PROJECT SUMMARY / ABSTRACT The Environmental influences on Child Health Outcomes (ECHO) Pediatric Cohorts program launched in 2016, bringing together more than 30 extant cohorts to investigate the roles of a broad range of early exposures on five key child health outcomes. ECHO is now expanding to include new cohorts starting in pregnancy. We propose to recruit the Environmental Factors in FEtal to Childhood Trajectories EFFECT cohort to participate in the ECHO program. EFFECT will be a prospective birth cohort of 2,800 pregnant people, their partners, and their children recruited in southern New York State over 7 years. The scientific premise of our cohort is that social determinants of health (SDoH) impacting both parents before a child’s birth play a significant role in the development of child obesity. Our Specific Aims are: Aim 1: Test the hypothesis that in-utero chemical and maternal psychosocial exposures during pregnancy interact to create differential childhood growth trajectories (growth latency and growth spurts) from birth to age 5. We will leverage survey and biomarker data collected under the ECHO core protocol to model the impact of concurrent in utero exposure to phthalates and maternal stress on childhood growth trajectories. Aim 2: Test the hypothesis that early life exposure to adverse social determinants of health (SDoH) are associated with higher rates of child obesity and that this association varies by racial/ethnic background. We will leverage specialized exposure data (psychosocial environment) and specialized outcome data (obesity) to test the hypothesis that exposure to parental material hardships and psychosocial vulnerabilities is associated with higher rates of child obesity, particularly for children from minority groups. Aim 3: Recruit and retain a robust, diverse cohort of 2,800 families and implement the ECHO protocol with high fidelity. We will partner with our extremely diverse patient population and leverage innovative participant-centric technological support as well as committed community engagement to achieve this Aim. Exploratory Aim 4: To measure the direct and interactive effects of preconception physiologic and psychosocial exposures on child weight outcomes. We will measure the direct and interactive effects of pre- conception adiposity and caregiver receipt of social support on early life measures of child obesity risk. Our proposed cohort and study team are perfectly positioned to meet the current needs of the ECHO program: 1) to address solution-oriented scientific questions of high priority; 2) to increase the number of enrolled pregnant participants; 3) to facilitate the enrollment of the non-gestational parent; 4) to facilitate collection of preconception data; 5) to increase the racial, ethnic, and socioeconomic diversity of the ECHO cohort; and 6) to increase diversity in race, ethnicity, career stage, and professional background of the research workforce.

PROJECT NARRATIVE We will recruit 2,800 pregnant people, their partners, and their children into the EFFECT cohort to study how social and community influences before a child’s birth play a role in the development of child obesity. Our proposed cohort and study team are perfectly positioned to meet the current needs of the ECHO program: 1) to address solution-oriented scientific questions of high priority; 2) to increase the number of enrolled pregnant participants; 3) to facilitate the enrollment of the non-gestational parent; 4) to facilitate collection of preconception data; 5) to increase the racial, ethnic, and socioeconomic diversity of the ECHO cohort; and 6) to increase diversity in race, ethnicity, career stage, and professional background of the study team.