Cohort profile: The ECHO prenatal and early childhood pathways to health consortium (ECHO-PATHWAYS)

Kaja Z. Lewinn, Catherine J. Karr, Marnie Hazlehurst, Kecia Carroll, Christine Loftus, Ruby Nguyen, Emily Barrett, Shanna H. Swan, Adam A. Szpiro, Alison Paquette, Paul Moore, Elizabeth Spalt, Lisa Younglove, Alexis Sullivan, Trina Colburn, Nora Byington, Lauren Sims Taylor, Stacey Moe, Sarah Wang, Alana CordeiroAria Mattias, Jennifer Powell, Tye Johnson, Amanda Norona-Zhou, Ale X. Mason, Nicole R. Bush, Sheela Sathyanarayana

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Purpose Exposures early in life, beginning in utero, have long-term impacts on mental and physical health. The ECHO prenatal and early childhood pathways to health consortium (ECHO-PATHWAYS) was established to examine the independent and combined impact of pregnancy and childhood chemical exposures and psychosocial stressors on child neurodevelopment and airway health, as well as the placental mechanisms underlying these associations. Participants The ECHO-PATHWAYS consortium harmonises extant data from 2684 mother-child dyads in three pregnancy cohort studies (CANDLE [Conditions Affecting Neurocognitive Development and Learning in Early Childhood], TIDES [The Infant Development and Environment Study] and GAPPS [Global Alliance to Prevent Prematurity and Stillbirth]) and collects prospective data under a unified protocol. Study participants are socioeconomically diverse and include a large proportion of Black families (38% Black and 51% White), often under-represented in research. Children are currently 5-15 years old. New data collection includes multimodal assessments of primary outcomes (airway health and neurodevelopment) and exposures (air pollution, phthalates and psychosocial stress) as well as rich covariate characterisation. ECHO-PATHWAYS is compiling extant and new biospecimens in a central biorepository and generating the largest placental transcriptomics data set to date (N=1083). Findings to date Early analyses demonstrate adverse associations of prenatal exposure to air pollution, phthalates and maternal stress with early childhood airway outcomes and neurodevelopment. Placental transcriptomics work suggests that phthalate exposure alters placental gene expression, pointing to mechanistic pathways for the developmental toxicity of phthalates. We also observe associations between prenatal maternal stress and placental corticotropin releasing hormone, a marker of hormonal activation during pregnancy relevant for child health. Other publications describe novel methods for examining exposure mixtures and the development of a national spatiotemporal model of ambient outdoor air pollution. Future plans The first wave of data from the unified protocol (child age 8-9) is nearly complete. Future work will leverage these data to examine the combined impact of early life social and chemical exposures on middle childhood health outcomes and underlying placental mechanisms.

Original languageEnglish
Article numbere064288
JournalBMJ Open
Issue number10
StatePublished - 21 Oct 2022


  • developmental neurology & neurodisability
  • fetal medicine
  • paediatric thoracic medicine
  • public health


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