PROJECT SUMMARY NYU Grossman School of Medicine (NYUGSOM) presents an application for: (1) ongoing enrollment of pregnancies, conceiving partners and their children from the NYU Children’s Health and Environment Study (NYU CHES, UG3/UH3OD023305) into the Environmental influences on Child Health Outcomes Program (ECHO) Cohort, (2) follow up of already enrolled mother-infant pairs and (3) piloting of the ECHO preconception study. NYU CHES enrolls pregnant people <18 weeks gestation from NYUGSOM-affiliated obstetric clinics. The cohort is diverse ( 50% Hispanic, 9.7% Asian, 5.2% Black; 49% Public Insurance ) and Over the past seven years, we exceeded our expected enrollment by over 100% (>2000 mother-child pairs compared with the planned 1000). We sustained strong retention despite the COVID-19 pandemic, with nearly 72-83% visit completion at each of five time points in infancy (4-7, 8-11, 12-27, 18-23 and 24-35 months) and biospecimen collection rates as high as 80% in pregnancy. We contributed substantially to ECHO-wide science, with an emphasis on chemical/physical environmental exposures (our Specialized Exposure area). PI Trasande was the inaugural co-chair of the Obesity Working Group, and NYU CHES contributed specialized measures of obesity (our Specialized Outcome area) through the application of plethysmography and dual-absorption X-ray absorptiometry. We vigorously responded to the pandemic by co-leading the COVID-19 Working Group, completing a multi-cohort study of SARS-CoV-2 infection and birth outcomes supported by an ECHO Supplement, and obtaining funding from the NIH RECOVER Initiative to identify long-term effects of SARS-CoV-2 infection in children. Our scientific productivity is manifested not only in our 32 cohort-specific publications, but more importantly in our contribution to a plethora of ECHO-wide publications that span all five of ECHO’s outcomes. We propose to continue our enrollment of new pregnancies at the rate we achieved during the previous funding period (520 mother-child pairs/year). We will continue to implement the ECHO Cohort Data and Biospecimen Collection Protocol and its central data capture system (REDCap Central) among all participants. We anticipate enrolling 200 NYU CHES mothers and their partners each year into the Preconception Pilot Study as soon as feasible after delivery. We suggest innovative science for the pregnancy and preconception cohorts, including expanding our study of chemical and physical exposures to include novel contaminants such as heterocyclic aromatic amines and melamine, led by Co-I Kannan, who directs a NIEHS Human Health Exposure Analysis Resource laboratory (U2CES026542). We apply an innovative digital platform for participant engagement, retention and data collection developed by Vibrent Health for the NIH All of Us Study, which we recommend for broader application in the ECHO Program. PI Trasande is an international leader in children’s environmental health (CEH) and directs an...