Penn-CHOP ECHO

Early exposures affect health across the life course. Extensive healthcare efforts have been made to prevent adverse pregnancy outcomes and to optimize child growth, health, and neurodevelopment. However, birth and childhood outcomes remain major areas of public health concern. Macroenvironmental health promoting factors (greenspace, walkability) and health threatening factors (neighborhood conditions) may affect health directly through inflammatory and immunologic pathways. Macroenvironments may also contribute to lived experiences of income potential and educational attainment. Combined with interpersonal individual exposures, macroenvironments may alter individuals’ microenvironmental health factors such as diet, physical activity, psychosocial stress, and sleep. While macro- and microenvironmental exposures have been studied individually, the impact of neighborhood environments on complex health disorders in pregnancy and early childhood remains understudied and the interplay with microenvironmental factors is unknown. We propose a causal inference framework to evaluate the role of specific macroenvironment factors (Aim 1) to reduce the risks of abnormal fetal growth, preterm birth, obesity, asthma, and neurodevelopmental delays by age 3. We will also identify optimal components of microenvironmental factors of diet, physical activity, and sleep, during pregnancy (Aim 2) and among couples during preconception (Aim 4), that can best be utilized to maximize reductions in adverse maternal and child health outcomes. We have assembled a multidisciplinary team of experts at the University of Pennsylvania and Children’s Hospital of Philadelphia who are well-positioned to complete the study and recruit up to 2500 pregnant women, partners, and offspring, with retention of at least 75% at age 3 in a population reflective of the Philadelphia community (Aim 3). The culture of clinical research and excellent scientific environment makes Penn and CHOP the ideal place to innovate in the field of maternal-child health. The Penn-CHOP ECHO study team is committed to the success of this work and looks forward to working collaboratively with the other ECHO Study Sites, Coordinating Centers, and Cores.