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DURHAM, N.C., May 24, 2023 /PRNewswire/ — Prenatal exposure to tobacco, alcohol, and illegal drugs may increase a child’s risk of displaying certain problem behaviors in later childhood, according to new research funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Children ages 6 to 11 who were exposed to alcohol and tobacco before birth were more likely to display rule-breaking or aggressive behaviors, while children exposed to illegal drugs, such as cocaine, methamphetamine, or heroin, before birth were more likely to have higher rates of anxiety, depression, or withdrawn behaviors, according to findings published in the Journal of Pediatrics. However, ECHO researchers pointed out that not all children exposed to substances had behavioral problems.

“Our work shows that we may be able to identify children with certain behavioral challenges based on their mothers’ prenatal substance use profiles,” said Sarah Maylott, PhD of Duke University. “With further research, clinicians and researchers could use these results to identify and support children at higher risk for behavior problems.”

About 2,000 women from 10 ECHO cohorts across the country participated in the study from 2000-2020. The research team divided the women into two groups based on the types of substances used during pregnancy and then compared the behavior of both groups’ children.  

Future large-scale studies can look at how the quantity and timing of substance use during pregnancy affect children’s risk for behavioral problems and how the home environment may contribute to that risk. Researchers can also explore what factors lead to resilient outcomes for children with prenatal substance exposure.

Dr. Maylott led this collaborative research published in the Journal of Pediatrics.

About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit

SOURCE NIH Environmental influences on Child Health Outcomes (ECHO) Program

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