In New Hampshire, a mom is busily crocheting hundreds of baby blankets for Virginia newborns enrolled in the nation’s largest long-term study of early brain and child development.
This New Hampshirite is deeply invested because her own daughter, Dr. Brittany Howell, is leading the Virginia Tech arm of the research, which is enrolling mothers and their children from Southwest Virginia.
The HEALthy Brain and Child Development, or HBCD, Study Consortium brings together 27 research institutions across the country to explore how prenatal and early childhood experiences shape brain development.
The broad goal of the study is to understand what impacts child development, beginning prenatally, Howell said during an interview. Over the next decade, researchers will follow mothers and their children to study how maternal health, environmental exposures and substance use affect brain development.
This month marks the release of the study’s first data set, which includes biomedical and behavioral data from more than 1,400 pregnant women and their children, tracked across three early developmental stages from birth through 9 months of age. The findings will help inform future research, policy decisions and community action, Howell said.
Virginia Tech joined the study one year after most other institutions. Since launching locally in 2021, Howell and her team have completed more than 1,000 visits with 149 children enrolled. They aim to recruit 300 families, with a focus on rural participation.
So far, the average travel time to Roanoke for families is two hours, but there is funding in place to support participants who aren’t able to make the drive themselves. Howell said her team is capturing a significant portion of the non-urban families for this study, a population that is often left out of research.
“The reality is most average families don’t participate in research, and I don’t think it’s because they don’t want to, it’s because they don’t have access to it,” Howell said, adding that the equipment and specialists are typically concentrated in cities.
“You don’t get rural representation and you certainly don’t get average American families [in research]. So our community, I think, is in a really unique position in that we have all of that right here,” she said.
Howell is an associate professor at Fralin Biomedical Research Institute at VTC, in the Department of Human Development and Family Science. She’s also the director of the Maternal Influence on Neurodevelopment — or MIND — Lab.
For this study, she is joined by two other principal investigators at Virginia Tech: Martha Ann Bell, university distinguished professor and professor of psychology in the College of Science, and Kathy Hosig, a professor of population health sciences of the Virginia-Maryland College of Veterinary Medicine and director of the Virginia Tech Center for Public Health Practice and Research.
What happens during research visits?
Funding is in place to minimize barriers that rural families may face, including transportation, access to car seats, hotel stays and meals.
The research team will drive participants who cannot travel to the study sites, which Howell says helps break down preconceived ideas about the researchers themselves.
“When you’re riding in the car together, it helps people understand that we’re people, too,” she said.
Those who volunteer for the study begin during the mother’s second trimester of pregnancy, when they visit the research institute in Roanoke for surveys and sample collection, such as blood and urine.
The second visit takes place within a month after the baby’s due date, when the baby undergoes an MRI scan to capture images of the brain. Unlike CT scans or X-rays, MRIs do not expose infants to radiation, Howell said.
When the babies are between 3 and 9 months old, researchers will assess them through interactive games, saliva samples, MRI scans and EEG scans, which measure brain activity. Infants also briefly wear an activity and heart rate monitor.
At 9 to 15 months, families return for the same assessments, which continue at intervals up to 48 months. From then until age 10, follow-ups shift to annual visits.
Howell emphasized that researchers are not looking for problems in children, but rather studying how they grow, think, behave, form emotions, interact socially and develop cognitively in their earliest years.
A key goal, she said, is to inform better care for future generations of children and families.
“[This study] is really a place where people can contribute,” Howell said. “I always make the parallel between this and voting. This is a way for you to voice how you are.”
Research on substance exposure could influence decision-making for moms
Opioid exposure is a central focus of the study, Howell said. Researchers aim to determine whether developmental effects come from the pharmacological impact of the drug itself or from environmental factors that often accompany opioid use. So far, no study has been large enough to show whether prenatal drug use affects a child’s brain development or if the outcomes are tied to the environments where exposure is more common, Howell said.
The vast majority of recruitment for this population comes from peer support navigators — people who have lived experience with substance-use disorders. One peer support specialist in Southwest Virginia has played a key role in enrolling mothers in recovery who are able to take part in the study.
Researchers are examining a wide range of exposures, including neonatal abstinence syndrome, which is when a mother uses drugs during pregnancy and the baby is then born with illicit drugs in their system.
This will impact decision-making when looking at treatment options for opioid-use disorder, Howell said. Currently, the most effective treatment uses controlled prescription opioids to ease withdrawal symptoms and support long-term recovery.
“[Mothers] have had to make a really hard decision: Is it worth the potential risk to continue to expose my baby to prescription medicines that I know might still impact them versus what might happen if I’m not on this medication,” Howell said. “And so we’re hoping that this study will disentangle a lot of that so they can make a better informed decision.”
The research also extends to other substances, including stimulants, alcohol, nicotine and cannabis.
From sheep, to monkeys, to people
Howell grew up on a hobby farm in New Hampshire with her mother and sister. Each spring, when the sheep were sheared, and she and her sister would choose the colors to dye the yarn. Their mother then knitted sweaters for them in the shades they picked.
Howell’s parents separated when she was young, and until about age 8, her mom raised the girls on her own.
“You start to look at those [family] relationships, and there is no reason I should be here right now, statistically speaking. However, I have an amazing mom and sister and that is one of the reasons that I started to think about early experience,” Howell said. “What is it about early experience that sets you on these trajectories?”
That question has fueled her research for years. She began by studying monkey behavior in multiple labs but eventually realized the findings could not be directly applied to humans.
That realization brought her first to the Institute of Child Development at the University of Minnesota for her postdoctoral research, and then to Roanoke, where she joined the research institute.
Her mother is carrying on the tradition of creating homespun goods that influenced her own daughter’s early childhood. Today, she continues to support her daughter’s work by crocheting blankets for the babies enrolled in the HEALthy Brain and Child Development study.
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Correction 2:25 p.m. Oct. 2: Starting at age 4, through age 10, children participating in the study have annual follow-up visits at FBRI. A description of this part of the study was incorrect in an earlier version of this story. Additionally, Brittany Howell was at the Institute of Child Development at the University of Minnesota before coming to Roanoke. This position was not included in the earlier story.