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

项目总结 关于高危妊娠和残疾儿童的补充回声的首要目标(补充 ECHO)队列旨在通过研究患有以下疾病的儿童来促进ECHO研究中的残疾包容性 并利用来自残疾回声参与者的现有数据。我们的科学前提是 心理社会环境暴露(如SDH、压力、社会环境、歧视)和可改变 个人因素(如父母教养方式、社会支持、心理健康)影响身心健康 残疾儿童产生明确的功能、福祉和参与社区的结果 和家庭生活。我们的假设是，我们可以识别特定的环境因素，这些因素与 在从残疾到典型发展的连续过程中，预期健康结果是积极的。致富的ECHO Cohort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)比较有无症状儿童的轨迹 残疾随着时间的推移，从出生到学龄(5-6岁)，以积极的健康(儿童福祉)为主要 结果。我们将评估(B)产前环境和心理社会暴露的影响，以及(C)产后- 随着时间的推移，出生营养、睡眠健康和体力活动对这些儿童队列中积极健康轨迹的影响。 目标2：在整个队列(A)中，我们将确定母亲产前和围产期的心理社会暴露情况 出生后结局(如出生缺陷、出生体重、早产、早期生活残疾)的高危和 不复杂的怀孕。(B)我们将测试哪些产前、围产期和产后因素最能预测初级 儿童在学龄期的幸福感(积极健康)的结果，调整了共线性效应。(C)比较 残疾儿童和非残疾儿童的队列，我们将检查父母的养育方式和照顾者社会 支持是与比预期更好的积极健康相关的可修改的暴露。 目标3：为了确保对回声科学的意义和影响，增强回声队列强调多样性 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。我们的 方法将：(A)招募最有可能接生儿童的高危妊娠参与者 残疾人，包括经常被排除在研究研究之外的残疾人。我们将(B) 与社区残疾人利益相关者合作，设计参与、保留和传播 战略，以及(C)使各队列中残疾的早期回声监测标准化。 目标4：在二次妊娠的ECHO参与者队列中，我们将探索围产儿是否 与年龄较大的Echo兄弟姐妹的积极儿童健康相关的环境暴露(在目标2b中确定) 可以预测第二次妊娠的产后结局。

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.