Exploring environmental influences on pregnancy, child health and disabilities

How does a pregnant person's environment, diet, stress, medications and social wellbeing affect their pregnancy and -; down the road -; their child's health?

That will be the focus of a new two-year study from scientists at Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, which will examine how environmental factors affect children, including those with a variety of disabilities.

The scientists recently were awarded $5 million from the National Institutes of Health (NIH) to join a national consortium -; theEnvironmental influences on Child Health Outcomes (ECHO) Program -; that will examine how perinatal and early childhood environments and experiences influence the health of children as they grow and develop. While other awardees will focus on asthma and cardiometabolic health in children, the scientists at Northwestern and Lurie Children's will specifically focus on people with disabilities who have historically been left out of medical research.

ECHO is a huge national cohort of children's health, and with this study, we're finally studying their mothers, too. There's so much to be learned about the mother-child dyad and the bidirectional ways in which they influence each other. We are recruiting a huge diverse population of pregnant people, enriched with those who are typically excluded."

Dr. Lynn Yee, Northwestern co-principal investigator, the Thomas J. Watkins Memorial Professor of Obstetrics and Gynecology at Feinberg School of Medicine

The hope is to one day use the findings from ECHO to develop interventions to improve maternal and child health, Yee said.

The national ECHO program focuses on five key pediatric outcomes with a high public health impact: pre-, peri- and post-natal outcomes; upper and lower airway health; obesity; neurodevelopment; and what makes people healthy. When ECHO first started seven years ago, there was less emphasis on studying pregnancy. Now, the team at Northwestern and Lurie Children's are part of a new phase of ECHO focused on recruiting pregnant people.

"This is an exciting opportunity to study the health of pregnant people," Yee said. "We're recruiting before kids even exist to understand the impact of maternal health and the events of pregnancy on child wellbeing."

Depending on the results of the first two years, the grant could bring further funding for five more years, with a potential total of $32 million over seven years.

Studying children with and without disabilities

The scientists won't know which children have disabilities until several years down the road, but the goal is that if they recruit high-risk mothers, including those whose pregnancies may be affected by genetic differences, they will eventually have a cohort with more children with disabilities.

"I think our disability focus goes hand-in-hand with having a broad, inclusive perspective on studying maternal-child health," Yee said. "We are excited to include all interested pregnant people in this study."

The $5 million grant, entitled "Enriching ECHO Cohorts with High-risk Pregnancies and Children with Disabilities (Enriching ECHO)," will advance disability inclusivity in ECHO research by studying children with a spectrum of disabilities, including neurodevelopmental conditions like ADHD and autism, and by drawing from existing data from ECHO participants with disabilities. The investigators also will collaborate with other ECHO sites to complete additional scientific investigations using the consortium-wide data, such as regarding asthma or environmental toxins.

Beginning in January 2024, pregnant people will be recruited before the 20th week of gestation from obstetric practices at Northwestern's Prentice Women's Hospital and Hackensack University Medical Center.

"People with multiples deliver earlier and are at higher risk for complications," Yee said. "We will also be able to enroll moms and babies who might have problems detected on ultrasound, like club foot or brain abnormalities, who would not be able to participate in other studies because they're considered 'abnormal.' Historically, they're underrepresented, and their development is important too."

The study will also include seven years of follow up of the women and their children at Lurie Children's and the Joseph M Sanzari Children's Hospital at HUMC.

"This will be a cohort that's enriched with babies who are identified with complications early in pregnancy or in the newborn period but also babies who are developing typically," said co-principal investigator Dr. Aaron Hamvas, the Raymond & Hazel Speck Berry Professor of Neonatology at Feinberg and head of the neonatology division at Lurie Children's. "A certain proportion of children will have disabilities that will be unmasked as they approach school age. We would be completely unaware normally, but the data in our study will provide an opportunity to look back as we get further into this."

What the scientists will examine

One of the first areas the scientists will examine is the health of the placenta. Along with Enriching ECHO co-investigators from Northwestern, Drs. Jeffery Goldstein, Stephanie Fisher and Leena Mithal, they'll watch for infections and inflammatory lesions (e.g. clots and other vascular issues) to see if they have any effect on the likelihood of the baby having autism or developmental delay.

The scientists also will collect specimens throughout pregnancy, such as blood, urine, stool, and even teeth, nails and hair. One test can examine cortisol levels in hair to assess a person's stress level over the previous three months, for example.

Will also focus on what makes individuals healthy

The scientists also will work to identify specific environmental factors associated with better-than-expected positive health outcomes to determine what makes kids healthy, not just what makes them sick.

This also means studying individuals who get pregnant easily and experience optimal pregnancies without complications. In addition, pregnant people who enroll in ECHO can continue to be followed between pregnancies, allowing the scientists to study health before pregnancy.

"We are aiming to recruit a large proportion of high-risk patients, such as people with multiples, diabetes, prior preterm birth, a prior disabled child, a disability in the pregnant person or abnormality on the ultrasound, but we also want 'typical' moms too, because we're thinking of ways in which to optimize health and not just examining populations with challenges," Yee said.

The study will be funded by NIH grant UG3OD035546.