increase the levels of key metabolites in newborns. However, other metabolites which were linked with maternal health characteristics were not associated with changes in childhood BMI.

What was the study's impact?

Previous research has shown associations between levels of some newborn metabolites and childhood growth, overweight, and obesity. This study provides additional insights on the maternal factors and potential in utero pathways connecting newborn metabolism and later metabolic dysfunction in children. Such imbalance may increase a person’s lifetime risk of coronary heart disease, diabetes, stroke, and other serious health problems.

Who was involved?

This study included 3,492 infants enrolled in three ECHO research sites with linked newborn screening metabolic data.

What happened during the study?

The researchers used data on maternal health characteristics collected from questionnaires, birth certificates, and medical records. Child BMI was obtained from medical records and study visits. The researchers used statistical tools to evaluate possible links between maternal health characteristics and newborn metabolism.

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

What happens next?

This study is an early step in assessing biological pathways through which maternal health characteristics may influence prenatal metabolic development. These metabolic changes may then influence health after birth. Future studies are needed to further explore the potential pathways through which maternal health characteristics may impact child health.

Where can I learn more?

Access the full journal article, titled “The Associations of Maternal Health Characteristics, Newborn Metabolite Concentrations, and Child Body Mass Index among US Children in the ECHO Program,” in Metabolites.

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

Published April 1, 2023

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ECHO Study Links Maternal Health Factors With Newborn Metabolism and Child Body Mass Index

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

Authors: Marie Camerota, 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, and a career development award from the National Institute of Mental Health.

What were the study results?

ECHO researchers used the neurobehavioral scores to classify babies into one of six groups based on different patterns of behavior. While each group exhibited different characteristics, 4 of these groups contained infants with normal patterns of behavior. Only two of the six groups were characterized as poorly regulated. The first of these groups was hyper-aroused, or too excitable. The other group was hypo-aroused, or slow to respond.

Babies with poorly regulated behavior were more likely to be male, have younger mothers, and have mothers who were depressed or used tobacco during pregnancy. Babies born at all different gestational ages were found in each of the six groups.

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 describes a possible link between demographic and health characteristics of mothers and babies with patterns of behavior in newborns. Previous studies conducted in single cohorts have described similar patterns of poorly regulated behavior in infants. The current study replicated those findings using a larger and more diverse population. If these patterns of behavior continue to be found in other large studies, this might suggest that these patterns could generalize to babies outside these studies. This information could be used to identify babies at risk for poorly regulated behavior who might benefit from early interventions and prevention services to help promote positive health outcomes for children.

Why was the study needed?

Behavior patterns in newborns can be used as indicators of long-term developmental outcomes. Previous studies have looked at the link between demographic and medical characteristics of mothers and their infant’s behavior shortly after birth, but these studies were conducted with smaller groups of babies who were very similar to one another (e.g., studies with babies who were all born full term). There is a need for studies that include a larger sample representing more diverse pairs of mothers and their babies, including babies who were born all across the gestational age spectrum.

Who was involved?

This study included 1,112 mother-infant pairs from 5 ECHO cohorts across the United States. Infants were born at gestational ages from 22 to 42 weeks.

What happened during the study?

The babies received a neurobehavioral exam shortly after they were born to test their responses to objects and people, their reflexes, and their movement. Either mothers reported information about their own and their babies’ demographic characteristics and health information or it was collected from their medical records. ECHO researchers looked at how the mothers’ demographic characteristics and health during pregnancy were related to their newborns’ behavior patterns.

What happens next?

More research is needed to determine which of the characteristics studied are stronger predictors of babies’ neurobehavior patterns, and whether the impact of these factors changes in babies born at different gestational ages. Further research is also needed to learn more about how babies’ neurobehavior shortly after birth is related to their health and development later in childhood.

Where can I learn more?

Access the full journal article, titled “Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program," 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 February 25, 2023

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

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ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

Authors: Stephanie Eick, Rachel Morello-Frosch, 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?

Pregnant participants who were over 30 years old and had a college degree had lower levels of oxidative stress. Levels of oxidative stress were higher among pregnant participants who were overweight or obese and unmarried. Also, current smokers or those with less than a high school education had higher levels of a oxidative stress biomarker. These results help identify how social, biologic, and behavioral factors may contribute to poor health in mothers and 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 the study's impact?

This is the largest study to date looking at the relationship between biological, social, and behavioral factors and oxidative stress during pregnancy. The results of this study provide important clues into how socioeconomic inequalities can contribute to poor health in pregnant women. This study may also inform future studies looking at risk factors for preterm birth.

Why was this study needed?

There is little data on what can cause oxidative stress during pregnancy. Oxidative stress is a process that can trigger cell damage and it is thought to play a role in the development of some diseases. By identifying biological, behavioral, and socioeconomic factors in a mother’s day-to-day life that may lead to increased risk for oxidative stress, research can help inform the development of targeted strategies for the prevention of poor prenatal health outcomes.

Who was involved?

This study involved approximately 2,000 pregnant participants in the mainland United States and Puerto Rico who were enrolled in one of four ECHO cohorts.

What happened during the study?

Researchers collected urine samples from participants and measured the levels of biomarkers for oxidative stress. Researchers calculated how levels of oxidative stress biomarkers changed in response to biological, behavioral, and social factors. Maternal age, pre-pregnancy body mass index, marital/partnered status, parity, and smoking status were included as biological and behavioral factors while race/ethnicity, maternal education, and stressful life events were considered social factors.

What happens next?

The research team is examining the impact of oxidative stress on adverse pregnancy outcomes, such as preterm birth.

Where can I learn more?

The full journal article, titled “Associations between social, biologic, and behavioral factors and biomarkers of oxidative stress during pregnancy: Findings from four ECHO cohorts” is published in Science of the Total Environment.

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

Published April 29, 2022

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ECHO Study Identifies Biological, Behavioral, and Social Factors Affecting Pregnancy Health

Obesity and Diabetes During Pregnancy Linked to Higher Risk of Autism-Related Traits in Children

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Obesity and Diabetes During Pregnancy Linked to Higher Risk of Autism-Related Traits in Children

Authors: Kristen Lyall, Christine Ladd-Acosta, 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?

Maternal obesity and gestational diabetes were associated with indicators of autism-related social behaviors. Investigators did not see increases in these behaviors for children of mothers with preeclampsia or gestational hypertension. Neither preterm birth or low birth weight, which are common complications of obesity and gestational diabetes, did not seem to drive the associations with these pregnancy conditions.

What was the study's impact?

Obesity and gestational diabetes are common pregnancy conditions, so understanding their impact on the developing child is an important public health issue. This study suggests that these conditions may increase the likelihood of ASD-related traits, highlighting the need for better prenatal care and more monitoring of pregnant women experiencing conditions like obesity.

Why was this study needed?

Many studies have linked childhood autism diagnosis back to maternal health conditions during pregnancy—like obesity, gestational diabetes (high blood sugar during pregnancy), gestational hypertension (high blood pressure during pregnancy), and preeclampsia (high blood pressure during pregnancy and signs of kidney/liver damage). But less is known about how these conditions may relate to subtler changes in child social development. This research looks at how risk factors of obesity, gestational diabetes, gestational hypertension, and preeclampsia relate to autism-related traits like social communication more broadly.

Who was involved?

This study included nearly 7,000 participants from 40 ECHO cohorts across the United States. Eight of these cohorts included participants considered to be at higher risk for autism spectrum disorder (ASD) based on known risk factors. The study only included cohorts that collected information on at least one of the four pregnancy conditions listed above and child social development/autism-related behaviors. Children were between the ages of 2.5-18 years, with an average age of approximately 8 years old.

What happened during the study?

The research team pulled together information on maternal health conditions during pregnancy, maternal age, child social development/autism-related behaviors, and participant demographics. They then examined the relationship between each pregnancy condition, separately and in combination, and child social development outcomes.

What happens next?

More work is needed to determine the underlying biologic and social mechanisms linking maternal obesity to child social behaviors and autism.

Where can I learn more?

Access the full journal article, titled “Cardiometabolic pregnancy complications in association with autism-related traits as measured by the Social Responsiveness Scale in ECHO” in the American Journal of Epidemiology.

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

Published March 31, 2022

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Obesity and Diabetes During Pregnancy Linked to Higher Risk of Autism-Related Traits in Children