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

BACKGROUND

Limited access to healthy foods, resulting from residence in neighborhoods with low-food access or from household food insecurity, is a public health concern. Contributions of these measures during pregnancy to birth outcomes remain understudied.

OBJECTIVES

We examined associations between neighborhood food access and individual food insecurity during pregnancy with birth outcomes.

METHODS

We used data from 53 cohorts participating in the nationwide Environmental Influences on Child Health Outcomes-Wide Cohort Study. Participant inclusion required a geocoded residential address or response to a food insecurity question during pregnancy and information on birth outcomes. Exposures include low-income-low-food-access (LILA, where the nearest supermarket is >0.5 miles for urban or >10 miles for rural areas) or low-income-low-vehicle-access (LILV, where few households have a vehicle and >0.5 miles from the nearest supermarket) neighborhoods and individual food insecurity. Mixed-effects models estimated associations with birth outcomes, adjusting for socioeconomic and pregnancy characteristics.

RESULTS

Among 22,206 pregnant participants (mean age 30.4 y) with neighborhood food access data, 24.1% resided in LILA neighborhoods and 13.6% in LILV neighborhoods. Of 1630 pregnant participants with individual-level food insecurity data (mean age 29.7 y), 8.0% experienced food insecurity. Residence in LILA (compared with non-LILA) neighborhoods was associated with lower birth weight [β -44.3 g; 95% confidence interval (CI): -62.9, -25.6], lower birth weight-for-gestational-age z-score (-0.09 SD units; -0.12, -0.05), higher odds of small-for-gestational-age [odds ratio (OR) 1.15; 95% CI: 1.00, 1.33], and lower odds of large-for-gestational-age (0.85; 95% CI: 0.77, 0.94). Similar findings were observed for residence in LILV neighborhoods. No associations of individual food insecurity with birth outcomes were observed.

CONCLUSIONS

Residence in LILA or LILV neighborhoods during pregnancy is associated with adverse birth outcomes. These findings highlight the need for future studies examining whether investing in neighborhood resources to improve food access during pregnancy would promote equitable birth outcomes.

Early Infant Prefrontal Cortical Microstructure Predicts Present and Future Emotionality

BACKGROUND

High levels of infant negative emotionality (NE) and low positive emotionality (PE) predict future emotional and behavioral problems. The prefrontal cortex (PFC) supports emotional regulation, with each PFC subregion specializing in specific emotional processes. Neurite Orientation Dispersion and Density Imaging (NODDI) estimates microstructural integrity and myelination via the neurite density index (NDI) and dispersion via the orientation dispersion index (ODI), with potential to more accurately evaluate microstructural alterations in the developing brain. Yet, no study has used these indices to examine associations between PFC microstructure and concurrent or developing infant emotionality.

METHODS

We modeled PFC subregional NDI and ODI at 3 months with caregiver-reported infant NE and PE at 3 months (n=61) and at 9 months (n=50), using multivariable and subsequent bivariate regression models.

RESULTS

The most robust statistically-significant findings were positive associations among 3-month rACC ODI and cACC NDI and concurrent NE, and 3-month lOFC ODI and prospective NE; and a negative association between 3-month dlPFC ODI and concurrent PE. Multivariate models also revealed that other PFC subregional microstructure measures, and infant and caregiver sociodemographic and clinical factors, predicted infant 3- and 9-month NE and PE.

CONCLUSIONS

Greater NDI and ODI, reflecting greater microstructural complexity, in PFC regions supporting salience perception (rACC), decision-making (lOFC), action selection (cACC), and attentional processes (dlPFC) might result in greater integration of these subregions with other neural networks, greater attention to salient negative external cues, thus higher NE and/or lower PE. These findings provide potential infant cortical markers of future psychopathology risk.

Feasibility and acceptability of measuring prenatal stress in daily life using smartphone-based ecological momentary assessment and wearable physiological monitors

High levels of stress during pregnancy can have lasting effects on maternal and offspring health, which disproportionately impacts families facing financial strain, systemic racism, and other forms of social oppression. Developing ways to monitor daily life stress during pregnancy is important for reducing stress-related health disparities. We evaluated the feasibility and acceptability of using mobile health (mHealth) technology (i.e., wearable biosensors, smartphone-based ecological momentary assessment) to measure prenatal stress in daily life. Fifty pregnant women (67% receiving public assistance; 70% Black, 6% Multiracial, 24% White) completed 10 days of ambulatory assessment, in which they answered smartphone-based surveys six times a day and wore a chest-band device (movisens EcgMove4) to monitor their heart rate, heart rate variability, and activity level. Feasibility and acceptability were evaluated using behavioral meta-data and participant feedback. Findings supported the feasibility and acceptability of mHealth methods: Participants answered approximately 75% of the surveys per day and wore the device for approximately 10 hours per day. Perceived burden was low. Notably, participants with higher reported stressors and financial strain reported lower burden associated with the protocol than participants with fewer life stressors, highlighting the feasibility of mHealth technology for monitoring prenatal stress among pregnant populations living with higher levels of contextual stressors. Findings support the use of mHealth technology to measure prenatal stress in real-world, daily life settings, which shows promise for informing scalable, technology-assisted interventions that may help to reduce health disparities by enabling more accessible and comprehensive care during pregnancy.

The ADHD Phenotype in Black and White Girls From Childhood to Adolescence: Results From the Community-Based Pittsburgh Girls Study

OBJECTIVE

The goal of the present study is to describe the ADHD phenotype from childhood to adolescence in Black and White girls in a community sample.

METHOD

Primary caregivers enrolled in the population-based, longitudinal Pittsburgh Girls Study reported on girls' ADHD symptoms and impairment from ages 7 to 17; diagnostic subtypes were estimated based on meeting symptom criteria.

RESULTS

The prevalence of any subtype of ADHD ranged from 6.4 to 9.2% and from 2.3 to 6.4% for Black and White girls respectively; the inattentive subtype was most endorsed. A relatively equal number of new diagnoses at each age was observed. Persistence of ADHD diagnoses was typically 1 to 2 years.

CONCLUSIONS

ADHD in the community is relatively common, with the inattentive subtype as the most common phenotype for Black and White girls. Research on developmentally sensitive periods for symptom exacerbation or new onset of ADHD in girls is needed.

Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO programme

OBJECTIVE

n-3 fatty acid consumption during pregnancy is recommended for optimal pregnancy outcomes and offspring health. We examined characteristics associated with self-reported fish or n-3 supplement intake.

DESIGN

Pooled pregnancy cohort studies.

SETTING

Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999 to 2020.

PARTICIPANTS

A total of 10 800 pregnant women in twenty-three cohorts with food frequency data on fish consumption; 12 646 from thirty-five cohorts with information on supplement use.

RESULTS

Overall, 24·6 % reported consuming fish never or less than once per month, 40·1 % less than once a week, 22·1 % 1-2 times per week and 13·2 % more than twice per week. The relative risk (RR) of ever (v. never) consuming fish was higher in participants who were older (1·14, 95 % CI 1·10, 1·18 for 35-40 v. <29 years), were other than non-Hispanic White (1·13, 95 % CI 1·08, 1·18 for non-Hispanic Black; 1·05, 95 % CI 1·01, 1·10 for non-Hispanic Asian; 1·06, 95 % CI 1·02, 1·10 for Hispanic) or used tobacco (1·04, 95 % CI 1·01, 1·08). The RR was lower in those with overweight v. healthy weight (0·97, 95 % CI 0·95, 1·0). Only 16·2 % reported n-3 supplement use, which was more common among individuals with a higher age and education, a lower BMI, and fish consumption (RR 1·5, 95 % CI 1·23, 1·82 for twice-weekly v. never).

CONCLUSIONS

One-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and n-3 supplement use was uncommon, even among those who did not consume fish.

Resilience to stress during pregnancy: Biopsychosocial mechanisms and implications for offspring emotional and behavioral outcomes in toddlerhood

Exposure to high levels of stress during pregnancy is a known risk factor for a wide range of offspring outcomes, but little is known about the biopsychosocial factors underlying resilience and recovery from stress during pregnancy. The current study investigated associations between emotional and instrumental support during pregnancy and resilience to stress during pregnancy, including perceived resilience (belief in ability to "bounce back" from adversity) and physiological resilience (ability to physiologically recover quickly after an acute stressor). We further tested whether support and resilience during pregnancy predicted offspring internalizing and externalizing behaviors. Participants included 130 pregnant women (ages 26-28 years; 58% Black, 27% White, 15% Multiracial; 28% receiving public assistance) from a population-based longitudinal study. During pregnancy, participants reported on emotional and instrumental support, current life stressors, and perceived resilience to stress. In addition, heart rate variability was recorded continuously before, during, and after a controlled stress test to measure physiological recovery from stressors. When offspring were 2-3 years of age, mothers reported on children's internalizing and externalizing problems. Results from moderated mediation analyses indicated that emotional, but not instrumental, support was associated with perceived resilience during pregnancy, which predicted lower internalizing and externalizing problems in offspring. Emotional support also predicted greater physiological recovery during pregnancy, but only for individuals reporting multiple life stressors. Findings suggest that emotional support may influence psychological and physiological responses to stress during pregnancy, with implications for offspring emotional and behavioral health. Clinical implications of these results and directions for future research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prenatal stress and externalizing behaviors in childhood and adolescence: A systematic review and meta-analysis

Accumulating evidence suggests that psychological distress during pregnancy is linked to offspring risk for externalizing outcomes (e.g., reactive/aggressive behaviors, hyperactivity, and impulsivity). Effect sizes across studies have varied widely, however, due to differences in study design and methodology, including control for the confounding continuation of distress in the postnatal period. Clarifying these inconsistencies is necessary to guide the precision of prevention efforts and inform public health policies. A meta-analysis was conducted with 55 longitudinal studies to investigate the association between prenatal psychological distress (anxiety, depression, and perceived stress) and offspring externalizing behaviors. Results revealed a significant but small effect (r = .160) of prenatal distress on externalizing behaviors. The magnitude of the prenatal effect size remained largely unchanged after adjusting for postnatal distress (r = .159), implicating a unique effect of psychological distress during the prenatal period in the etiology of externalizing behaviors. Moderation tests showed that prenatal effects did not vary based on type and timing of psychological distress during pregnancy. Greater instability of distress from prenatal to postnatal periods predicted larger effects. Prenatal effects were comparable across most externalizing outcomes, consistent with the common comorbidity of externalizing spectrum disorders, although effects appeared smaller for nonaggressive rule-breaking (vs. aggressive) behaviors. Significant associations persisted across all developmental periods, appearing slightly larger in early childhood. We discuss these results in the context of developmental and psychobiological theories of externalizing behavior, offer preliminary clinical and public health implications, and highlight directions for future research including the need for longitudinal studies with more racially and socioeconomically diverse families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prenatal Exposure to Nonpersistent Environmental Chemicals and Postpartum Depression

Importance

Postpartum depression (PPD) affects up to 20% of childbearing individuals, and a significant limitation in reducing its morbidity is the difficulty in modifying established risk factors. Exposure to synthetic environmental chemicals found in plastics and personal care products, such as phenols, phthalates, and parabens, are potentially modifiable and plausibly linked to PPD and have yet to be explored.

Objective

To evaluate associations of prenatal exposure to phenols, phthalates, parabens, and triclocarban with PPD symptoms.

Design, Setting, and Participants

This was a prospective cohort study from 5 US sites, conducted from 2006 to 2020, and included pooled data from 5 US birth cohorts from the National Institutes of Health Environmental Influences on Child Health Outcomes (ECHO) consortium. Participants were pregnant individuals with data on urinary chemical concentrations (phenols, phthalate metabolites, parabens, or triclocarban) from at least 1 time point in pregnancy and self-reported postnatal depression screening assessment collected between 2 weeks and 12 months after delivery. Data were analyzed from February to May 2022.

Exposures

Phenols (bisphenols and triclosan), phthalate metabolites, parabens, and triclocarban measured in prenatal urine samples.

Main Outcomes and Measures

Depression symptom scores were assessed using the Edinburgh Postnatal Depression Scale (EPDS) or the Center for Epidemiologic Studies Depression Scale (CES-D), harmonized to the Patient-Reported Measurement Information System (PROMIS) Depression scale. Measures of dichotomous PPD were created using both sensitive (EPDS scores ≥10 and CES-D scores ≥16) and specific (EPDS scores ≥13 and CES-D scores ≥20) definitions.

Results

Among the 2174 pregnant individuals eligible for analysis, nearly all (>99%) had detectable levels of several phthalate metabolites and parabens. PPD was assessed a mean (SD) of 3 (2.5) months after delivery, with 349 individuals (16.1%) and 170 individuals (7.8%) screening positive for PPD using the sensitive and specific definitions, respectively. Linear regression results of continuous PROMIS depression T scores showed no statistically significant associations with any chemical exposures. Models examining LMW and HMW phthalates and di (2-ethylhexyl) phthalate had estimates in the positive direction whereas all others were negative. A 1-unit increase in log-transformed LMW phthalates was associated with a 0.26-unit increase in the PROMIS depression T score (95% CI, -0.01 to 0.53; P = .06). This corresponded to an odds ratio (OR) of 1.08 (95% CI, 0.98-1.19) when modeling PPD as a dichotomous outcome and using the sensitive PPD definition. HMW phthalates were associated with increased odds of PPD (OR, 1.11; 95% CI, 1.00-1.23 and OR, 1.10; 95% CI, 0.96-1.27) for the sensitive and specific PPD definitions, respectively. Sensitivity analyses produced stronger results.

Conclusions and Relevance

Phthalates, ubiquitous chemicals in the environment, may be associated with PPD and could serve as important modifiable targets for preventive interventions. Future studies are needed to confirm these observations.

Covariate-guided Bayesian mixture of spline experts for the analysis of multivariate high-density longitudinal data

With rapid development of techniques to measure brain activity and structure, statistical methods for analyzing modern brain-imaging data play an important role in the advancement of science. Imaging data that measure brain function are usually multivariate high-density longitudinal data and are heterogeneous across both imaging sources and subjects, which lead to various statistical and computational challenges. In this article, we propose a group-based method to cluster a collection of multivariate high-density longitudinal data via a Bayesian mixture of smoothing splines. Our method assumes each multivariate high-density longitudinal trajectory is a mixture of multiple components with different mixing weights. Time-independent covariates are assumed to be associated with the mixture components and are incorporated via logistic weights of a mixture-of-experts model. We formulate this approach under a fully Bayesian framework using Gibbs sampling where the number of components is selected based on a deviance information criterion. The proposed method is compared to existing methods via simulation studies and is applied to a study on functional near-infrared spectroscopy, which aims to understand infant emotional reactivity and recovery from stress. The results reveal distinct patterns of brain activity, as well as associations between these patterns and selected covariates.

Hooked on a thought: Associations between rumination and neural responses to social rejection in adolescent girls

Rumination is a significant risk factor for psychopathology in adolescent girls and is associated with heightened and prolonged physiological arousal following social rejection. However, no study has examined how rumination relates to neural responses to social rejection in adolescent girls; thus, the current study aimed to address this gap. Adolescent girls (N = 116; ages 16.95-19.09) self-reported on their rumination tendency and completed a social evaluation fMRI task where they received fictitious feedback (acceptance, rejection) from peers they liked or disliked. Rejection-related neural activity and subgenual anterior cingulate cortex (sgACC) connectivity were regressed on rumination, controlling for rejection sensitivity and depressive symptoms. Rumination was associated with distinctive neural responses following rejection from liked peers including increased neural activity in the precuneus, inferior parietal gyrus, dorsolateral prefrontal cortex, and supplementary motor area (SMA) and reduced sgACC connectivity with multiple regions including medial prefrontal cortex, precuneus and ventrolateral prefrontal cortex. Greater precuneus and SMA activity mediated the effect of rumination on slower response time to report emotional state after receiving rejection from liked peers. These findings provide clues for distinctive cognitive processes (e.g., mentalizing, conflict processing, memory encoding) following the receipt of rejection in girls with high levels of rumination.

Associations between COVID-19-related family hardships/distress and children's Adverse Childhood Experiences during the pandemic: The Environmental influences on Child Health Outcomes (ECHO) program

BACKGROUND

Economic hardships imposed by the pandemic could have implications for children's experiences of adversity in the home, or Adverse Childhood Experiences (ACEs).

OBJECTIVE

This observational cohort study examined associations between COVID-19-related hardships and distress (e.g., job loss, caregiver stress) and the cumulative number of child ACEs reported by caregivers during the pandemic (i.e., March 1, 2020-February 28, 2022).

PARTICIPANTS AND SETTING

The study included children (N = 4345; median age = 6.0 years, interquartile range = 4-9 years) and their parents/caregivers who participated in the NIH-funded Environmental influences in Child Health Outcomes (ECHO) Program.

METHODS

We described socio-demographic characteristics and pandemic-related family hardships/distress and cumulative child ACE scores reported during pre-pandemic and pandemic periods. We used negative binomial regression models to evaluate associations between pandemic-related family hardships and cumulative child ACE scores reported during the pandemic.

RESULTS

Each caregiver-reported hardship/distress was associated with higher child ACE scores reported during the pandemic. After accounting for pre-pandemic child ACE scores, moderate and severe symptoms of pandemic-related traumatic stress among caregivers were associated with 108 % and 141 % higher child ACE scores reported during the pandemic, respectively, compared with no or low caregiver symptoms. In addition, finance-related stress during the pandemic was associated with 47 % higher child ACE scores. After adjusting for pre-pandemic child experiences of neglect, most sources of stress remained significantly associated with higher child ACE scores reported during the pandemic, particularly severe/very severe symptoms of pandemic-related traumatic stress among caregivers. Findings held for children with no known pre-pandemic ACEs.

CONCLUSIONS

This research suggests that caregivers experiencing financial hardships and those with severe pandemic-related traumatic stress may require additional support systems during stressful events.

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts

Background

In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region.

Methods

We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression.

Results

After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category.

Conclusion

In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.

Developmental Models of Depression, Externalizing Problems, and Self-regulatory Processes: Integrated Data Analysis Across Four Longitudinal Studies of Youth

Integrative data analysis (IDA) was used to derive developmental models of depression, externalizing problems, and self-regulatory processes in three prevention trials of the Family Check-Up and one longitudinal, community-based study of girls over a 10-year span covering early to late adolescence (N = 4,773; 74.9% female, 41.7% white). We used moderated nonlinear factor analysis to create harmonized scores based on all available items for a given participant in the pooled dataset while accounting for potential differences in both the latent factor and the individual items as a function of observed covariates. We also conducted latent growth model analyses to examine developmental trajectories of risk. Results indicated a bidirectional relationship between depression and externalizing problems, with greater baseline externalizing problems and depression predicting growth in inhibitory control difficulties. Furthermore, initial level of inhibitory control difficulties was associated with growth in depression. We did not, however, find a relationship between early inhibitory control difficulties and growth in externalizing problems. This work illustrates the utility of IDA techniques to harmonize data across multiple studies to identify risk factors for the development of depression and externalizing problems that can be targeted by prevention efforts.

Is BMI a Useful Indicator of Prenatal Health Among Black American Women?

OBJECTIVE

BMI is commonly used to measure risk to prenatal health but may not be sensitive to adiposity-associated health problems for Black women. The aim of the present study was to test associations between indices of prenatal health and BMI in Black women.

METHODS

Data were from 652 women enrolled in two studies. Height and weight were used to calculate BMI. Depression and perceived stress were measured via maternal report, systemic inflammation via C-reactive protein (CRP), and nutrition by the ratio of omega-3 docosahexaenoic acid to omega-6 arachidonic acid fatty acids.

RESULTS

Neither perceived stress, depression, nor fatty acids were associated with prenatal BMI. CRP levels were positively associated with BMI (beta = 6.56, t = 13.30, p < .001). The prevalence of high-risk levels of CRP (> 3 mg/L) was below 10% for all weight classes except for BMI ≥ 40.

CONCLUSIONS

Results suggest that BMI may not be a sensitive index of adiposity related risk to prenatal health for Black women.

The general psychopathology factor (p) from adolescence to adulthood: Exploring the developmental trajectories of p using a multi-method approach

Considerable attention has been directed towards studying co-occurring psychopathology through the lens of a general factor (p-factor). However, the developmental trajectory and stability of the p-factor have yet to be fully understood. The present study examined the explanatory power of dynamic mutualism theory - an alternative framework that suggests the p-factor is a product of lower-level symptom interactions that strengthen throughout development. Data were drawn from a population-based sample of girls (N = 2450) who reported on the severity of internalizing and externalizing problems each year from age 14 to age 21. Predictions of dynamic mutualism were tested using three distinct complementary statistical approaches including: longitudinal bifactor models, random-intercept cross-lagged panel models (RI-CLPMs), and network models. Across methods, study results document preliminary support for mutualistic processes in the development of co-occurring psychopathology (that is captured in p). Findings emphasize the importance of exploring alternative frameworks and methods for better understanding the p-factor and its development.

Menstrual Cycle Irregularity in Adolescence Is Associated With Cardiometabolic Health in Early Adulthood

Background Menstrual cycle irregularities are associated with cardiovascular and cardiometabolic disease. We tested associations between age at menarche and cycle irregularity in adolescence and cardiometabolic health in early adulthood in a subsample from the Pittsburgh Girls Study. Methods and Results Data from annual interviews were used to assess age at menarche and cycle irregularity (ie, greater or less than every 27-29 days) at age 15 years. At ages 22 to 25 years, cardiometabolic health was measured in a subsample of the Pittsburgh Girls Study (n=352; 68.2% Black), including blood pressure, waist circumference, and fasting serum insulin, glucose, and lipids. T tests were used for continuous data and odds ratios for dichotomous data to compare differences in cardiometabolic health as a function of onset and regularity of menses. Early menarche (ie, before age 11 years; n=52) was associated with waist circumference (P=0.043). Participants reporting irregular cycles (n=50) in adolescence had significantly higher levels of insulin, glucose, and triglycerides, and higher systolic and diastolic blood pressure (P values range from 0.035 to 0.005) and were more likely to have clinical indicators of cardiometabolic predisease in early adulthood compared with women who reported regular cycles (odds ratios ranged from 1.89 to 2.56). Conclusions Increasing rates and earlier onset of cardiovascular and metabolic disease among women, especially among Black women, highlights the need for identifying early and reliable risk indices. Menstrual cycle irregularity may serve this purpose and help elucidate the role of women's reproductive health in protecting and conferring risk for later cardiovascular and cardiometabolic diseases.

Adolescent Mothers' Psychological Wellbeing during Pregnancy and Infant Emotional Health

OBJECTIVE

Although many studies have identified risk factors for adolescent pregnancy, much less is known about factors that support pregnant adolescents' psychological wellbeing and offspring outcomes. This study drew on strength-based frameworks to investigate family and neighborhood factors linked to social connectedness that predict psychological wellbeing during adolescent pregnancy and offspring outcomes.

METHOD

Participants included 135 adolescent mothers (ages 14-21; 90% Black American) assessed annually since childhood as part of a longitudinal study. During preadolescence (ages 11-13), data on contextual stressors and neighborhood support were gathered from participants' caregivers; participants also rated their perceived trust/attachment with caregivers before and during pregnancy. To assess changes in psychological wellbeing, adolescents reported positive and depressed mood before and during pregnancy. A path analysis model tested the prospective associations between family and neighborhood factors, psychological wellbeing during pregnancy, and offspring outcomes (birth outcomes; observed infant positive/negative emotions at age 3-months).

RESULTS

Positive mood decreased from pre-pregnancy to pregnancy, whereas depressed mood remained stable. Adjusting for pre-pregnancy mood, perceived caregiver trust/attachment during pregnancy was associated with prenatal positive mood. Prenatal positive mood, in turn, reduced risk of preterm birth and indirectly predicted positive infant emotions via birth outcomes. Neighborhood support in preadolescence predicted lower prenatal depressed mood, but depressed mood did not predict infant outcomes beyond positive mood. Contextual life stress was not associated with prenatal mood after adjusting for family and neighborhood support.

CONCLUSIONS

Findings highlight changes in positive-valence emotions during adolescent pregnancy that may have unique associations with birth outcomes and offspring emotions.

The association between preconception loss of control over eating and depressive symptom trajectories from childhood through first pregnancy

OBJECTIVE

Loss of control over eating (LOC) during pregnancy impacts prenatal health and often co-occurs with depressive symptoms. However, the role of depression history as a risk factor for LOC prior to pregnancy is unclear; information that is essential for effective prenatal health promotion. We examined the association between trajectories of depressive symptoms from childhood to first pregnancy and preconception LOC.

METHOD

Participants (N = 1031) were predominantly Black, first-time mothers enrolled in the population-based Pittsburgh Girls Study. LOC and depressive symptoms were measured annually. Pre-pregnancy height and weight, and gestational weight gain data were abstracted from medical records.

RESULTS

There was a significant difference in age of first conception for Black and White individuals (t = 8.73, df = 976, p < .001). Latent class analysis revealed four and three classes of depressive symptom trajectories for Black and White individuals, respectively. In the entire sample, the high-changing and moderate-decreasing classes of depressive symptoms were each associated with lifetime, in preconception year and not in preconception year, LOC (X2  = 56.7, p < .001).

DISCUSSION

High levels of lifetime depressive symptoms may increase vulnerability to future LOC prior to first pregnancy, suggesting potential targets for interventions to improve maternal health.

PUBLIC SIGNIFICANCE

Both depression history and disordered eating behaviors are known to influence prenatal health. The present study revealed associations between high levels of depressive symptoms from childhood through first pregnancy and loss of control over eating that included the year prior to conception. Results highlight potential targets for preconception interventions with relevance for future prenatal health.

Prenatal depression and risk of child autism-related traits among participants in the Environmental influences on Child Health Outcomes program

This study evaluated the association between prenatal depression and offspring autism-related traits. The sample comprised 33 prenatal/pediatric cohorts participating in the Environmental influences on Child Health Outcomes program who contributed information on prenatal depression and autism-related traits. Autism-related traits were assessed continuously and at the diagnostic cut-off using the Social Responsiveness Scale for children up to 12 years of age. Main analyses included 3994 parent-child pairs with prenatal depression diagnoses data; secondary analyses included 1730 parent-child pairs with depression severity data. After confounder adjustment, we observed an increase in autism-related traits among children of individuals with prenatal depression compared to those without (adjusted β = 1.31 95% CI: 0.65, 1.98). Analyses stratified by child sex documented a similar significant association among boys (aβ = 1.34 95%CI: 0.36, 2.32) and girls (aβ = 1.26 95% CI: 0.37, 2.15). Prenatal depression was also associated with increased odds of moderate to severe autism-related traits (adjusted odds ratio: 1.64, 95%CI: 1.09, 2.46), the screening threshold considered high risk of autism spectrum disorder (ASD) diagnosis. Findings highlight the importance of prenatal depression screening and preventive interventions for children of pregnant individuals with depression to support healthy development. Future research is needed to clarify whether these findings reflect overlap in genetic risk for depression and ASD-related traits or another mechanism.

The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort

The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children's health in the United States. The EWC harmonizes extant data and collects new data using a standardized protocol, the ECHO-Wide Cohort Data Collection Protocol (EWCP). EWCP visits occur at least once per life stage, but the frequency and timing of the visits vary across cohorts. As of March 4, 2022, the EWC cohorts contributed data from 60,553 children and consented 29,622 children for new EWCP data and biospecimen collection. The median (interquartile range) age of EWCP-enrolled children was 7.5 years (3.7-11.1). Surveys, interviews, standardized examinations, laboratory analyses, and medical record abstraction are used to obtain information in 5 main outcome areas: pre-, peri-, and postnatal outcomes; neurodevelopment; obesity; airways; and positive health. Exposures include factors at the level of place (e.g., air pollution, neighborhood socioeconomic status), family (e.g., parental mental health), and individuals (e.g., diet, genomics).

Preconception interpersonal personality features predict postpartum maternal parenting behaviors

Individual differences in personality traits affect the quality of social relationships. The parent-child relationship is among the most impactful social relationships in an individual's life, and positive parenting behaviors are known to support positive child development. The present study aimed to identify personality predictors-measured prior to conception at age 16-on later positive parenting behaviors. Young women (n = 207; 83.5% Black or multiracial; 86.9% receiving public assistance) who were followed since childhood as part of a prospective longitudinal study were observed interacting with their infants 4 months postpartum. We tested prospective associations between personality factors relevant to the quality and maintenance of social relationships-empathy, callousness, and rejection sensitivity-and coded dimensions of parenting behavior: maternal warmth, responsiveness, and mental state talk. We additionally examined potential moderating effects of infant affect on the relations between personality and parenting behavior. Results indicated that preconception empathy predicted later maternal warmth and responsivity, whereas preconception callousness was inversely associated with maternal warmth. The association between rejection sensitivity and maternal mental state talk was moderated by infant affect, consistent with a "goodness-of-fit" framework. The present study is the first to our knowledge to report associations between preconception personality and later parenting behaviors. The findings suggest that a woman's personality traits in adolescence, potentially years before she becomes a mother, can predict her behavior during interactions with her infant. Clinically, findings suggest the potential for interventions in adolescence to influence later parenting behavior and ultimately impact children's developmental outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Developing a National-Scale Exposure Index for Combined Environmental Hazards and Social Stressors and Applications to the Environmental Influences on Child Health Outcomes (ECHO) Cohort

Tools for assessing multiple exposures across several domains (e.g., physical, chemical, and social) are of growing importance in social and environmental epidemiology because of their value in uncovering disparities and their impact on health outcomes. Here we describe work done within the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort Study to build a combined exposure index. Our index considered both environmental hazards and social stressors simultaneously with national coverage for a 10-year period. Our goal was to build this index and demonstrate its utility for assessing differences in exposure for pregnancies enrolled in the ECHO-wide Cohort Study. Our unitless combined exposure index, which collapses census-tract level data into a single relative measure of exposure ranging from 0-1 (where higher values indicate higher exposure to hazards), includes indicators for major air pollutants and air toxics, features of the built environment, traffic exposures, and social determinants of health (e.g., lower educational attainment) drawn from existing data sources. We observed temporal and geographic variations in index values, with exposures being highest among participants living in the West and Northeast regions. Pregnant people who identified as Black or Hispanic (of any race) were at higher risk of living in a "high" exposure census tract (defined as an index value above 0.5) relative to those who identified as White or non-Hispanic. Index values were also higher for pregnant people with lower educational attainment. Several recommendations follow from our work, including that environmental and social stressor datasets with higher spatial and temporal resolutions are needed to ensure index-based tools fully capture the total environmental context.

Timing of Violence Exposure and Girls' Temperament Stability From Childhood to Adolescence

Individual differences in temperament (e.g., negative emotionality) are robust early predictors of emotional and behavioral health. Although temperament is often conceptualized as relatively stable across the lifespan, evidence suggests that it may change over time as a function of social context. Extant studies have been limited by cross-sectional or short-term longitudinal designs that have precluded tests of stability as well as factors that may influence stability across developmental periods. In addition, few studies have tested the impact of social contexts that are common for children living in urban and under-resourced environments, such as exposure to community violence. In the present study we hypothesized that levels of negative emotionality, activity, and shyness would decrease across development from childhood to mid-adolescence as a function of early exposure to violence in the Pittsburgh Girls Study, a community study of girls enriched for families living in low-resourced neighborhoods. Temperament was assessed by parent- and teacher-report on the Emotionality Activity Sociability Shyness Temperament Survey in childhood (5-8-years-old), early-adolescence (11-years-old), and mid-adolescence (15-years-old). Violence exposure (e.g., victim of or witness to violent crime, exposure to domestic violence) was assessed annually via child and parent report. Results showed that on average, combined caregiver and teacher reports of negative emotionality and activity level exhibited small but significant reductions from childhood to adolescence, whereas shyness remained stable. Violence exposure in early adolescence predicted increases in negative emotionality and shyness by mid-adolescence. Violence exposure was not associated with stability of activity level. Our findings suggest that exposure to violence, particularly in early adolescence, amplifies individual differences in shyness and negative emotionality, underlying an important pathway of risk for developmental psychopathology.

A lifespan perspective on depression in the postpartum period in a racially and socioeconomically diverse sample of young mothers

BACKGROUND

Consistent evidence from retrospective reports and case registry studies indicates that a history of depression is a major risk factor for depression in the peripartum period. However, longitudinal studies with racially and socioeconomically diverse samples of young mothers are lacking, and little is known about developmental patterns of depression across the lifespan that can inform preventive interventions.

METHODS

Young primiparous mothers (n = 399, 13-25 years, 81% Black) were recruited from a population-based prospective study that began in childhood. Women reported on depression symptoms for at least 3 years prior to their pregnancy, during pregnancy, and at 4 months postpartum. Linear regression models were used to estimate change in pre-pregnancy depression severity and to evaluate associations between patterns of lifetime history and postpartum depression symptoms.

RESULTS

Results revealed high levels of continuity in depression from pregnancy to postpartum, and across multiple years pre-pregnancy to postpartum. Overall, depression severity leading up to pregnancy decreased over time, but patterns of worsening or improving symptoms were not associated with depression severity in the postpartum period. Instead, area under the pre-pregnancy trajectory curve, representing cumulative lifetime depression burden, was uniquely associated with postpartum depression after adjusting for prenatal depression severity.

CONCLUSIONS

Depression in the postpartum period should be considered within a lifespan perspective of risk that accumulates before conception. Clinical screening and early interventions are needed in adolescence and young adulthood to prevent the onset and persistence of depressive symptoms that could have long-term implications for peripartum health.

Sociodemographic Variation in Children's Health Behaviors During the COVID-19 Pandemic

Background: Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, how they vary by sociodemographic characteristics, and the extent to which parent coping strategies mitigate the impact of pandemic-related financial strain on these behaviors. Methods: This study used pooled data from 50 cohorts in the Environmental influences on Child Health Outcomes Program. Children or parent proxies reported sociodemographic characteristics, health behaviors, and parent coping strategies. Results: Of 3315 children aged 3-17 years, 49% were female and 57% were non-Hispanic white. Children of parents who reported food access as a source of stress were 35% less likely to engage in a higher level of physical activity. Children of parents who changed their work schedule to care for their children had 82 fewer min/day of screen time and 13 more min/day of sleep compared with children of parents who maintained their schedule. Parents changing their work schedule were also associated with a 31% lower odds of the child consuming sugar-sweetened beverages. Conclusions: Parents experiencing pandemic-related financial strain may need additional support to promote healthy behaviors. Understanding how changes in parent work schedules support shorter screen time and longer sleep duration can inform future interventions.

Greater Gestational Vitamin D Status is Associated with Reduced Childhood Behavioral Problems in the Environmental Influences on Child Health Outcomes Program

BACKGROUND

Vitamin D deficiency is common in pregnancy. Vitamin D plays an important role in the developing brain, and deficiency may impair childhood behavioral development.

OBJECTIVES

This study examined the relationship between gestational 25(OH)D concentrations and childhood behavior in the Environmental influences on Child Health Outcomes (ECHO) Program.

METHODS

Mother-child dyads from ECHO cohorts with data available on prenatal (first trimester through delivery) or cord blood 25(OH)D and childhood behavioral outcomes were included. Behavior was assessed using the Strengths and Difficulties Questionnaire or the Child Behavior Checklist, and data were harmonized using a crosswalk conversion. Linear mixed-effects models examined associations of 25(OH)D with total, internalizing, and externalizing problem scores while adjusting for important confounders, including age, sex, and socioeconomic and lifestyle factors. The effect modification by maternal race was also assessed.

RESULTS

Early (1.5-5 y) and middle childhood (6-13 y) outcomes were examined in 1688 and 1480 dyads, respectively. Approximately 45% were vitamin D deficient [25(OH)D < 20 ng/mL], with Black women overrepresented in this group. In fully adjusted models, 25(OH)D concentrations in prenatal or cord blood were negatively associated with externalizing behavior T-scores in middle childhood [-0.73 (95% CI: -1.36, -0.10) per 10 ng/mL increase in gestational 25(OH)D]. We found no evidence of effect modification by race. In a sensitivity analysis restricted to those with 25(OH)D assessed in prenatal maternal samples, 25(OH)D was negatively associated with externalizing and total behavioral problems in early childhood.

CONCLUSIONS

This study confirmed a high prevalence of vitamin D deficiency in pregnancy, particularly among Black women, and revealed evidence of an association between lower gestational 25(OH)D and childhood behavioral problems. Associations were more apparent in analyses restricted to prenatal rather than cord blood samples. Interventions to correct vitamin D deficiency during pregnancy should be explored as a strategy to improve childhood behavioral outcomes.

Early infant prefrontal gray matter volume is associated with concurrent and future infant emotionality

High levels of infant negative emotionality (NE) are associated with emotional and behavioral problems later in childhood. Identifying neural markers of high NE as well as low positive emotionality (PE) in infancy can provide neural markers to aid early identification of vulnerability, and inform interventions to help delay or even prevent psychiatric disorders before the manifestation of symptoms. Prefrontal cortical (PFC) subregions support the regulation of NE and PE, with each PFC subregion differentially specializing in distinct emotional regulation processes. Gray matter (GM) volume measures show good test-retest reliability, and thus have potential use as neural markers of NE and PE. Yet, while studies showed PFC GM structural abnormalities in adolescents and young adults with affective disorders, few studies examined how PFC subregional GM measures are associated with NE and PE in infancy. We aimed to identify relationships among GM in prefrontal cortical subregions at 3 months and caregiver report of infant NE and PE, covarying for infant age and gender and caregiver sociodemographic and clinical variables, in two independent samples at 3 months (Primary: n = 75; Replication sample: n = 40) and at 9 months (Primary: n = 44; Replication sample: n = 40). In the primary sample, greater 3-month medial superior frontal cortical volume was associated with higher infant 3-month NE (p < 0.05); greater 3-month ventrolateral prefrontal cortical volume predicted lower infant 9-month PE (p < 0.05), even after controlling for 3-month NE and PE. GM volume in other PFC subregions also predicted infant 3- and 9-month NE and PE, together with infant demographic factors, caregiver age, and/or caregiver affective instability and anxiety. These findings were replicated in the independent sample. To our knowledge, this is the first study to determine in primary and replication samples associations among infant PFC GM volumes and concurrent and prospective NE and PE, and identify promising, early markers of future psychopathology risk.

Depression screening may not capture significant sources of prenatal stress for Black women

Exposure to stress during pregnancy, including depression, has a significant impact on maternal health. Black women experience varied stressors that impact pregnancy outcomes. Although the move to engage in universal screening of women for depression is a positive step toward improving women's health, it has been deployed without a comprehensive examination of its utility for capturing exposure to other stressors with known associations with perinatal and neonatal health problems for Black women such as discrimination stress. In the present study, we examine the overlap between several sources of stress and a positive screen on the Edinburgh Postnatal Depression Scale (EPDS) in Black pregnant women. Data were gathered from a study examining the effects of stress on prenatal health (N = 168). Discrimination stress, structural and systemic racism stress, perceived stress, and partner abuse were measured using standardized questionnaires during pregnancy. Using a score of ≥ 13 to indicate probable depression the sensitivity of the EPDS to identify women who experienced high levels of discrimination stress (41.7%), structural and systemic racism (39.5%), perceived stress (63.4%), and partner abuse (45.2%) was suboptimal. Lowering the threshold for a positive screen on the EPDS to a score of 10 improved sensitivity but did not solve the problem of under-identification of women whose health is at risk. The focus on depression screening for pregnant women should be re-considered. A screening toolkit that more rigorously and broadly assesses risk and need for support and intervention is needed to improve perinatal health outcomes for Black women.

Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study

Prenatal antidepressant exposure has been associated with increased risk for neurodevelopmental disorders in childhood, including autism spectrum disorder (ASD). The current study utilized multi-cohort data from the Environmental influences on Child Health Outcomes (ECHO) program (N = 3129) to test for this association, and determine whether the association remained after adjusting for maternal prenatal depression and other potential confounders. Antidepressants and a subset of selective serotonin reuptake inhibitors (SSRIs) were examined in relation to binary (e.g., diagnostic) and continuous measures of ASD and ASD related traits (e.g., social difficulties, behavior problems) in children 1.5 to 12 years of age. Child sex was tested as an effect modifier. While prenatal antidepressant exposure was associated with ASD related traits in univariate analyses, these associations were statistically non-significant in models that adjusted for prenatal maternal depression and other maternal and child characteristics. Sex assigned at birth was not an effect modifier for the prenatal antidepressant and child ASD relationship. Overall, we found no association between prenatal antidepressant exposures and ASD diagnoses or traits. Discontinuation of antidepressants in pregnancy does not appear to be warranted on the basis of increased risk for offspring ASD.

Disordered eating during pregnancy among individuals participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

BACKGROUND

Food insecurity is associated with adverse psychosocial and health consequences in pregnancy. In non-pregnant populations, evidence suggests that food insecurity is linked to eating pathology, independent of depression or anxiety. Food assistance programs intended to reduce food insecurity, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), may unintentionally contribute to eating pathology through a "feast-or-famine" cycle (i.e., cyclical periods of food deprivation and food access over the benefit month). Thus, the present study examined associations between WIC participation and disordered eating in pregnancy, covarying for depressive symptoms.

METHODS

The present study is a secondary analysis of the Pittsburgh Girls Study (PGS), a 21-year prospective longitudinal study that over-sampled households in low resourced neighborhoods. The present analysis included a subset of pregnant PGS participants (N = 210; 13-25 years of age) who reported on WIC participation, and disordered eating and depressive symptoms on validated measures.

RESULTS

Negative binomial regression models covarying for participant's age at conception and gestational age at assessment found that WIC participation was associated with higher scores on overall eating pathology as well as dieting and oral control subscales, but not bulimic or food preoccupation subscales, or a binge-eating item. Patterns of findings did not change when depressive symptom severity was included in models.

DISCUSSION

WIC participation was associated with eating pathology during pregnancy. Future research should clarify directional relationships among food insecurity, food assistance, and eating behavior in pregnancy to promote health equity.

Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program

OBJECTIVE

 We sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic.

STUDY DESIGN

 Data of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes.

RESULTS

 Symptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B =  - 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B =  - 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B =  - 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life.

CONCLUSION

 In this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic.

KEY POINTS

· COVID-19 was associated with shortened gestations.. · Depression was associated with shortened gestations.. · However, stress during the pandemic remained unchanged.. · Most women reported negative impacts of the pandemic..

Neural Network Functional Interactions Mediate or Suppress WM-Emotional Behavior Relationships in Infants

BACKGROUND

Elucidating the neural basis of infant positive emotionality (PE) and negative emotionality (NE) can identify biomarkers of pathophysiological risk. Our goal was to determine how functional interactions among large-scale networks supporting emotional regulation influence WM microstructural-emotional behavior relationships in 3-month-old infants. We hypothesized that microstructural-emotional behavior relationships would be differentially mediated or suppressed by underlying resting-state functional connectivity (rsFC), particularly between Default Mode Network (DMN) and Central Executive Network (CEN) structures.

METHODS

The analytic sample comprised primary caregiver-infant dyads [52 infants (42% female, mean age at scan=15.10 weeks)], with infant neuroimaging and emotional behavior assessments at 3 months. Infant WM and rsFC were assessed by diffusion-weighted imaging/tractography and resting-state magnetic resonance imaging (MRI) during natural, non-sedated sleep. The Infant Behavior Questionnaire-R provided measures of infant PE and NE.

RESULTS

Following significant WM-emotional behavior relationships, multimodal analyses were performed using whole-brain voxelwise mediation. Results revealed that greater cingulum bundle volume was significantly associated with lower infant PE (ß = -0.263, p = 0.031); however, a pattern of lower rsFC between CEN and DMN structures suppressed this otherwise negative relationship. Greater uncinate fasciculus volume was significantly associated with lower infant NE (ß = -0.296, p = 0.022); however, lower orbitofrontal cortex (OFC)-amygdala rsFC, suppressed this otherwise negative relationship, while greater OFC-CEN rsFC mediated this relationship.

CONCLUSIONS

Functional interactions among neural networks have an important influence on WM microstructural-emotional behavior relationships in infancy. These relationships can elucidate neural mechanisms contributing to future behavioral and emotional problems in childhood.

Impact of sedentary behavior and emotional support on prenatal psychological distress and birth outcomes during the COVID-19 pandemic

Abstract.

BACKGROUND

Studies have reported mixed findings regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women and birth outcomes. This study used a quasi-experimental design to account for potential confounding by sociodemographic characteristics.

METHODS

Data were drawn from 16 prenatal cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) program. Women exposed to the pandemic (delivered between 12 March 2020 and 30 May 2021) (n = 501) were propensity-score matched on maternal age, race and ethnicity, and child assigned sex at birth with 501 women who delivered before 11 March 2020. Participants reported on perceived stress, depressive symptoms, sedentary behavior, and emotional support during pregnancy. Infant gestational age (GA) at birth and birthweight were gathered from medical record abstraction or maternal report.

RESULTS

After adjusting for propensity matching and covariates (maternal education, public assistance, employment status, prepregnancy body mass index), results showed a small effect of pandemic exposure on shorter GA at birth, but no effect on birthweight adjusted for GA. Women who were pregnant during the pandemic reported higher levels of prenatal stress and depressive symptoms, but neither mediated the association between pandemic exposure and GA. Sedentary behavior and emotional support were each associated with prenatal stress and depressive symptoms in opposite directions, but no moderation effects were revealed.

CONCLUSIONS

There was no strong evidence for an association between pandemic exposure and adverse birth outcomes. Furthermore, results highlight the importance of reducing maternal sedentary behavior and encouraging emotional support for optimizing maternal health regardless of pandemic conditions.

Psychological Well-being across the Perinatal Period: Life Satisfaction and Flourishing in a Longitudinal Study of Black and White American Women

Psychological well-being (life satisfaction and flourishing) during the perinatal period has implications for both maternal and child health. However, few studies have investigated the extent to which psychological well-being changes from preconception to postpartum periods, particularly among diverse samples of women. Using prospectively collected data from an ongoing longitudinal study, we investigated changes in two dimensions of psychological well-being from preconception to postpartum among 173 Black and White American women. Results showed that changes in life satisfaction (i.e., global quality of life) and flourishing (e.g., self-acceptance, sense of purpose) over the perinatal period were moderated by race. For life satisfaction, White women reported an increase from preconception to pregnancy with increased life satisfaction levels remaining stable from pregnancy to postpartum. However, Black women reported no changes in life satisfaction across these timepoints. In contrast, both Black and White women reported an increase in flourishing levels across the perinatal period, although the timing of these changes differed. Findings highlight a need for greater clinical and empirical attention to the way in which psychological well-being changes during the perinatal period to optimize health and inform strengths-based intervention targets.

Intergenerational transmission of the effects of maternal exposure to childhood maltreatment in the USA: a retrospective cohort study

BACKGROUND

Childhood maltreatment is associated with adverse health outcomes and this risk can be transmitted to the next generation. We aimed to investigate the association between exposure to maternal childhood maltreatment and common childhood physical and mental health problems, neurodevelopmental disorders, and related comorbidity patterns in offspring.

METHODS

We conducted a retrospective cohort study using data from the Environmental influences on Child Health Outcomes (ECHO) Program, which was launched to investigate the influence of early life exposures on child health and development in 69 cohorts across the USA. Eligible mother-child dyads were those with available data on maternal childhood maltreatment exposure and at least one child health outcome measure (autism spectrum disorder, attention-deficit hyperactivity disorder [ADHD], internalising problems, obesity, allergy, and asthma diagnoses). Maternal history of childhood maltreatment was obtained retrospectively from the Adverse Childhood Experiences or Life Stressor Checklist questionnaires. We derived the prevalence of the specified child health outcome measures in offspring across childhood and adolescence by harmonising caregiver reports and other relevant sources (such as medical records) across cohorts. Child internalising symptoms were assessed using the Child Behavior Checklist. Associations between maternal childhood maltreatment and childhood health outcomes were measured using a series of mixed-effects logistic regression models. Covariates included child sex (male or female), race, and ethnicity; maternal and paternal age; maternal education; combined annual household income; maternal diagnosis of depression, asthma, ADHD, allergy, or autism spectrum disorder; and maternal obesity. Two latent class analyses were conducted: to characterise patterns of comorbidity of child health outcomes; and to characterise patterns of co-occurrence of childhood maltreatment subtypes. We then investigated the association between latent class membership and maternal childhood maltreatment and child health outcomes, respectively.

FINDINGS

Our sample included 4337 mother-child dyads from 21 longitudinal cohorts (with data collection initiated between 1999 and 2016). Of 3954 mothers in the study, 1742 (44%) had experienced exposure to abuse or neglect during their childhood. After adjustment for confounding, mothers who experienced childhood maltreatment were more likely to have children with internalising problems in the clinical range (odds ratio [OR] 2·70 [95% CI 1·95-3·72], p<0·0001), autism spectrum disorder (1·70 [1·13-2·55], p=0·01), ADHD (2·09 [1·63-2·67], p<0·0001), and asthma (1·54 [1·34-1·77], p<0·0001). In female offspring, maternal childhood maltreatment was associated with a higher prevalence of obesity (1·69 [1·17-2·44], p=0·005). Children of mothers exposed to childhood maltreatment were more likely to exhibit a diagnostic pattern characterised by higher risk for multimorbidity. Exposure to multiple forms of maltreatment across all subtypes of maternal childhood maltreatment was associated with the highest risk increases for most offspring health outcomes, suggesting a dose-response relationship.

INTERPRETATION

Our findings suggest that maternal childhood maltreatment experiences can be a risk factor for disease susceptibility in offspring across a variety of outcomes and emphasise the need for policies focusing on breaking the intergenerational transmission of adversity.

FUNDING

Environmental influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health.

Associations between trajectories of adolescent conduct problems and psychological well-being in young women

INTRODUCTION

Despite the clinical relevance, little is known about variability in positive adult outcomes (i.e., flourishing, life satisfaction) of female adolescent conduct problems (CP), or interpersonal factors that promote these types of well-being. We hypothesized differential associations between adolescent CP trajectories and indicators of adult well-being due to level of positive relationships with caregivers during ages 12-17.

METHOD

Data were drawn from participants (N = 1965) of the Pittsburgh Girls Study, a longitudinal study of girls' development. Caregiver reported CP, adolescent reports of parental trust and positive parenting, and adolescent-reported peer delinquency were assessed annually between ages 12-17. Well-being in young adulthood was measured using self-reported flourishing and life satisfaction between ages 18-22.

RESULTS

Latent class growth analysis of adolescent CP revealed four trajectories characterized as low stable (20.0%), moderate stable (63.9%), adolescent-onset (8.1%), and high quadratic (8.0%). Main effects of trust and positive relationships with caregivers during adolescence on well-being in early adulthood were found. Positive parenting was found to moderate the association between CP trajectory and flourishing. The magnitude of the negative association between the high quadratic trajectory group and life satisfaction decreased as positive parenting increased.

CONCLUSION

These results support the importance of intervention in adolescence to focus on increasing trusting and positive relationships with caregivers for all females, as this may increase well-being in adulthood regardless of adolescent CP history.

Mutualistic processes in the development of psychopathology: The special case of borderline personality disorder

Borderline personality disorder (BPD) is a serious mental illness characterized by instability in affective, cognitive, and interpersonal domains. BPD co-occurs with several mental disorders and has robust, positive associations with the general factors of psychopathology (p-factor) and personality disorders (g-PD). Consequently, some researchers have purported BPD to be a marker of p, such that the core features of BPD reflect a generalized liability to psychopathology. This assertion has largely stemmed from cross-sectional evidence and no research to date has explicated the developmental relationships between BPD and p. The present study aimed to investigate the development of BPD traits and the p-factor by examining predictions of two opposing frameworks: dynamic mutualism theory and the common cause theory. Competing theories were evaluated to determine which perspective best accounted for the relationship of BPD and p from adolescence into young adulthood. Data were drawn from the Pittsburgh Girls Study (PGS; N = 2,450) and included yearly self-assessments of BPD and other internalizing and externalizing indices from ages 14 to 21. Theories were examined using random-intercept cross-lagged panel models (RI-CLPMs) and network models. Results indicated that neither dynamic mutualism nor the common cause theory could fully explain the developmental relations between BPD and p. Instead, both frameworks were partially supported, with p found to strongly predict within-person change in BPD at several ages. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Preconception stress exposure from childhood to adolescence and birth outcomes: The impact of stress type, severity and consistency

The negative effects of prenatal stress on offspring health are well established, but there remains little understanding of the influence of stress prior to conception despite known effects on biological systems that are important for a healthy pregnancy. Furthermore, operational definitions of stress vary considerably, and exposure is often characterized via summed, ordinal scales of events. We hypothesized that type, severity, and consistency of preconception stress would be associated with birthweight and gestational age (GA) at birth. Data were drawn from a subsample of participants in the 21-year longitudinal Pittsburgh Girls Study (PGS, N = 2,450) that has followed women annually since childhood. Prior work in the PGS derived three domains of stress exposure between ages 7-17 years related to subsistence (e.g., resource strain, overcrowding), safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression). We tested the effects of dimensions of preconception stress on birthweight and GA among offspring of 490 PGS participants who delivered at age 18 or older (n = 490; 76% Black, 20% White, 4% Multiracial). Our hypotheses were partially supported with results varying by stress type and severity and by infant sex. Severity of preconception exposure to subsistence stress was prospectively associated with lower offspring birthweight (B = -146.94, SE = 69.07, 95% CI = -282.66, -11.22). The association between severity of caregiving stress in childhood and adolescence and GA at birth was moderated by infant sex (B = 0.85, SE = .41, 95% CI = 0.04, 1.66), suggesting greater vulnerability to this type of stress for male compared to female infants. Exposure to safety stressors did not predict birth outcomes. Infants of Black compared with White mothers had lower birthweight in all models regardless of preconception stress type, severity or consistency. However, we observed no moderating effects of race on preconception stress-birth outcome associations. Demonstrating specificity of associations between preconception stress exposure and prenatal health has the potential to inform preventive interventions targeting profiles of exposure to optimize birth outcomes.

Association of Severe Bronchiolitis during Infancy with Childhood Asthma Development: An Analysis of the ECHO Consortium

Objective: Many studies have shown that severe (hospitalized) bronchiolitis during infancy is a risk factor for developing childhood asthma. However, the population subgroups at the highest risk remain unclear. Using large nationwide pediatric cohort data, namely the NIH Environmental influences on Child Health Outcomes (ECHO) Program, we aimed to quantify the longitudinal relationship of bronchiolitis hospitalization during infancy with asthma in a generalizable dataset and to examine potential heterogeneity in terms of major demographics and clinical factors. Methods: We analyzed data from infants (age <12 months) enrolled in one of the 53 prospective cohort studies in the ECHO Program during 2001−2021. The exposure was bronchiolitis hospitalization during infancy. The outcome was a diagnosis of asthma by a physician by age 12 years. We examined their longitudinal association and determined the potential effect modifications of major demographic factors. Results: The analytic cohort consisted of 11,762 infants, 10% of whom had bronchiolitis hospitalization. Overall, 15% subsequently developed asthma. In the Cox proportional hazards model adjusting for 10 patient-level factors, compared with the no-bronchiolitis hospitalization group, the bronchiolitis hospitalization group had a significantly higher rate of asthma (14% vs. 24%, HR = 2.77, 95%CI = 2.24−3.43, p < 0.001). There was significant heterogeneity by race and ethnicity (Pinteraction = 0.02). The magnitude of the association was greater in non-Hispanic White (HR = 3.77, 95%CI = 2.74−5.18, p < 0.001) and non-Hispanic Black (HR = 2.39, 95%CI = 1.60−3.56; p < 0.001) infants, compared with Hispanic infants (HR = 1.51, 95%CI = 0.77−2.95, p = 0.23). Conclusions: According to the nationwide cohort data, infants hospitalized with bronchiolitis are at a higher risk for asthma, with quantitative heterogeneity in different racial and ethnic groups.

Physical and social anhedonia in female adolescents: A factor analysis of self-report measures

Anhedonia is a transdiagnostic symptom of psychopathology that includes diminished positive emotions and anticipation and enjoyment of reward, with particular salience during adolescence. However, the construct validity of anhedonia dimensions is not well established, thus limiting operationalization and generalization of the construct. We applied exploratory and confirmatory factor analyses to identify latent dimensions of anhedonia across four commonly used self-report measures covering different facets of anhedonic experience within a nonclinical sample of female adolescents across two waves of data collection (N = 173, Mage = 19.25; N = 147, Mage = 20.23). Factor analyses yielded a two-factor model with a physical anhedonia factor emphasizing enjoyment from physical sensations and a social anhedonia factor focusing on emotional connections with other people. These results have implications for the measurement of anhedonia in women's emotional well-being and mental health research, including research designed to identify facets of anhedonia that predict the onset, severity, and persistence of psychopathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Person-centered patterns of substance use during the COVID-19 pandemic and their associations with COVID-related impacts on health and personal finances in young Black and White women

BACKGROUND

Population-level statistics on pandemic-related change in substance use can obscure patterns of use (e.g., polysubstance use) within individuals. This longitudinal study used a person-centered approach to identify subgroups with respect to patterns of substance use prior to and during the COVID-19 pandemic, and to examine profile correlates (e.g., socio-demographic characteristics), which can inform tailored intervention.

METHODS

The two youngest age cohorts of the Pittsburgh Girls Study (n = 938; 59.1 % Black, 40.9 % White; mean age= 26.2 (SD= 0.8)), a longitudinal community sample, provided data on past year frequency of cigarette/e-cigarette use, binge drinking (>4 drinks per occasion), and cannabis use prior to and during the pandemic, and perceived change in use. Latent profile analysis identified subgroups. Profile correlates were examined (e.g., sociodemographics, COVID-19 infection status and reported exposure, COVID-19 impacts on psychological health and finances).

RESULTS

Seven profiles were identified: "Low use", "Occasional binge drinking", "Cannabis use", "Cigarette/e-cigarette & binge drinking", "Occasional binge drinking & cannabis", "Binge drinking & cannabis", and "Polysubstance use". Black women were overrepresented in "Low use", which was associated with fewer pandemic effects on health. Profiles associated with more frequent binge drinking were more likely to report COVID-19 infection, whereas "Cannabis use" had lower reported infection prevalence. "Polysubstance use" had more COVID-related depression and income loss, on average, than "Low use".

CONCLUSIONS

Distinct subgroups representing single substance use, co-use, and polysubstance use prior to and during the pandemic were identified. The profiles show differential response to COVID-19 impacts, ranging from relative hardiness to specific needs to guide personalized treatment.

Trajectories of depressive symptoms among mothers of preterm and full-term infants in a national sample

To examine postpartum depressive symptom trajectories from birth to age 5 and their risk factors in a national sample of mothers of preterm and full-term infants. The racially and ethnically diverse sample comprised 11,320 maternal participants (Mage = 29; SD = 5.9) in the Environmental influences on Child Health Outcomes (ECHO) Program in the USA with data on newborn gestational age at birth (≥ 22 weeks) and maternal depression symptoms during the first 5 years following childbirth. Growth mixture models determined the number and trajectory of postpartum depression classes among women in the preterm and full-term groups, and we examined predictors of class membership. Five trajectories described depressive symptoms for both groups; however, notable differences were observed. One in 5 mothers of preterm infants developed clinically relevant depressive symptoms over time compared with 1 in 10 mothers of full-term infants. Among women who delivered preterm compared with those who delivered full-term, symptoms were more likely to increase over time and become severe when offspring were older. Distinct subgroups describe mothers' depressive symptom trajectories through 5 years following childbirth. Mild to moderate depressive symptoms may onset or persist for many women beyond the initial postpartum period regardless of newborn gestational age at birth. For women with preterm infants, initially mild symptoms may increase to high levels of severity during the preschool and toddler years.

Indoor and outdoor air pollution and couple fecundability: a systematic review

BACKGROUND

Air pollution is both a sensory blight and a threat to human health. Inhaled environmental pollutants can be naturally occurring or human-made, and include traffic-related air pollution (TRAP), ozone, particulate matter (PM) and volatile organic compounds, among other substances, including those from secondhand smoking. Studies of air pollution on reproductive and endocrine systems have reported associations of TRAP, secondhand smoke (SHS), organic solvents and biomass fueled-cooking with adverse birth outcomes. While some evidence suggests that air pollution contributes to infertility, the extant literature is mixed, and varying effects of pollutants have been reported.

OBJECTIVE AND RATIONALE

Although some reviews have studied the association between common outdoor air pollutants and time to pregnancy (TTP), there are no comprehensive reviews that also include exposure to indoor inhaled pollutants, such as airborne occupational toxicants and SHS. The current systematic review summarizes the strength of evidence for associations of outdoor air pollution, SHS and indoor inhaled air pollution with couple fecundability and identifies gaps and limitations in the literature to inform policy decisions and future research.

SEARCH METHODS

We performed an electronic search of six databases for original research articles in English published since 1990 on TTP or fecundability and a number of chemicals in the context of air pollution, inhalation and aerosolization. Standardized forms for screening, data extraction and study quality were developed using DistillerSR software and completed in duplicate. We used the Newcastle-Ottawa Scale to assess risk of bias and devised additional quality metrics based on specific methodological features of both air pollution and fecundability studies.

OUTCOMES

The search returned 5200 articles, 4994 of which were excluded at the level of title and abstract screening. After full-text screening, 35 papers remained for data extraction and synthesis. An additional 3 papers were identified independently that fit criteria, and 5 papers involving multiple routes of exposure were removed, yielding 33 articles from 28 studies for analysis. There were 8 papers that examined outdoor air quality, while 6 papers examined SHS exposure and 19 papers examined indoor air quality. The results indicated an association between outdoor air pollution and reduced fecundability, including TRAP and specifically nitrogen oxides and PM with a diameter of ≤2.5 µm, as well as exposure to SHS and formaldehyde. However, exposure windows differed greatly between studies as did the method of exposure assessment. There was little evidence that exposure to volatile solvents is associated with reduced fecundability.

WIDER IMPLICATIONS

The evidence suggests that exposure to outdoor air pollutants, SHS and some occupational inhaled pollutants may reduce fecundability. Future studies of SHS should use indoor air monitors and biomarkers to improve exposure assessment. Air monitors that capture real-time exposure can provide valuable insight about the role of indoor air pollution and are helpful in assessing the short-term acute effects of pollutants on TTP.

Cardiometabolic Pregnancy Complications in Association With Autism-Related Traits as Measured by the Social Responsiveness Scale in ECHO

Prior work has examined associations between cardiometabolic pregnancy complications and autism spectrum disorder (ASD) but not how these complications may relate to social communication traits more broadly. We addressed this question within the Environmental Influences on Child Health Outcomes program, with 6,778 participants from 40 cohorts conducted from 1998-2021 with information on ASD-related traits via the Social Responsiveness Scale. Four metabolic pregnancy complications were examined individually, and combined, in association with Social Responsiveness Scale scores, using crude and adjusted linear regression as well as quantile regression analyses. We also examined associations stratified by ASD diagnosis, and potential mediation by preterm birth and low birth weight, and modification by child sex and enriched risk of ASD. Increases in ASD-related traits were associated with obesity (β = 4.64, 95% confidence interval: 3.27, 6.01) and gestational diabetes (β = 5.21, 95% confidence interval: 2.41, 8.02), specifically, but not with hypertension or preeclampsia. Results among children without ASD were similar to main analyses, but weaker among ASD cases. There was not strong evidence for mediation or modification. Results suggest that common cardiometabolic pregnancy complications may influence child ASD-related traits, not only above a diagnostic threshold relevant to ASD but also across the population.

Associations between combined exposure to environmental hazards and social stressors at the neighborhood level and individual perinatal outcomes in the ECHO-wide cohort

Limited studies examine how prenatal environmental and social exposures jointly impact perinatal health. Here we investigated relationships between a neighborhood-level combined exposure (CE) index assessed during pregnancy and perinatal outcomes, including birthweight, gestational age, and preterm birth. Across all participants, higher CE index scores were associated with small decreases in birthweight and gestational age. We also observed effect modification by race; infants born to Black pregnant people had a greater risk of preterm birth for higher CE values compared to White infants. Overall, our results suggest that neighborhood social and environmental exposures have a small but measurable joint effect on neonatal indicators of health.

Factor structure of the Outness Inventory in a sample of Black and White lesbian and bisexual young adult women

Introduction

The Outness Inventory (OI; Mohr & Fassinger, 2000) is the most commonly used measure for assessing an individual's level of outness, or openness about sexual identity. However, data on the validity of the OI factor structure across diverse populations is limited. The present study aimed to test the factor structure of the OI in a population-based sample of Black and White young adult women.

Method

Participants included 319 lesbian and bisexual women drawn from the Pittsburgh Girls Study (PGS), a large longitudinal study of 5- to 8-year-old girls (53% Black) oversampled from low-income neighborhoods and followed through adulthood. Participants completed the 11-item OI at ages 20-23 years. Confirmatory factor analyses evaluated measurement invariance of the OI across race and suggested significant differences in factor structure between Black and White sexual minority women. Exploratory factor analyses were conducted separately by race.

Results

An EFA revealed three factors for the Black subsample: Family, Straight Friends, and Work/Strangers. Three factors also emerged for the White subsample, representing Familiar Acquaintances, Less Familiar Acquaintances, and Work.

Conclusion

Additional research is needed to investigate potential culturally-based differences in domains of disclosure, which may help to better understand how specific contexts of outness relate to mental health.

A Longitudinal Study of Differences in Perceived Parenting Practices Between Sexual Minority and Heterosexual Girls

Parental warmth and control are consistent and persistent correlates of adolescent health and may be particularly important for sexual minority girls, who experience higher rates of adverse health outcomes than their heterosexual peers. Differences in perceptions of parental trust, positivity, supervision, and discipline from ages 11-17 years were examined between sexual minority and heterosexual girls using data from the Pittsburgh Girls Study, a longitudinal, community-based study. Results indicated that sexual minority girls reported lower levels of parental trust and positivity compared to heterosexual girls beginning in mid-adolescence; differences in supervision were present at age 11 years and persisted over time. Further investigation of this perceived difference is warranted given the importance of familial support for health promotion.

Capturing the dynamic nature of stress exposure in the Pittsburgh Girls Study

Background

The science of stress exposure and health in humans has been hampered by differences in operational definitions of exposures and approaches to defining timing, leading to results that lack consistency and specificity. In the present study we aim to empirically derive variability in type, timing and chronicity of stress exposure for Black and White females using prospectively collected data in the Pittsburgh Girls Study (PGS).

Methods

The PGS is an ongoing 20-year longitudinal, community-based study. In this paper we focused on annual caregiver reports of three domains of stress: subsistence (e.g., resource strain, overcrowding); safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression) from early childhood through adolescence. Z-scores were used to conduct a finite mixture model-based latent class trajectory analysis. Model fit was compared using the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). We examined differences in timing and chronicity of stress exposure between Black and White girls.

Results

Distinct trajectory groups characterized by differential timing and chronicity of stress exposure were observed across all stress domains. Six trajectories characterized subsistence and safety stress, and five characterized caregiving stress. Variability in initial level, chronicity, and magnitude and timing of change was observed within and across domains of stressors. Race differences also varied across the domains: race differences in timing and chronicity were most pronounced for the subsistence and safety domains, whereas Black and White girls had similar levels of exposure to caregiving stress.

Conclusions

Substantial variability in timing and chronicity was observed within and across stress domains. Modeling specific domains and dimensions of stress exposure is likely important in testing associations between exposure and health; such specificity may lead to more effective deployment of preventive interventions based on stress exposure.

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Distinct trajectories in exposure were observed for subsistence, safety, and caregiving stress domains.

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Race differences in timing and chronicity of exposure were pronounced for subsistence and safety domains.

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Patterns of exposure (e.g., level, timing) are likely critical for understanding the impact on stress exposure on health.

Regional and sociodemographic differences in average BMI among US children in the ECHO program

OBJECTIVE

The aim of this study was to describe the association of individual-level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region and variation in child BMI by region.

METHODS

This study used pooled data from 25 prospective cohort studies. Region of residence (Northeast, Midwest, South, West) was based on residential zip codes. Age- and sex-specific BMI z scores were the outcome.

RESULTS

The final sample included 14,313 children with 85,428 BMI measurements, 49% female and 51% non-Hispanic White. Males had a lower average BMI z score compared with females in the Midwest (β = -0.12, 95% CI: -0.19 to -0.05) and West (β = -0.12, 95% CI: -0.20 to -0.04). Compared with non-Hispanic White children, BMI z score was generally higher among children who were Hispanic and Black but not across all regions. Compared with the Northeast, average BMI z score was significantly higher in the Midwest (β = 0.09, 95% CI: 0.05 to 0.14) and lower in the South (β = -0.12, 95% CI: -0.16 to -0.08) and West (β = -0.14, 95% CI: -0.19 to -0.09) after adjustment for age, sex, race/ethnicity, and birth weight.

CONCLUSIONS

Region of residence was associated with child BMI z scores, even after adjustment for sociodemographic characteristics. Understanding regional influences can inform targeted efforts to mitigate BMI-related disparities among children.