Long-Term Children's Study Promises Big Dividends

Science has only just begun to understand the relationship between genes and the environment, especially when it comes to such conditions as autism and diabetes. Over the next 25 years, at 105 locations throughout the U.S., the National Children's Study will track 100,000 American children from before their birth through their 21st birthdays, seeking insights into the root causes, genetic and environmental, of both disorders, as well as myriad other conditions, including asthma, birth defects and obesity.

A joint enterprise of the U.S. Department of Health and Human Services (including CDC and NIH) and EPA, the National Children's Study (NCS) will bring together hundreds of scientists, health care providers and public health officials to recruit a representative sample of women to the observational study. Researchers will track details of their pregnancies and later their children's height and weight, diet, environmental exposures, access to health care and incidence of disease.

Lynn Goldman, a former EPA official and current professor of Environmental Health Sciences at the Bloomberg School, helped draft the executive order that established the study. Today, as a principal investigator for the NCS Center at the School and a member of the NCS steering committee, the pediatrician collaborates with her peers within the federal government and at study centers around the country to design research protocols. This is something I've cared about for a long time," says Goldman, MD, MPH, who also co-chairs the study's environmental exposure work group. Closer to home, she will oversee recruitment of study participants in Baltimore and Montgomery counties and, beginning in 2011, local data collection.

The study holds special promise in the realm of such statistically rare diagnoses as autism spectrum disorders and, in an international collaboration with other large pediatric cohort studies, pediatric cancer. "Normally in cancer we use case-controlled study designs," says Goldman, referring to experimental designs that begin with individuals already diagnosed with a certain condition and subsequently identify matched control subjects. "But we're never really sure that the controls are drawn from the same population as the cases, and that they are truly representative." Due to the scale and prospective nature of the NCS, even rare outcomes will be represented in statistically significant numbers.

Two years before her death in 2008, Hopkins School of Medicine pediatric epidemiologist Janet Hardy spent a day with Goldman, sharing tips gleaned from her own experience as principal investigator for the Hopkins center of the $100 million Collaborative Perinatal Project (CPP). The 12-center, two-decade-long study was launched in 1957 with an enrollment of 60,000 pregnant women to investigate the precursors of cerebral palsy. Early on, the study revealed prevention strategies for blindnes and deafness; the CPP data sets remain a valuable resource. Hardy's most important recommendation, says Goldman, was to create a strong research team at Hopkins.

"The winds can blow in all kinds of ways, both favorable and unfavorable on the federal side," says Goldman, who has already begun cultivating collaborations among her colleagues to design adjunct studies that will leverage the rich data set generated by the NCS. "If you're the captain of a ship, you want to trim the sails on your ship while participating in efforts to assure success of the overall fleet," she says. "It's a balancing act."

Longitudinal cohort studies don't come cheap, but the findings offer enormous public health benefits, says Goldman. "When we invest in research that yields solid findings on how to promote healthy development of children, there's an enormous payoff in the end," she says. "This effort will generate tremendously valuable dividends."