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Perceived Stress During Pregnancy Associated with Autism-related Traits in Children

Posted on by Jodi Snare

Higher perceived stress during pregnancy may be associated with greater severity of autism-related traits in children, according to a recent ECHO Cohort study led by Luke Grosvenor, PhD, of Kaiser Permanente Northern California.

Many mothers experience higher levels of stress and other mental health challenges during pregnancy. Previous studies have found that pregnancy stress may be associated with increased risk of autism spectrum disorder (ASD) in children, but these studies have mostly focused on the occurrence of isolated adverse or stressful events that occur in the mother’s life during pregnancy. Fewer studies have measured general perceived stress among mothers during pregnancy. To better understand whether this prenatal exposure may be associated with severity of autism-related traits in children, researchers collected information from over 4,000 mothers and their children enrolled in 20 ECHO Cohort Study Sites across the United States.

Key Takeaways include:

  • Higher perceived stress during pregnancy was associated with slightly more severe autism‑related traits in children.
  • At higher prenatal perceived stress levels, children showed slightly higher scores on tests measuring social and behavioral traits related to autism. Children whose mothers had either moderate or high categorical stress scored higher than those whose mothers reported low or no stress.
  • The link between pregnancy stress and autism‑related traits did not differ between boys and girls.
  • The relationship between prenatal stress and autism‑related traits remained consistent even when the researchers accounted for mothers’ co-occurring prenatal depressive symptoms.
  • Stress during pregnancy is normal and common to experience. While the results of this study indicate that there may be a small association between pregnancy stress and autism-related traits, they do not imply that stress during pregnancy causes autism spectrum disorder or autism-related traits to occur in children.

“This study provides evidence for small yet significant associations between higher prenatal perceived stress and greater severity of autism-related traits,” said Dr. Grosvenor. “These results could have implications for prenatal mental health screening and behavioral interventions aimed at improving child outcomes.”

Future studies could help researchers better understand the specific periods during pregnancy during which stress may have the greatest association with child health and development and how other related social and emotional factors may influence this effect.

This collaborative research, titled “Associations between Prenatal Perceived Stress and Child Autism-Related Traits in the ECHO Cohort,” is published in The Journal of Pediatrics.

Read the research summary.

 

Prenatal Stress and Maternal Adverse Childhood Experiences Linked to Higher Risk of Child Mental Health Problems

Posted on by Jodi Snare

Stress during pregnancy and a mom’s own adverse childhood experiences (ACEs) may be associated with higher risk of mental health problems for their children, according to a recent ECHO Cohort study led by Shaikh Ahmad, PhD, Alexandra Sullivan, PhD, and Nicole Bush, PhD of University of California, San Francisco, and Marie Churchill, MS and Rosa Crum, MD, MHS of Johns Hopkins Bloomberg School of Public Health.

The global rise in pediatric mental health problems has highlighted the importance of identifying factors that may affect children’s mental health. Previous research has suggested that maternal stress—both adverse experiences during the mother’s own childhood and stress during pregnancy—may affect child mental health. To better understand how these exposures affect child mental health, researchers collected information from over 6,000 mothers and their children enrolled in 34 ECHO Cohort Study Sites across the United States.

Key Takeaways include:

  • Mothers’ own ACEs and experiences of stress during pregnancy were each independently associated with a higher risk of mental health problems in their children, suggesting that maternal stressors during each period may have contributed to the child’s risk in a potentially accumulative manner.
  • These effects on children included both internalizing (e.g., anxiety, depression) and externalizing (e.g., ADHD, behavior problems) mental health issues.
  • The effects of maternal ACEs and pregnancy stress on child mental health problems were similar for boys and girls and were seen throughout childhood and adolescence.

“Using a large and diverse sample, this study highlights the potential two-generational benefits of early screening and intervention related to maternal stress and adversity—not only in improving maternal health, but also in reducing mental health problems in offspring,” said Dr. Ahmad.

Additional research could help researchers identify other factors that may influence the risk of child mental health problems (e.g., paternal ACEs) and factors that could improve support for pregnant women.

This collaborative research, titled “Maternal Adverse Childhood Experiences and Prenatal Stress: Intergenerational Transmission and Offspring Mental Health in the ECHO Cohort,” is published in Psychological Medicine.

Read the research summary.

Limited Access to Medical Services Linked to Differences in Children’s Sleep Patterns, New ECHO Cohort Study Finds

Posted on by Jodi Snare

Children living in communities with too few healthcare providers may experience different sleep patterns than those in better-resourced areas, according to a new ECHO Cohort study led by Brittany Lancaster, PhD, of Mississippi State University, Christy W. Hockett, PhD, of the Avera Research Institute, and Anna Wallisch, PhD, of the University of Kansas Medical Center.

Most prior research on child sleep has focused on individual and family-level behaviors—such as routines or screen use—without fully considering how living in rural or medically underserved communities shapes access to health-promoting resources. Families in these areas often face barriers such as long travel distances, limited medical services, and fewer health supports. These challenges can indirectly influence key behaviors, such as sleep.

This study included 22,234 youth ages 1–17 years, categorized into four groups based on whether they lived in rural areas, medically underserved areas, both, or neither. Using parent or self-reported questionnaires, researchers examined sleep duration, bedtimes, wake times, time to fall asleep, and bedtime habits, then compared patterns across these community types. A medically underserved area is defined as having too few primary care providers, high infant mortality, or high poverty and/or high elderly population.

Key Takeaways Include:

  • Children in medically underserved areas tended to go to bed later, wake up later, and were less likely to get the recommended amount of sleep, especially among children aged 12 and under.
  • Rural versus non‑rural differences were small; rural children generally went to bed and woke up earlier, while preschoolers in non‑rural areas slept longer due to more frequent naps.
  • Bedtime habits differed slightly: toddlers and teens in well‑resourced areas were more likely to have consistent bedtime routines, while preschoolers in underserved communities were more likely to use electronics before bed.
  • Results suggest that limited access to medical services—not rurality alone—may contribute more meaningfully to disparities in children’s sleep health.

“Our findings highlight an increased need to support families in medically underserved areas with practical strategies for bedtime routines and reducing screen time before bed, as these approaches may meaningfully improve sleep duration and quality among young children,” Dr. Lancaster said.

Targeted community programs through daycares, schools, and community centers may help support healthier sleep practices, particularly in medically underserved areas. Future research will continue to examine how environment, resources, and community characteristics influence children’s sleep.

This collaborative research, titled “Exploring Sleep Outcomes in Youth Across Settings: Are There Differences based on Rurality or Medically Underserved Status in the ECHO Cohort?”, is published in Sleep Medicine.

Family Lifestyle and Behavior Changes During COVID-19 Pandemic Associated with Youth Mental Health

Posted on by Jodi Snare

Children and teens who experienced significant changes in their lifestyle and health behaviors during the COVID-19 pandemic may be more likely to experience symptoms of pandemic-related post-traumatic stress (PTS), according to a recent ECHO Cohort study led by Amy Margolis, PhD of The Ohio State University.

The United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. To understand how changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic influenced youth PTS symptoms, researchers collected information from 7,786 children and 1,353 teens and young adults and their parents or caregivers across the United States between April 2020 and August 2021.

Key Takeaways include:

  • Two groups of families were identified based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.
  • Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes.
  • Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children. Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores.
  • Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors associated with PTSS scores. Stability in these areas was linked to lower PTSS scores.
  • The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability for parents to isolate safely as key factors in reducing youth PTS symptoms.

This collaborative research, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” is published in the Journal of Clinical Child & Adolescent Psychology.

Read the research summary.

Social and Neighborhood Factors

ECHO Social and Neighborhood Research

SOCIAL AND NEIGHBORHOOD

ECHO researchers use data from more than 64,000 children and their families across the U.S. to examine associations between neighborhood and social factors and health conditions, including obesity, asthma, pre-term birth, low birthweight, and anxiety and depression.

ECHO Discovery
Webinar Recordings

Aris & Smith: Neighborhood Opportunities and Disparities in Child Health Outcomes & Lung Function Measured by Oscillometry in the Healthy Start and PETALS Cohorts

 

Resources

Visit these sites to learn more about social and neighborhood factors.

World Health Organization: Social Determinants of Health

CDC: Social Determinants of Health

CDC: Parks, Recreation, and Green Spaces

CDC: Land Use and Community Design

QUESTIONS

For more information, please email the NIH at NIHKidsandEnvironment@od.nih.gov.
For media inquiries or to request an interview, contact Rebekah Yeager at rebekah.yeager@nih.gov. 

The ECHO Program investigates social and neighborhood factors—such as access to housing, healthy food, transportation, parks, and education—that can influence child health outcomes. The neighborhoods where children grow up play an important role in their health. Because children are still developing, they may be especially sensitive to their surroundings, which can affect their health not just in childhood but throughout their lives.  Tools like the Child Opportunity Index (COI) and the Social Vulnerability Index (SVI) combine dozens of these indicators into a single measure, making it easier for researchers to explore how differences in community resources can affect children’s well-being and future opportunities.

What We're Learning

Since its launch, the ECHO Program has published more than 2,000 research articles on a wide range of child health topics. Within this body of work, many studies have examined how social and neighborhood factors shape children’s health and development.

Here are some research highlights:

Children Living in Low-income Neighborhoods with Low Food Access at Higher Risk of Developing Asthma, ECHO Study Finds
June 2025
Higher risks of developing asthma were seen in children from birth to age 11, and the increased risk was more noticeable in girls and Hispanic children

Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations
March 2025
Non-Hispanic Black children in these neighborhoods had the highest rate of this type of asthma that requires emergency care or medical treatment.

Food Insecurity in Pregnancy & Early Life May Be Linked to Higher Chance of Obesity in Children & Adolescents
September 2024
Children who faced food insecurity during early childhood—or whose mothers experienced it during pregnancy—had a higher BMI and more than 50% increased chance of developing obesity or severe obesity in childhood and adolescence.

ECHO Study Suggests Living Near Green Space Is Associated with Lower Anxiety and Depression in Preschool-Age Kids
April 2024
Higher levels of green spaces, up to three-fourths of a mile from a child’s home, were linked with lower symptoms of anxiety and depression from ages 2 to 5.

Neighborhood-Level Poverty and Food Insecurity During Pregnancy Associated With Lower Birthweight and Small for Gestational Age Infants, NIH Study Finds
March 2024
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.

 

Read More ECHO Research Related to Social and Neighborhood Factors

Living in Low-income-low-food-access Neighborhoods Linked to Higher Risk of Childhood Asthma

Posted on by Jodi Snare

Living in a low-income neighborhood with low food access was associated with higher risks of developing asthma, according to a recent ECHO Cohort study led by Veronica A. Wang, PhD, Antonella Zanobetti, PhD, and Diane Gold, MD of Harvard T. H. Chan School of Public Health and Rima Habre, ScD of the University of Southern California.

Asthma is characterized by chronic inflammation in the lungs, and prior research shows that a nutritious diet can reduce airway inflammation. However, access to affordable and healthy foods is often difficult for many communities that have limited access to supermarkets or grocery stores. In this study, the researchers wanted to learn whether living in a low-income-low-food access neighborhood was associated with childhood asthma and whether this association was modified by sociodemographic factors.

The study included 16,012 children from 35 ECHO Cohort study sites across the U.S., and the investigators used low-income-low-food-access (LILA) neighborhood metrics from the U.S. Department of Agriculture’s Food Access Research Atlas to evaluate each child’s neighborhood food access.

Key Takeaways include:

  • Living in a low-income neighborhood with low food access was associated with higher risks of developing asthma for both cumulative early (age 0-5 years) and cumulative middle (age 0-11 years) childhood, which stronger associations observed for cumulative early childhood.
  • The increased risk of asthma was more noticeable among girls, Hispanic children, and children whose mothers had less than a high school education.
  • The findings suggest that food access in the immediate vicinity of residence and that vehicle access may be important and may contribute to disparities in childhood asthma development.

This collaborative research, titled “Residing in a low-income-low-food-access neighbourhood and asthma in early and middle childhood in the Environmental influences on Child Health Outcomes (ECHO) program: a multisite cohort study,” is published in BMJ Open.