Prenatal Environment And Child Health (PEACH) in ECHO
Abstract
Few modifiable factors have been identified that improve neurodevelopmental (ND) outcomes. One such factor,
supplemental folic acid (SFA), taken before and during the first weeks post-conception, reduced risk for neural
tube defects (NTDs) by up to 70% in randomized trials, initiating mandatory food grain fortification and guidelines
for SFA intake for people who could or had become pregnant, with subsequent increases in blood folate
concentrations and reduced NTD prevalence. While generally regarded as a public health success, the impacts
have not been evenly distributed across sub-populations within the US, with Hispanic populations at higher risk
for NTDs, more likely to have suboptimal folate status, and less likely to take SFA. Further, the biologic
mechanisms behind this protection remain unclear. Prenatal SFA and adequate folate status has since been
associated with improved behavioral and language outcomes, higher executive functioning, and reduced risk for
attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and associated traits. High
folate/SFA has also been shown to attenuate increased risks associated with several contaminant exposures
that are more prevalent in groups that are under-represented in research and/or more likely to have sub-optimal
folate status and less likely to meet SFA intake recommendations. One example includes plasticizers in personal
care products that are more prevalent in Hispanic populations and are linked to increased ND risk which is
attenuated with prenatal SFA. Many gaps in understanding and implementation of SFA measures need to be
addressed to increase the public health impact of SFA interventions to their fullest potential: 1) How does the
timing of SFA initiation and its association with blood folate differ across subpopulations? 2) What other child
health outcomes are associated with prenatal SFA and blood folate? 3) How do these associations differ by the
timing and dose of SFA intake? 4) How do doses and timing of SFA and folate concentrations linked with
improved child outcomes differ across people with different genetic, environmental, and nutritional backgrounds?
5) Does periconceptional SFA/folate status modify associations between environmental contaminants, including
novel chemicals, and ND outcomes including behavioral problems and high autistic traits? 6) What biologic
pathways are modified in utero by periconceptional SFA and suboptimal folate status? 7) How do those biologic
pathways relate to known ND pathways? 8) How does the conceiving partner's preconception folate status relate
to placenta epigenetics and the child's outcomes? Our strong team with relevant expertise in reproductive,
environmental and nutritional epidemiology, interactions, epigenetics and ND assessment, plus ample
experience engaging community partners, will recruit 740 expecting families in Northern California representing
diverse racial, ethnic, socioeconomic, genetic and environmental backgrounds to enrich the ECHO cohort with
participants traditionally underrepresented in research to address these gaps and produce findings that will
substantially inform public health policies for more effective improvement of child developmental outcomes.