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Perinatal factors and emotional, cognitive, and behavioral dysregulation in childhood and adolescence

Washington | December 4, 2023

Researchers investigate association between maternal inflammation risk factors and dysregulation in children

A studyopens in new tab/window in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, used data from the National Institutes of Health (NIH) funded Environmental Influences on Child Health Outcomes (ECHO) research program and found behavioral dysregulation in childhood and adolescence (eg, difficulties with attention, anxiety, depression, and aggression) was associated with four modifiable maternal risk factors known to be associated with inflammation during pregnancy (maternal lower education, obesity, prenatal infections, and smoking). These risk factors are likely targets for interventions to improve offspring behavioral outcomes.

About 13 percent of the children and adolescents studied were identified as having emotional and behavioral challenges. Children born to mothers with a prenatal infection had a higher risk for dysregulation later in childhood compared to children born to mothers without an infection. Lower maternal education levels, pre-pregnancy obesity, and smoking during pregnancy were also associated with a higher likelihood of childhood dysregulation. Children and adolescents who had a parent or sibling with a mental health disorder were also more likely to experience dysregulation. Having a mother with gestational diabetes had no significant association with child dysregulation. In summary, multiple risk factors associated with inflammation, such as lower maternal educational attainment, pre-pregnancy obesity, prenatal infections, and prenatal tobacco use, all of which are potentially modifiable, were strongly correlated with dysregulation in offspring.

This collaborative ECHO research was led by Jean A. Frazier, MD, of UMass Chan Medical School and Mike O’Shea, MD, of the University of North Carolina at Chapel Hill. ECHO researchers collected data on maternal factors before and during pregnancy and then used the Child Behavior Checklist (CBCL) to identify children ages 6 to 18 years who had emotional, cognitive, and behavioral dysregulation. The assessments were collected between 2009 and 2021. The study involved 4,595 children and adolescents from 18 ECHO research cohorts across the United States.

First author Jean A. Frazier, MD, the Robert M. and Shirley S. Siff Chair in Autism, professor of psychiatry and pediatrics and Executive Director of the Eunice Kennedy Shriver Center at UMass Chan Medical School, said, “Understanding how these factors can affect a child’s behavior can help guide interventions and support strategies to improve children’s well-being.”

The authors recommend that future studies should explore the mechanisms linking maternal factors and childhood dysregulation, interventions for children guided by knowledge about inflammation experienced by their mother, and specific methods to prevent or mitigate the factors leading to maternal inflammation.


Notes for editors

The article is "Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence," by Jean A. Frazier, MD, Xiuhong Li, MAS, Xiangrong Kong, PhD, Stephen R. Hooper, PhD, Robert M. Joseph, PhD, David M. Cochran, MD, PhD, Sohye Kim, PhD, Rebecca C. Fry, PhD, Patricia A. Brennan, PhD, Michael E. Msall, MD, Raina N. Fichorova, MD, PhD, Irva Hertz-Picciotto, PhD, MPH, Julie L. Daniels, PhD, MPH, Jin-Shei Lai, PhD, OTR, Richard E. Boles, PhD, Bharathi J. Zvara, PhD, Isha Jalnapurkar, MD , Julie B. Schweitzer, PhD, Rachana Singh, MD, MS, Jonathan Posner, MD, Deborah H. Bennett, PhD, Karl C.K. Kuban, MD, T. Michael O’Shea, MD, MPH, on behalf of program collaborators for Environmental influences on Child Health Outcomes ( in new tab/window.). It appears in Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), volume 62, issue 12 (December 2023), published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; please contact Jean A. Frazier, MD at [email protected] .

About ECHO

Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission 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


Journal of the American Academy of Child and Adolescent Psychiatryopens in new tab/window (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

About Elsevier

As a global leader in scientific information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making with innovative solutions based on trusted, evidence-based content and advanced AI-enabled digital technologies.

We have supported the work of our research and healthcare communities for more than 140 years. Our 9,500 employees around the world, including 2,500 technologists, are dedicated to supporting researchers, librarians, academic leaders, funders, governments, R&D-intensive companies, doctors, nurses, future healthcare professionals and educators in their critical work. Our 2,900 scientific journals and iconic reference books include the foremost titles in their fields, including Cell Press, The Lancet and Gray’s Anatomy.

Together with the Elsevier Foundationopens in new tab/window, we work in partnership with the communities we serve to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

Elsevier is part of RELXopens in new tab/window, a global provider of information-based analytics and decision tools for professional and business customers. For more information on our work, digital solutions and content, visit



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