Studying the Environment’s Impact on Pediatric Health Outcomes

A massive population database is expected to inform and transform children’s health outcomes.

Researchers from Nationwide Children’s Hospital and The Ohio State University are focusing on how early exposures might be associated with areas such as neurodevelopment and cardiovascular outcomes as part of a large national study, Environmental influences on Child Health Outcomes (ECHO) Program.

The interdisciplinary team just completed their first year recruiting participants and collecting data to answer crucial questions about how early environmental influences affect child health and development.

“We’re just starting to better understand how cardiometabolic risk factors and even social risk factors, like unemployment, insurance, education, health care access and food insecurity during pregnancy, can impact lifelong health outcomes. This study aims to advance that understanding in a novel way,” says Kartik Venkatesh, MD, PhD, associate professor of Obstetrics and Gynecology at The Ohio State University College of Medicine.

Dr. Venkatesh is joined by collaborators Sarah Keim, PhD, MA, MS, principal investigator in the Center for Biobehavioral Health at the Abigail Wexner Research Institute (AWRI) at Nationwide Children’s; Jonathan Slaughter, MD, MPH, principal investigator in the Center for Perinatal Research at Nationwide Children’s; and Courtney Lynch, PhD, MPH, associate professor of reproductive and perinatal epidemiology at The Ohio State University College of Medicine.

The researchers will follow children from post-conception through age 21 by collecting data from the parents, children and the environment. The goal is to improve and inform children’s health for generations. Researchers will collect samples from the parents and the children, including saliva, blood, placenta, hair, stool, clipped nails and even baby teeth.

The Ohio scientists also plan to compare what they learn from patient biospecimen samples and survey questions to geographic data gathered from zip codes, such as air quality and water pollutants.

The research team joins 45 centers from around the country participating in the ECHO Cohort. Nationwide Children’s and Ohio State make up the only Ohio center and are funded by a seven-year $17.7 million grant. The data collected in the study is being used to build a national pediatric health database with data from 55,000 children and 20,000 pregnancies enrolled by 2030 – including 850 children from central Ohio.

Nothing of the ECHO study’s kind has existed in the United States since the Collaborative Perinatal Project in the 1960s when researchers had access to significantly less data. ECHO’s observational and intervention research will inform high-impact programs, policies and practices for years to come.

Scientists at Ohio State began in 2024 enrolling pregnant patients and their partners. Researchers at Nationwide Children’s will follow them through age 21.

The Ohio researchers are currently focusing on how the birth parents’ cardiometabolic health during pregnancy influence childhood neurodevelopment and behavior. They anticipate conducting additional studies in the future.

The national consortium brings diverse participant populations together into one large ECHO Cohort that scientists can use to address research questions about the effects of early environmental exposures on child health and development – questions that no smaller study can answer alone.

“For a lot of important questions about children’s health, we need a large number of children to be able to determine the potential causes and identify ways to prevent disease or promote good health,” says Dr. Keim.

As the study continues over the next two decades, researchers will likely investigate questions that no one has anticipated at the study’s outset. Additional grants will be offered on an ongoing basis.

Right Time, Right Place

The time is particularly ripe for taking a comprehensive look at the effect of environmental exposures on children’s health outcomes. Scientists understand more about genetics and the microbiome than ever before.

And many people are more aware of the impact of social determinants of health.

“We realize that your neighborhood where you grew up, your identity, sexuality, race and ethnicity are really important exposures for your overall experience in life,” says Dr. Slaughter, principal investigator on the ECHO study for the Ohio cohort.

Digital technology such as smartwatches, remote digital monitors and telehealth make monitoring study participants easier and less intrusive than ever.

Ultimately, says Dr. Slaughter, the ECHO cohort will help researchers improve children’s lives by understanding what exposures during pregnancy and childhood influence health outcomes.

“When we’re making choices about what to focus on as a society, this will be the study that gives us the information we need to help improve children and how they grow in America,” he says.

Ohio Cohort Ideal for Diverse Population Study

Central Ohio residents come from urban and rural areas throughout the Midwest and from countries worldwide. The city’s steady population growth and diverse communities make Columbus an ideal location for the study.

“Our area’s diverse population means we’ve got participants from Appalachia, the Midwest and from other parts of the world, including Somalia and Nepal. Columbus is a microcosm of the United States,” says Dr. Slaughter.

Ohioans in three OSU-Wexner Medical Center clinics representing urban, suburban and rural areas are invited to join the study. Participants need to be less than 20 weeks pregnant to qualify.

Ohio parents have been eager to join the study and exceeded year-one recruitment goals of 75 pregnant individuals.

“There’s a growing consensus that what happens during pregnancy can have a profound impact on children, but this is going to another level of breadth and depth of information that will better inform parents on how to give their children the best possible start,” says Dennis Durbin, MD, MSCE, president of AWRI at Nationwide Children’s.

For the four Ohio investigators and their team, ECHO is a once-in-a-career opportunity to contribute to data that will inform research for decades to come.

“This is a transformative study to understand important pregnancy and early life exposures on later childhood outcomes – something that doesn’t currently exist in the United States,” says Dr. Venkatesh.

Close, Productive Collaboration

The researchers from Nationwide Children’s and Ohio State have a rich history of collaboration, including recruiting patients from pregnancy through birth and studying the same infants and children.

Ohio State features a large infrastructure for recruiting and enrolling pregnant patients, with research assistants actively recruiting and gathering samples from clinics and on the labor and delivery unit 24/7.

“You don’t know when someone will show up to deliver, so it could be really hard to capture samples if you don’t have someone already there,” says Dr. Lynch.

Once patients deliver, they can expect a warm handoff from the Ohio State team to the Nationwide Children’s researchers.

“We always like to find research opportunities where we can blend the expertise from Nationwide Children’s with the complementary expertise from Ohio State because together, we can always do more impactful work than either one can do alone,” says Dr. Durbin.

Into the Unknown

Access to the massive pediatric database can help answer a broad range of questions. For example, there’s a constant debate about whether obesity is caused by nature versus nurture.

“We don’t have a good sense of how much genetics plays into the increasing obesity epidemic. That’s something we’ll be able to answer at ECHO because we will have the biological data of these individuals, the social and the environmental data,” says Dr. Lynch.

Dr. Venkatesh, a high-risk obstetrician and perinatal epidemiologist, says the research questions he and the Ohio team are asking in ECHO are highly relevant.

“I encounter these questions in my conversations with colleagues and patients, and often, it’s really hard to get robust, high-quality scientific data,” he says.

Dr. Lynch is one of only a handful of reproductive and perinatal epidemiologists studying the impact of stress and mood disorders on reproductive outcomes. She anticipates that having better data on what early exposures mean for the risk of pregnancy loss, preterm birth and a child’s future health could help doctors better advise people.

“We hope to provide data that can help pediatricians offer anticipatory guidance to families about how to help keep your family healthy,” says Dr. Lynch.

Dr. Keim, who studies how prenatal health impacts children’s health outcomes, says, “ECHO fits in well with work I’ve been doing my whole career because it takes a holistic lifespan view of children’s health by not just looking at the child in isolation, but considers their whole family and all kinds of aspects of their environment.”

Ultimately, what researchers will study from ECHO remains to be determined. “When you see big studies about children’s exposures during pregnancy and childhood around the country, they’ll be coming from this database. There are studies we haven’t even thought of yet that will be done based on the data we collected,” says Dr. Slaughter.

“We have to stay open-minded and follow the science because it would be shortsighted to have all our ideas laid out now while this continues until the children turn 21. The ways we’re going to use it are already evolving,” says Dr. Keim.

Dr. Keim has worked on a study of children born in the 1960s in her research and now imagines a future where some ECHO babies grow up to become scientists using the massive dataset they helped build.

“Maybe they’ll be curious and want to learn about themselves and their friends, and this shows them what science can do to help kids and communities,” she says.

This article appeared in the 2025 Spring/Summer issue. Download the issue here.

Image credits: Nationwide Children’s