PROJECT SUMMARY This is a competitive renewal application (1) to continue to follow children in the Illinois Kids Development Study (IKIDS) who are Level 2 participants in ECHO, and (2) to continue recruiting new pregnant women into the IKIDS- ECHO cohort. A key goal of our continued recruiting effort is to increase the racial/ethnic and income diversity of our cohort through new recruiting partnerships with community agencies – the Champaign-Urbana Public Health District (CUPHD) and Promise Health Care (our local federally qualified health center) – that serve a primarily low-income, racially and ethnically diverse population of pregnant women. Specifically, we propose to enroll 660 additional pregnant women (and their conceiving partners, if available) through our partnerships with these two entities during the next phase of ECHO. We will rely heavily on community engagement, input from an established Community Advisory Board, and feedback from focus groups to develop recruitment and retention strategies that are effective for both retaining our current Level 2 participants and recruiting, enrolling, and retaining new pregnant participants. A subset of these participants who report a moderate to high likelihood of becoming pregnant again will be enrolled in the planned preconception pilot study. Our scientific aims will be addressed in a series of ECHO Concept Papers and will build on our previous work investigating the impacts of maternal prenatal stress or chemical exposures on birth outcomes and neurodevelopment. Leveraging data from multiple ECHO cohorts will allow us to apply state-of-the-art mixtures methods to investigate the impact of multiple chemical and non-chemical stressors on birth outcomes (gestational age at birth; birth weight; anogenital distance) and child cognitive development (specific domains from the NIH toolbox cognitive battery; measures of language development). We will also use novel approaches to evaluate the ability of a healthy maternal diet to mitigate the negative impact of these exposures on our outcomes of interest. Our hypothesis is that multiple prenatal stressors and/or chemical exposures jointly impact child neurodevelopment and birth outcomes, and these impacts can be mitigated by a healthy diet. We will use multiple measures of prenatal psychosocial stress from the core ECHO protocol (Aim 1), multiple studied and novel phthalates/replacements and phenols from the ECHO-WC-HHEAR novel chemicals analysis (Aim 2) or both chemicals and stressors in our mixtures models. To assess the impact of diet, we will use a novel approach in which we will include multiple dietary components calculated using established diet quality indices, together with multiple measures of maternal psychosocial stress or multiple chemicals, to understand the cumulative effects of the diet/stress or diet/chemical mixture and to evaluate if particular components of healthier diets can lessen or negate adverse associations of maternal stress or chemical exposures with child cognition or birth outcomes. Lastly, an exploratory aim will evaluate associations of maternal preconception stressors with (1) birth outcomes and (2) neurodevelopment during infancy.

PROJECT NARRATIVE This project will investigate the impact of prenatal exposures to complex mixtures of chemical and non-chemical stressors on key child health outcomes. It will also explore whether a healthy maternal diet during pregnancy can lessen the impact of these stressors on the child. This solution-oriented approach takes into account the complexity of real-world exposures and has strong potential to influence programs designed to improve children’s health.