Enriching ECHO Cohorts with High-risk Pregnancies and Children with Health Challenges (Enriching ECHO) - PROJECT/NARRATIVE/ The overarching goal of the Enriching ECHO with High-risk Pregnancies and Children with Health Challenges (Enriching ECHO) cohort is to advance ECHO research by investigating environmental exposures that are associated with suboptimal and positive health outcomes in children with and without physical, sensory and developmental challenges. Investigating factors associated with the full range of outcomes in children will enable us to identify critical predictors and inflection points to promote positive health for a lifetime. Our scientific premise is that prenatal and perinatal environmental exposures and modifiable personal factors (e.g., parenting style, social supports) impact the wellbeing of children with chronic health challenges resulting in definable outcomes of function, life satisfaction, and participation in community and family life. Our hypothesis is that we can identify modifiable factors associated with better-than-expected positive health outcomes along the continuum of development that allow children with chronic health challenges, and, by extension, all children, to thrive. The Enriching ECHO award will address this hypothesis via the following specific aims: Aim 1: Award 301 will (a) recruit participants with high-risk pregnancies who are most likely to deliver children at risk for chronic health challenges; (b) collaborate with community stakeholders with physical limitations and sensory impairments to design engagement, retention, and dissemination strategies; (c) standardize early ECHO surveillance for chronic health challenges; (d) ensure the ECHO protocol is implemented with high fidelity. Aim 2: Leveraging ECHO core data elements, we will (a) compare trajectories from birth to school-age of typically developing children and those with sensory-motor impairments, and with cognitive/behavioral challenges with positive health (child well-being) as the primary outcome. We will (b) evaluate the effect of prenatal environmental exposures and (c) the moderating effects of child postnatal nutrition, sleep health and physical activity on the slopes of positive health trajectories from birth to school-age. Aim 3: In the entire ECHO cohort (a) we will identify maternal pre- and peri-natal psychosocial and chemical exposures associated with postnatal outcomes (birthweight, prematurity, birth defects, early life health challenges, neurodevelopment) in high-risk and in uncomplicated pregnancies. (b) We will test which pre-, peri-and post-natal factors best predict the primary outcome of child well-being (positive health) at school-age. (c) Comparing children with and without a reported chronic health condition, we will examine whether parenting style and caregiver social support are modifiable exposures associated with better-than-expected positive health. Aim 4: In a cohort of ECHO participants with second pregnancies, we will explore whether the peri-natal environmental exposures associated with positive child health in the older ECHO sibling are predictive of post-natal birth outcomes in the second ECHO pregnancy.
