COMBO

COMBO is the only longitudinal mother-child cohort that combines: 

• maternal mental health 
• ongoing child developmental data 
• Covid infection status during pregnancy and comprehensive evaluations of multiple components of the child’s early relationships (including bonding, attachment, maternal sensitivity, and dyadic emotional synchrony) to uncover how each aspect maps onto future outcomes across multiple domains of development, throughout the lifespan of the child. 

Distinct in this way from initiatives such as ECHO, ABCD, HBCD, and RECOVER, the COMBO cohort is singularly poised to accelerate advancements in generational health outcomes across medical fields, with a particular focus on how early relationships shape life-course health and wellbeing for families. 

With over 2,000 mother-baby pairs (“dyads”) enrolled in its first 5 years (and additional caregivers soon to be included in the national expansion), this study has grown far beyond COVID and will continue to follow children born during the pandemic through adulthood. 

A World-Leading Study of Mothers and Babies 

A collaborative effort of over 200 inter-departmental physicians, scientists, staff, and students from over 20 institutions across the U.S., COMBO has developed some of the most sophisticated protocols for the qualitative and quantitative evaluation of ERH (including through the dyadic lens of emotional connection). 

This consortium-style model, which emerged out of Columbia’s award-winning Maternal Child Research Operations (MaCRO) Consortium team science model, enables highly skilled researchers across a broad range of expertise to compile and analyze unprecedented data on both parents and children, at key developmental time points, from the prenatal period throughout the child’s life course. 

Thanks to this model, COMBO’s collaborators are often the first to publish important findings about children born since 2020 and their families — to date, they have published over 25 foundational peer-reviewed manuscripts together and influenced national and global policies. 

Through the intersecting efforts of these many specialties — including public health, implementation science, medicine, neurology, nursing, pediatrics, OB/GYN, child development, psychology, neuroscience, engineering, computational science, psychiatry, and more — COMBO has created, and continues to build upon, an irreplaceable foundational data set on families who demonstrated resilience in an unprecedented time. 

Data from cohorts born during previous pandemics have taught us to be vigilant about later increases in diagnoses such as asthma, metabolic disturbances, autism spectrum disorder, mood disorders, and schizophrenia. As this generation ages into various risk windows, COMBO’s uniquely rich data set is critical to investigating potential adverse health consequences and primary prevention opportunities. 

COMBO’s first core mission is to continue following its unique cohort through adulthood, to understand this generation’s developmental needs and leverage that data into opportunities for both early intervention and primary prevention. 

As COMBO innovated interdisciplinary and remote protocols for studying ERH, it paved the way for a second core mission: to grow this cohort into the first national study focusing specifically on ERH. 

By attaching key, real-time, relational research to unprecedented social disruption, COMBO offers a once-in-a-generation opportunity: a truly comprehensive, longitudinal look at early childhood relationships as mediators of lifelong outcomes, complete with the context that makes that data actionable, faster. 

The Story of COMBO 

In March of 2020, Columbia was one of the hardest-hit hospitals in the country. There was no way to know how the pandemic would impact the generation of children about to be born. As a frontline physician in the Newborn Medicine Unit, center director Dr. Dumitriu saw firsthand the fear, stress, and grief new families were facing from uncertainty and separation.

Recognizing an unprecedented need to rapidly gather information about the effects on families, Dr. Dumitriu immediately pushed for resources and launched an initiative that became one of the first to find answers, globally. 

As an early relational health researcher from the start, Dr. Dumitriu’s unique perspective at this time helped lead reunite mothers and babies across the country, and around the world: 

When COMBO published the revolutionary finding that viral transmission from mother to baby is extremely rare (during pregnancy, birth, or breastfeeding), hospitals were able to end their precautionary policies of separating mothers and infants. The postpartum period is critical for maternal health, infant development, and the mom-baby relationship; this groundbreaking finding became the first of many from COMBO to directly alleviate families’ and clinicians’ stress, fear, and uncertainty. 

Their continued commitment to a relational focus in this research ultimately led to COMBO’s expansion into the first nationwide study to focus specifically on ERH and its lifelong outcomes.