Penn-CHOP ECHO

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Project Summary Health disparities start early in life, with Black infants (10.6 per 1,000) twice as likely to die compared to White infants (4.5 per 1,000). Adverse pregnancy outcomes are responsible for the majority of the Black-White infant mortality disparity. Extensive healthcare efforts have been taken 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 with ongoing inequities. Macroenvironmental health promoting factors (greenspace, walkability) and health threatening factors (pollution, neighborhood violence, extreme temperatures) 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 such as racism and violence, 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 to reduce disparities is completely 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, as well as whether such factors may improve racial disparities in these outcomes. 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 health disparities. 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 people, partners, and offspring, with retention of at least 75% at age 3, among whom 1250 will be recruited into the preconception pilot (Aim 3). The health system at Penn/CHOP serves a population underrepresented in other pregnancy and pediatric cohorts in the US (largely Medicaid-insured and plurality Black). The culture of clinical research, excellent scientific environment, and diverse population makes Penn and CHOP the ideal place to innovate in the field of maternal-child health equity. 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.