Importance:Although fluoride exposure at high levels during the perinatal period has been associated with socioemotional problems among children, there is limited evidence regarding potential associations at lower levels of fluoride exposure, particularly in the US. Objective:To examine the association between prenatal exposure to public drinking water fluoride levels and children's socioemotional problems in a pooled US pediatric consortium. Design, Setting, and Participants:This cohort study used observational pregnancy cohort data from January 1, 2005, to December 31, 2019, on children aged 1.5 to 17 years from the Environmental Influences on Child Health Outcomes (ECHO) Cohort, which took place at 20 prenatal pediatric cohort sites across 34 US states. Statistical analysis was conducted from December 2024 to December 2025. Exposure:Area-level, time-weighted, mean fluoride concentrations in public water were estimated based on residential addresses during pregnancy. Main Outcomes and Measures:Children's socioemotional problems were assessed using caregiver reports of internalizing and externalizing problems via the Child Behavior Checklist. Generalized estimating equation models evaluated the adjusted mean difference in T scores (1) across the range of exposure values in cubic spline models, (2) per 500.0-µg/L higher fluoride level in linear models, (3) across quartiles of exposure, and (4) at the US Public Health Services recommended cutoff (≤700.0 µg/L; 3998 less than the cutoff). Results:The cohort comprised 5520 children (mean [SD] age, 5.8 [3.0] years; 2849 boys [51.6%]). The mean (SD) prenatal time-weighted water fluoride level was 407.9 (361.0) µg/L (range, <1.4-3272.5 µg/L). The adjusted mean difference in emotional and behavioral problem T scores per 500.0-μg/L higher exposure to prenatal public water fluoride was -0.15 (95% CI, -0.85 to 0.56) for internalizing problems and 0.06 (95% CI, -0.44 to 0.55) for externalizing problems, consistently showing no associations at the continuous level. However, some positive associations were observed only when using change point models for externalizing problems (adjusted mean difference, 1.59 [95% CI, 0.72-2.47] per 500.0-µg/L increase above the inflection point), and for some subgroups. Conclusions and Relevance:In this cohort study, prenatal exposure to fluoride levels in regulated public water was not associated with internalizing and externalizing problems among offspring. In change point models, positive associations were found for externalizing problems. The results contribute to growing evidence that could inform future policy decisions regarding fluoride in the US public water systems. Additional studies are needed to further investigate this association, especially examining other sources of fluoride that may have an association with children's emotional and behavioral problems.

Background:Adverse childhood experiences (ACEs) are prevalent and have long-term effects on regulation, stress, and health. Given the heightened physiological and psychological vulnerability of pregnancy, early life adversity may increase susceptibility to traumatic stress during crisis, such as the COVID-19 pandemic. Objective:To evaluate associations between maternal ACE exposure and prenatal pandemic-related traumatic stress (PTS) measured by symptom count and domains. Methods:This secondary analysis included baseline data collected from a longitudinal cohort of 424 pregnant individuals receiving prenatal care in Kaiser Permanente Northern California between August 2020 and April 2021. ACEs were measured with the Adverse Childhood Experiences Questionnaire and dichotomized ≥3 versus <3 exposures, and by type (abuse, neglect, household dysfunction, violence in home). PTS was evaluated using the 9-item PTS Scale, capturing intrusion, avoidance, arousal, and dissociation. Linear and log-binomial regression models estimated associations between ACEs and PTS, adjusting for covariates. Results:Participants with ≥3 ACEs reported more traumatic stress symptoms (mean difference [MD]: 1.1; 95% confidence interval [CI]: 0.6,1.7) and significantly higher PTS scores (MD: 3.5; 95% CI: 2.0,5.0). After adjustment, higher ACE exposure was associated with elevated intrusion (risk ratio [RR]: 2.03; 95% CI: 1.34-3.07) and dissociation (RR: 1.54; 95% CI: 1.26-1.88) symptoms. Abuse, neglect, and household dysfunction were independently associated with higher total prenatal PTS scores; abuse and neglect were associated with increased dissociative symptoms, and household dysfunction was associated with higher intrusion and arousal symptoms. Conclusions:Higher ACE exposure was associated with increased prenatal PTS, with distinct risk patterns across ACE domains. Findings underscore the importance of trauma-informed, ACE-aware prenatal care models, especially during public health emergencies.

Objective: Although extant research points to nonverbal learning disability (NVLD) as a distinct disorder, it is not included in the diagnostic nomenclatures, and there is heterogeneity in how it is defined. A working group was formed to gain consensus on a standard DSM-type definition for NVLD, a necessary first step for proposing its inclusion in future DSM editions, and the disorder was renamed to better reflect the core deficit-visual-spatial problems. Method: An iterative process was used to reach consensus on a DSM-style criteria set that reconceptualizes NVLD as developmental visual-spatial disorder (DVSD). This process, similar to that used during the DSM-5 revision, included working with an advisory group of NVLD experts and obtaining feedback from experts in youth psychiatric diagnosis and child and adolescent mental health practitioners. Data on stakeholder acceptance of the new name were collected from adults who self-identify as having NVLD and parents of youth with NVLD. Results: During the iterative process, the criteria set shifted from syndromic, multi-area, and quantitative to single focused and more clinically oriented, conceptualizing individuals with the disorder as having persistent deficits in a single area-processing or integrating visual and spatial information. This fills a gap in the DSM system, which includes diagnoses underpinned by problems in other cognitive domains. Data indicate stakeholder acceptance of the name. Conclusion: A standard definition for NVLD, reconceptualized as DVSD and included in DSM, will lead to improved identification of youth with clinically significant visual-spatial deficits and associated functional impairment and improve research in the area. Plain language summary: Inclusion of nonverbal learning disability (NVLD) in the DSM would lead to improved identification of individuals with significant visual-spatial deficits and encourage research. Before a mental health disorder can be included in the DSM, it must be defined in a way that a wide range of clinicians can use. The authors report on a multiyear, iterative process used to formulate a behaviorally defined, clinically oriented DSM-style criteria set for NVLD, which included input from experts on NVLD and child psychiatric diagnoses and from mental health practitioners, resulting in NVLD being reconceptualized as "developmental visual spatial disorder" (DVSD). This criteria set will be included in a proposal to the DSM to include DVSD as a "condition for further study." Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Prevalence of autism diagnosis has historically differed by demographic factors. Using data from 8224 participants drawn from the Environmental influences on Child Health Outcomes (ECHO) Program, we examined relationships between demographic factors and parent-reported autism-related traits as captured by the Social Responsiveness Scale (SRS; T score > 65) and compared these to relations with parent-reported clinician diagnosis of ASD, in generalized linear mixed effects regression analyses. Results suggested lower odds of autism diagnosis, but not of SRS T > 65, for non-Hispanic Black children (adjusted odds ratio [OR] = 0.76, 95% CI 0.55, 1.06) relative to non-Hispanic White children. Higher maternal education was associated with reduced odds of both outcomes (OR = 0.73, 95% CI 0.51, 1.05 for ASD autism diagnosis and 0.4, 95% CI 0.29, 0.55 for SRS score). In addition, results suggested a lower likelihood of autism diagnosis but a higher likelihood of an SRS score > 65 in Black girls. Findings suggest lower diagnostic recognition of autism in non-Hispanic Black children, despite a similar degree of SRS-assessed autism-related traits falling in the clinically elevated range. Further work is needed to address this disparity.

Importance:Studies suggest developmental concerns for infants born during the COVID-19 pandemic, but evidence on its impact on toddler behavioral and emotional well-being remains limited. Objective:To assess whether birth timing relative to the COVID-19 pandemic is associated with toddler internalizing and externalizing problems. Design, Setting, and Participants:This retrospective cohort study utilized Environmental Influences on Child Health Outcomes (ECHO) cohort data collected between September 27, 2009, and July 21, 2023. Children were divided into 3 groups: the prepandemic group, who were born and assessed before March 13, 2020; the pandemic-assessed group, who were born before March 13, 2020, but assessed after that date; and the pandemic-born group, who were born and assessed on or after March 13, 2020. Data were collected from 9 ECHO cohort sites across the United States and Puerto Rico. Exposure:The COVID-19 pandemic, designated as starting on March 13, 2020. Main Outcome and Measure:Parent-reported internalizing and externalizing symptoms on the Preschool Child Behavior Checklist (CBCL 1½-5) at age 18 to 39 months. Results:The 3438 children (mean [SD] age, 2.33 years [5.38 months]; 1770 [51.5%] male; 537 [16.2%] Black, 1722 [50.1%] Hispanic; and 1538 [44.7%] White) were divided into 3 groups: 1323 in the prepandemic group (mean [SD] age, 2.41 years [5.66 months]); 1690 in the pandemic-assessed group (mean [SD] age, 2.32 years [5.16 months]); and 425 in the pandemic-born group (mean [SD] age, 2.14 years [4.47 months]). Both the pandemic-assessed group (unadjusted β = -1.51; 95% CI, -2.27 to -0.75; adjusted β = -1.73; 95% CI, -2.48 to -0.99) and the pandemic-born group (unadjusted β = -2.03; 95% CI, -3.13 to -0.93; adjusted β = -1.90; 95% CI, -2.99 to -0.80) had lower levels of internalizing problems compared with the prepandemic (ie, historical) group. Similarly, both the pandemic-assessed (unadjusted β = -1.74; 95% CI, -2.46 to -1.02; adjusted β = -1.81; 95% CI, -2.53 to -1.09) and the pandemic-born group (unadjusted β = -3.16; 95% CI, -4.20 to -2.12; adjusted β = -3.17; 95% CI, -4.22 to -2.12) each had lower levels of externalizing problems compared with the prepandemic group. Conclusions and Relevance:In this study, toddlers with prenatal and postnatal as well as those with only postnatal COVID-19 pandemic exposure showed fewer internalizing and externalizing problems than those born and assessed prior to the onset of the pandemic. These findings underscore the need for further research to identify protective factors that may buffer the impact of the pandemic on child behavior.

Background: Irritability affects up to 20% of youth and is a primary reason for referral to pediatric mental health clinics. Irritability is thought to be associated with disruptions in processing of reward, threat, and cognitive control; however, empirical study of these associations at both the behavioral and neural level have yielded equivocal findings that may be driven by small sample sizes and differences in study design. Associations between irritability and brain connectivity between cognitive control and reward- or threat-processing circuits remain understudied. Furthermore, better inhibitory control has been linked to lower irritability and differential neural functioning among irritable youth, suggesting that good inhibitory control may serve as a protective factor. Methods: We hypothesized that higher irritability scores would be associated with less positive (or negative) connectivity between cognitive control and threat-processing circuits and between cognitive control and reward-processing circuits in the Healthy Brain Network dataset (release 10.0; N = 4135). We also hypothesized that these associations would be moderated by inhibitory control such that weaker associations between irritability and connectivity would be detected in youths with better than with worse inhibitory control. Regression models were used to test whether associations between irritability and between-network connectivity were moderated by inhibitory control. Results: Counter to our hypothesis, we detected higher irritability associated with reduced connectivity between threat- and reward-processing and cognitive control networks only in 5- to 9-year-old boys. Inhibitory control did not moderate associations of irritability with between-network connectivity. Conclusions: Exploratory findings indicate that reduced between-network connectivity may underlie difficulty regulating negative emotions, leading to greater irritability.

Abstract Background Research and clinical practice rely heavily on caregiver‐report measures, such as the Child Behavior Checklist 1.5–5 (CBCL/1.5‐5), to gather information about early childhood behavior problems and to screen for child psychopathology. While studies have shown that demographic variables influence caregiver ratings of behavior problems, the extent to which the CBCL/1.5‐5 functions equivalently at the item level across diverse samples is unknown. Methods Item‐level data of CBCL/1.5‐5 from a large sample of young children (N = 9087) were drawn from 26 cohorts in the Environmental influences on Child Health Outcomes program. Factor analyses and the alignment method were applied to examine measurement invariance (MI) and differential item functioning (DIF) across child (age, sex, bilingual status, and neurodevelopmental disorders), and caregiver (sex, education level, household income level, depression, and language version administered) characteristics. Child race was examined in sensitivity analyses. Results Items with the most impactful DIF across child and caregiver groupings were identified for Internalizing, Externalizing, and Total Problems. The robust item sets, excluding the high DIF items, showed good reliability and high correlation with the original Internalizing and Total Problems scales, with lower reliability for Externalizing. Language version of CBCL administration, education level and sex of the caregiver respondent showed the most significant impact on MI, followed by child age. Sensitivity analyses revealed that child race has a unique impact on DIF over and above socioeconomic status. Conclusions The CBCL/1.5‐5, a caregiver‐report measure of early childhood behavior problems, showed bias across demographic groups. Robust item sets with less DIF can measure Internalizing and Total Problems equally as well as the full item sets, with slightly lower reliability for Externalizing, and can be crosswalked to the metric of the full item set, enabling calculation of normed T scores based on more robust item sets.

Studies examining the neurocognitive and circuit-based etiology of psychiatric illness are moving toward inclusive, global designs. A potential confounding effect of these associations is general intelligence; however, an internationally validated, harmonized intelligence quotient (IQ) measure is not available. We describe the procedures used to measure IQ across a five-site, multinational study and demonstrate the harmonized measure's cross-site validity. Culturally appropriate intelligence measures were selected: four short-form Wechsler intelligence tests (Brazil, Netherlands, South Africa, United States) and the Binet Kamat (India). Analyses included IQ scores from 255 healthy participants (age 18-50; 42% male). Regression analyses tested between-site differences in IQ scores, as well as expected associations with sociodemographic factors (sex, socioeconomic status, education) to assess validity. Harmonization (e.g., a priori selection of tests) yielded the compatibility of IQ measures. Higher IQ was associated with higher socioeconomic status, suggesting good convergent validity. No association was found between sex and IQ at any site, suggesting good discriminant validity. Associations between higher IQ and higher years of education were found at all sites except the United States. Harmonized IQ scores provide a measure of IQ with evidence of good validity that can be used in neurocognitive and circuit-based studies to control for intelligence across global sites.

BackgroundLow mitochondria DNA copy number (mtDNAcn) has been linked to cognitive decline. However, the role of mtDNAcn in healthy cognitive development is unclear. We hypothesized early-life mtDNAcn would be associated with children's learning and memory.MethodsWe quantified mtDNAcn in umbilical cord blood and child blood at ages 5-7 from participants in a prospective birth cohort. We administered the Children's Memory Scale (CMS) at ages 9-14 (N = 342) and the Wechsler Intelligence Scale for Children (WISC-IV) at ages 7 and 9 (N = 457). Associations between mtDNAcn tertiles and CMS and WISC were evaluated with linear regression and linear mixed-effects models, respectively. We examined non-linear associations using generalized additive mixed models.ResultsRelative to the middle tertile of mtDNAcn, lower childhood mtDNAcn was associated with lower WISC Working Memory (beta = -2.65, 95% CI [-5.24, -0.06]) and Full-Scale IQ (beta = -3.71 [-6.42, -1.00]), and higher CMS Visual Memory (beta = 4.70 [0.47, 8.93]). Higher childhood mtDNAcn was linked to higher CMS Verbal Memory (beta = 7.75 [2.50, 13.01]). In non-linear models, higher childhood mtDNAcn was associated with lower WISC Verbal Comprehension.ConclusionsOur study provides novel evidence that mtDNAcn measured in childhood is associated with children's neurocognitive performance. mtDNAcn may be a marker of healthy child development.ImpactMitochondrial DNA copy number (mtDNAcn) may serve as a biomarker for early-life neurocognitive performances in the children's population.Both low and high mtDNAcn may contribute to poorer neurocognition, reflected through learning and memory abilities.This research elucidated the importance of investigating mitochondrial biomarkers in healthy populations and facilitated advancements of future studies to better understand the associations between mitochondrial markers and adverse children's health outcomes.

Journal Article Cohort Profile: The Mothers and Newborns (MN) Cohort of the Columbia Center for Children's Environmental Health Get access Kylie W Riley, Kylie W Riley Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA https://orcid.org/0000-0001-6604-2826 Search for other works by this author on: Oxford Academic PubMed Google Scholar Jia Guo, Jia Guo Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Shuang Wang, Shuang Wang Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Pam Factor-Litvak, Pam Factor-Litvak Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Rachel L Miller, Rachel L Miller Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Howard Andrews, Howard Andrews Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Lori A Hoepner, Lori A Hoepner Department of Environmental and Occupational Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Amy E Margolis, Amy E Margolis Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Virginia Rauh, Virginia Rauh Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Andrew Rundle, Andrew Rundle Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Frederica Perera, Frederica Perera Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Julie B Herbstman Julie B Herbstman Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA Corresponding author. Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10128, USA. E-mail: jbh2678@cumc.columbia.edu Search for other works by this author on: Oxford Academic PubMed Google Scholar International Journal of Epidemiology, Volume 53, Issue 1, February 2024, dyae011, https://doi.org/10.1093/ije/dyae011 Published: 07 February 2024 Article history Received: 22 June 2023 Editorial decision: 29 December 2023 Accepted: 26 January 2024 Published: 07 February 2024

ImportanceRobust longitudinal studies of within-child changes in mental health associated with the COVID-19 pandemic are lacking, as are studies examining sources of heterogeneity in such changes.ObjectiveTo investigate within-child changes, overall and between subgroups, in youth mental health from prepandemic to midpandemic.Design, Setting, and ParticipantsThis cohort study used longitudinal prepandemic and midpandemic data from the Environmental influences on Child Health Outcomes (ECHO) Program, collected between January 1, 2015, and March 12, 2020 (prepandemic), and between March 13, 2020, and August 31, 2022 (midpandemic). Data were analyzed between December 1, 2022, and June 1, 2024. The sample included 9 US-based observational longitudinal pediatric ECHO cohorts. Cohorts were included if they collected the Child Behavior Checklist (CBCL) School Age version before and during the pandemic on more than 20 participants of normal birth weight aged 6 to 17 years.ExposureThe COVID-19 pandemic.Main Outcomes and MeasuresPrepandemic to midpandemic changes in CBCL internalizing, externalizing, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scores were estimated, and differences in outcome trajectories by child sociodemographic characteristics (age, sex, race, ethnicity, and poverty level) and prepandemic mental health problems were examined using established CBCL clinical score thresholds.ResultsA total of 1229 participants (mean [SD] age during the pandemic, 10.68 [2.29] years; 625 girls [50.9%]) were included. The sample was socioeconomically diverse (197 of 1056 children [18.7%] lived at ≤130% of the Federal Poverty Level; 635 (51.7%) identified as White, 388 (31.6%) as Black, 147 (12.0%) as multiracial, 40 (3.3%) as another race, and 118 (9.6%) as Hispanic). Generalized linear mixed-effects models revealed minor decreases in externalizing problems (β = −0.88; 95% CI, −1.16 to −0.60), anxiety (β = −0.18; 95% CI, −0.31 to −0.05), and ADHD (β = −0.36; 95% CI, −0.50 to −0.22), but a minor increase in depression (β = 0.22; 95% CI, 0.10 to 0.35). Youth with borderline or clinically meaningful prepandemic scores experienced decreases across all outcomes, particularly externalizing problems (borderline, β = −2.85; 95% CI, −3.92 to −1.78; clinical, β = −4.88; 95% CI, −5.84 to −3.92). Low-income (β = −0.76; 95% CI, −1.14 to −0.37) and Black (β = −0.52; 95% CI, −0.83 to −0.20) youth experienced small decreases in ADHD compared with higher income and White youth, respectively.Conclusions and RelevanceIn this longitudinal cohort study of economically and racially diverse US youth, there was evidence of differential susceptibility and resilience for mental health problems during the pandemic that was associated with prepandemic mental health and sociodemographic characteristics.

Although a considerable literature documents associations between early mother-infant interaction and cognitive outcomes in the first years of life, few studies examine the contributions of contingently coordinated mother-infant interaction to infant cognitive development. This study examined associations between the temporal dynamics of the contingent coordination of mother-infant face-to-face interaction at 4 months and cognitive performance on the Bayley Scales of Infant Development at age one year in a sample of (N = 100) Latina mother-infant pairs. Split-screen videotaped interactions were coded on a one second time base for the communication modalities of infant and mother gaze and facial affect, infant vocal affect, and mother touch. Multi-level time-series models evaluated self- and interactive contingent processes in these modalities and revealed 4-month patterns of interaction associated with higher one-year cognitive performance, not identified in prior studies. Infant and mother self-contingency, the moment-to-moment probability that the individual's prior behavior predicts the individual's future behavior, was the most robust measure associated with infant cognitive performance. Self-contingency findings showed that more varying infant behavior was optimal for higher infant cognitive performance, namely, greater modulation of negative affect; more stable maternal behavior was optimal for higher infant cognitive performance, namely, greater likelihood of sustaining positive facial affect. Although interactive contingency findings were sparse, they showed that, when mothers looked away, or dampened their faces to interest or mild negative facial affect, infants with higher 12-month cognitive performance were less likely to show negative vocal affect. We suggest that infant ability to modulate negative affect, and maternal ability to sustain positive affect, may be mutually reinforcing, together creating a dyadic climate that is associated with more optimal infant cognitive development.

Anxiety disorders are common and impairing1 and affect as many as 30% of youth with2 and without3 neurodevelopmental disorders. Nonverbal learning disability (NVLD) is an understudied neurodevelopmental disorder with an estimated prevalence of 3% in North American children and adolescents.4 Although definitions of NVLD vary, all include a core deficit of difficulty with visual-spatial processing. Importantly, anxiety is also a common psychiatric comorbidity for youth with NVLD, affecting roughly one-third of these youth.4,5 In youth with neurodevelopmental disorders, treatment is often sought or received for comorbid conditions (eg, anxiety, attention-deficit/hyperactivity disorder) or associated impairments, rather than for the symptoms or core deficits of the neurodevelopmental disorder itself.6 Considerable work has examined the adaptation of anxiety disorder treatments for children with attention-deficit/hyperactivity disorder7 and autism.8 Comparatively little work has explored treatment approaches for children with NVLD. Given the overlap of anxiety symptoms and visual-spatial problems in NVLD,9,10 herein we consider how these cognitive problems might interfere with patients' abilities to engage with common treatment approaches.

A large body of data shows that fetal brain development is vulnerable to disruption by air pollution experienced by the mother during pregnancy, adversely affecting cognitive and psychomotor capabilities during childhood (De Asis-Cruz et al., Biol Psychiatry 7:480–90, 2022; Morgan ZEM et al., Environ Health 22:11, 2023). This study has sought to identify gestational windows of susceptibility to prenatal exposure to air pollution. 470 African American and Latina mother/child pairs participated in a prospective cohort study based in the low-income communities of Northern Manhattan and the South Bronx, New York City. Gestational exposure to respirable particulate matter (PM2.5) and nitrogen dioxide (NO2) was assessed through validated models in relation to cognitive and motor development assessed at ages 1, 2, and 3 years using the Bayley-II Scales. Multiple linear regression models and distributed lag models (DLM) were used to identify critical windows of exposure by trimester and week of pregnancy. By linear regression, average exposures to NO2 during the first and second trimesters and the entire pregnancy were significantly and negatively associated with the mental developmental index (MDI) at age 1. Average exposures to PM2.5 during the second trimester and the entire pregnancy were also significantly, inversely associated with age 1 MDI. No significant associations were found between these exposures and MDI at age 2. NO2 exposure during the first trimester was significantly negatively associated with MDI at age 3. Using DLM, exposures to NO2 at lags 29–30 weeks (within the first trimester) and PM2.5 at lags 17–18 weeks (second trimester) were significantly and inversely associated with MDI at age 1. Significant, inverse associations were found between exposures to NO2 at lag 29 weeks and PM2.5 at lags 27–29 weeks and children’s MDI at age 3. No significant associations were found between psychomotor index (PDI) and prenatal exposures to NO2 or PM2.5 at ages 1, 2 or 3. Our finding that prenatal exposure to air pollution in the first and second trimesters was associated with lower scores for cognitive development at ages 1 and 3 is of concern because of the potential consequences of these outcomes for long-term functioning. They underscore the need for stronger policies to protect pregnant individuals and offspring, particularly during vulnerable, early life-stage of development.

IntroductionNational health policies to stop the spread of the COVID-19 virus in the US resulted in widespread school closures and disrupted learning in Spring 2020.MethodsThis study draws on unique individual-level data from n = 282 5–12 year olds enrolled in the NIH Environmental influences on Child Health Outcomes (ECHO) Research Program to investigate associations between caregiver-reported duration of Spring 2020 learning disruptions and academic achievement.ResultsLinear regression analyses estimated that children who experienced more than 4 weeks of instruction disruptions in Spring 2020 scored 4.5 points [95% CI: −8.77, −0.22] lower on age-normed math assessments compared to peers who had four or fewer weeks of disruption, adjusting for sociodemographic variables, pre-pandemic vocabulary, and COVID-19 family hardships and stress. No differences were found for reading. Children whose caregivers had higher levels of pandemic-related traumatic stress and lower educational attainment also had lower math scores, adjusting for all other covariates.DiscussionResults suggest educators and schools focus additional attention on supporting math instruction for children who experienced extended learning disruptions.

ABSTRACT Objective: Omega-3 (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 omega-3 supplement intake. Design: Pooled pregnancy cohort studies. Setting: Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999-2020. Participants: A total of 10,800 pregnant women in 23 cohorts with food frequency data on fish consumption; 12,646 from 35 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 (vs. never) consuming fish was higher in participants who were older (1.14, 95% CI: 1.10, 1.18 for 35-40 vs. <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 vs. healthy weight (0.97, 95% CI: 0.95, 1.0). Only 16.2% reported omega-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 vs. never). Conclusions: One-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and omega-3 supplement use was uncommon, even among those who did not consume fish.