Enriching ECHO Cohorts with High-risk Pregnancies and Children with Disabilities (Enriching ECHO)

项目摘要 加强欧盟人道主义事务处对高危孕妇和残疾儿童的服务的总体目标是： ECHO）队列是通过研究患有各种残疾的儿童， 残疾和利用现有的数据，从欧共体人道处参与者的残疾。我们的科学前提是 心理社会环境暴露（例如，SDH、压力、社会环境、歧视）， 个人因素（例如，父母教养方式、社会支持、心理健康等因素对儿童的身心健康有影响 在功能、福祉和参与社区方面产生可界定的成果 和家庭生活我们的假设是，我们可以确定特定的环境因素与优于- 预期的积极健康结果沿着残疾到典型发展的连续性。丰富的ECHO 队列将通过以下具体目标解决这一假设： 目标1：利用ECHO核心数据元素，我们将（a）比较有和没有 从出生到学龄（5 - 6岁），以积极的健康（儿童福祉）为主要目标， 结果。我们将评估（B）产前环境和社会心理暴露以及（c）产后 随着时间的推移，这些儿童群体的出生营养、睡眠健康和身体活动对积极健康轨迹的影响。 目标2：在整个队列中，（a）我们将确定与产妇产前和围产期心理暴露相关的 与产后结果（例如，出生缺陷，出生体重，早产，早期生活残疾）的高风险和 简单的怀孕(b)我们将测试哪些产前、产中和产后因素最能预测原发性高血压。 学龄期儿童福祉（积极健康）的结果，调整共线性效应。(c)比较 有残疾和没有残疾的儿童队列，我们将研究父母的教养方式和照顾者的社会 支持是与好于预期的积极健康相关的可改变的暴露。 目标3：为了确保对ECHO科学的重要性和影响，增强ECHO队列强调多样性 并通过让患有各种残疾的母亲和子女参与，将代表性不足的群体纳入其中。我们 方法将（a）招募高危妊娠的参与者，这些参与者最有可能生下患有 残疾人，包括残疾人谁往往被排除在研究。我们将（B） 与残疾人社区利益相关者合作，设计参与、保留和传播 （c）标准化各队列残疾的早期ECHO监测。 目的4：在一组第二次妊娠的ECHO参与者中，我们将探讨围产期是否存在 环境暴露与ECHO哥哥姐姐的阳性儿童健康相关（目标2b中确定） 预测第二次ECHO妊娠的产后分娩结果。

PROJECT SUMMARY The overarching goal of the Enriching ECHO with High-risk Pregnancies and Children with Disabilities (Enriching ECHO) cohort is to advance disabilities inclusivity in ECHO research by studying children with a spectrum of disability and by leveraging existing data from ECHO participants with disabilities. Our scientific premise is that psychosocial environmental exposures (e.g., SDH, stress, social environment, discrimination) and modifiable personal factors (e.g., parenting style, social supports, mental health) impact the physical and emotional health of children with disabilities resulting in definable outcomes of function, well-being, and participation in community and family life. Our hypothesis is that we can identify specific environmental factors associated with better -than- expected positive health outcomes along the continuumof disability to typical development. The EnrichingECHO cohort will address this hypothesis via the following specific aims: Aim 1: Leveraging ECHO core data elements, we will (a) compare trajectories of children with and without disabilities over time, from birth to school age (5-6 years), with positive health (child well-being) as the primary outcome. We will evaluate the effect of (b) pre-natal environmental and psychosocial exposures and (c) post- natal nutrition, sleep health, and physical activity on positive health trajectories in these child cohorts over time.. Aim 2: In the entire cohort (a) we will identify maternal pre- and peri-natal psychosocial exposures associated with post-natal outcomes (e.g., birth defects, birthweight, prematurity, early life disabilities) in high -risk and uncomplicated pregnancies. (b) We will test which pre-, peri-, and post-natal factors best predict the primary outcome of child well-being (positive health) at school-age, adjusting for co-linearity effects. (c) Comparing the cohorts of children with and without disability, we will examine whether parenting style and caregiver social support are modifiable exposures associated with better-than-expected positive health. Aim 3: To ensure significance and impact on ECHO science, the Enhancing ECHO cohort emphasizes diversity and inclusion of underrepresented groups by engaging mothers and offspring with a range of disabilities. Our approach will (a) recruit participants with high-risk pregnancies who are most likely to deliver children with disabilities and include individuals with disabilities who are often excluded from research studies. We will ( b) collaborate with community stakeholders with disabilities to design engagement, retention, and dissemination strategies, and (c) standardize early ECHO surveillance for disabilities across cohorts. Aim 4: In a cohort of ECHO participants with second pregnancies, we will explore whether the peri-natal environmental exposures associated with positive child health in the older ECHO sibling (identified in Aim 2b) are predictive of post-natal birth outcomes in the second ECHO pregnancy.