Advancing Understanding of Chemical Exposures and Maternal-child Health Through the U.S. Environmental Influences on Child Health Outcomes (ECHO) Program: A Scoping Review
Authors: Barrett Emily S. , Ames Jennifer L. , Eick Stephanie M. , Peterson Alicia K. , Rivera-Núñez Zorimar , Starling Anne P. , Buckley Jessie P. ,   for the ECHO Cohort Consortium, O‟Brien Barbara , Peterson Lisa , Parsons Patrick , Kurunthacalam Kannan , Arora Manish , Fennell Timothy R. , Sumner Susan J. , Du Xiuxia , Teitelbaum Susan L. , Wright Robert O. , Stapleton Heather M. , Ferguson P. Lee , Alshawabkeh Akram , Aschner Judy , Blair Clancy , Trasande Leonardo , Camargo Carlos , Dabelea Dana , Mitchell Daphne Koinis , Duarte Cristiane , Dunlop Anne , Elliott Amy , Ferrara Assiamira , Gern James , Breton Carrie , Hertz-Picciotto Irva , Hipwell Alison , Karagas Margaret , Karr Catherine , Lester Barry , Leve Leslie , MacKenzie Debra , Weiss Scott , McEvoy Cynthia , Lyall Kristen , O‟Connor Thomas , Oken Emily , O‟Shea Mike , Kerver Jean , Herbstman Julie , Schantz Susan , Stanford Joseph , Trasande Leonardo , Wright Rosalind , Sathyanarayana Sheela , Singh Anne Marie , Stroustrup Annemarie , Hartert Tina , Straughen Jennifer , Zhao Qi , Rivera-Spoljaric Katherine , Barrett Emily S , Hedderson Monique Marie , Hunt Kelly J , Mumford Sunni L , Nguyen Hong-Ngoc , Santos Hudson , Schmidt Rebecca , Slaughter Jonathan 
Published: July 2024

Abstract
Purpose of Review
Environmental chemical exposures may disrupt child development, with long-lasting health impacts. To date, U.S. studies of early environmental exposures have been limited in size and diversity, hindering power and generalizability. With harmonized data from over 60,000 participants representing 69 pregnancy cohorts, the National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) Program is the largest study of U.S. children’s health. Here, we: (1) review ECHO-wide studies of chemical exposures and maternal-child health; and (2) outline opportunities for future research using ECHO data.

Recent Findings
As of early 2024, in addition to over 200 single-cohort (or award) papers on chemical exposures supported by ECHO, ten collaborative multi-cohort papers have been made possible by ECHO data harmonization and new data collection. Multi-cohort papers have examined prenatal exposure to per- and polyfluoroalkyl substances (PFAS), phthalates, phenols and parabens, organophosphate esters (OPEs), metals, melamine and aromatic amines, and emerging contaminants. They have primarily focused on describing patterns of maternal exposure or examining associations with maternal and infant outcomes; fewer studies have examined later child outcomes (e.g., autism) although follow up of enrolled ECHO children continues. The NICHD’s Data and Specimen Hub (DASH) database houses extensive ECHO data including over 470,000 chemical assay results and complementary data on priority outcome areas (pre, peri-, and postnatal, airway, obesity, neurodevelopment, and positive health), making it a rich resource for future analyses.

Summary
ECHO’s extensive data repository, including biomarkers of chemical exposures, can be used to advance our understanding of environmental influences on children’s health. Although few published studies have capitalized on these unique harmonized data to date, many analyses are underway with data now widely available.