PROJECT SUMMARY / ABSTRACT The goal of the ECHO Ohio Cohort Site at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center (NCH-OSUWMC) is to contribute to the ECHO Cohort by collecting and providing valuable data on a diverse and often underserved population of participating pregnant individuals, conceiving partners, and children who live in our region, so we can improve maternal and child health everywhere by better understanding how exposures prior to and during pregnancy impact childhood outcomes. Nearly 1/5 of Ohio’s children live in poverty. The rate is more than twice that for non-Hispanic Black children. Central Ohio is diverse with a rapidly growing immigrant population including the largest ethnic Nepali and 2nd largest Somali refugee populations in the U.S.; 1 in 6 Columbus children have an immigrant parent. The patients we serve live not only in urban, suburban, and rural central Ohio, but also within Appalachian portions of southeast Ohio, Pennsylvania, and West Virginia. The communities we serve are ranked poorly across multiple maternal and child health well-being indicators, underscoring a critical need to better understand environmental influences in the perinatal period that contribute to adverse child outcomes both locally and nationally. The NCH-OSUWMC health system is highly experienced in contributing to large multicenter NIH studies involving pregnant individuals and children and well- poised to contribute interdisciplinary leadership. We have maintained a large perinatal repository of clinical, survey, and rich biospecimen data from pregnant individuals, their partners, and their children for over a decade. Our research coordinators and investigators are highly experienced in recruiting both pregnant individuals and children for research investigations and securely and efficiently processing health data and biospecimens. Of note, our track record in retaining diverse subpopulations of high-risk maternal/child dyads, as well as conceiving partners, for follow-up is strong. We provide specific expertise in evaluating lifestyle exposures in pregnancy, most prominently in maternal cardiovascular health, and outcomes expertise in pre-, peri-, and postnatal health and childhood neurodevelopment. We propose 1) evaluating the impact of maternal cardiovascular health during pregnancy using the American Heart Association Life’s Essential 8 framework on child socioemotional development and behavior to age 21, using existing ECHO Cohort Protocol core data elements and 2) investigating, using innovative methods (continuous glucose monitoring), the association between evolving maternal dysglycemia patterns across the peripartum period and child socioemotional development and behavior while evaluating neonatal anthropometrics as potential mediators. We propose to evaluate the interaction between genes and lifestyle exposures on socioemotional development via an association study complemented with imputed -omics data. In a preconception-focused aim, we propose examining the impact of maternal and paternal preconception cardiovascular health on socioemotional development and behavior. Our contributions to the ECHO cohort, providing diversity and expertise, will enhance knowledge leading to improved child health.

PROJECT NARRATIVE The ECHO Pregnancy Cohort will improve the health of children for generations to come by identifying, in a diverse population, how environmental exposures involving pregnant individuals and their conceiving partners, before and during pregnancy, impact the health of their children from birth to the transition to adulthood. The ECHO Ohio Cohort Site will specialize in evaluating lifestyle exposures, in a diverse group of pregnant individuals and conceiving partners from preconception through the perinatal period, and their relationship to perinatal and child health outcomes. In addition to actively contributing to all areas of ECHO data collection and providing leadership for the program, we propose to focus on how cardiovascular health, including dysglycemia, during pregnancy are associated with an infant’s health at birth and a child’s neurodevelopment from birth to early adulthood.