COVID-19 and Pregnancy: Does In Utero Exposure Impact Early Neurodevelopment?

In utero exposure to SARS-CoV-2 infection is not associated with adverse neurodevelopmental outcomes in offspring, according to study results published in JAMA Network Open.

Researchers sourced data from the Assessing the Safety of Pregnancy in the Coronavirus Pandemic (ASPIRE) trial, a nationwide prospective cohort of pregnant women who were enrolled prior to 10 weeks’ gestation and their children, to explore whether exposure to maternal COVID-19 impacts neurodevelopmental outcomes in offspring at ages 12, 18, and 24 months. The primary outcome was abnormal Ages and Stages Questionnaire, 3rd edition (ASQ-3) screening scores on any of 5 developmental domains (ie, communication, gross motor, fine motor, problem-solving, social skills). To investigate the relationship between prenatal infection and a high-risk screen for neurodevelopmental delay at 12, 18, and 24 months’ postpartum, mixed-effects logistic regression models were used.

A total of 2003 (mean age, 33.3; White, 87.8%; college education level, 87.4%) participants were eligible for inclusion, of whom 217 (10.8%) were exposed to SARS-CoV-2 during pregnancy.

Neurodevelopmental outcome data were available for 1757, 1522, and 1523 children at ages 12, 18, and 24 months, respectively. The prevalence of abnormal ASQ-3 screens among exposed vs unexposed offspring was 32.3% vs 29.4% (P =.39) at age 12 months, 22.4% vs 20.5% (P =.58) at age 18 months, and 19.2% vs 16.8% (P =.45) at age 24 months.

After adjusting for confounders, no difference in risk for abnormal neurodevelopmental screens was observed at age 12, 18, or 24 months.

No association was found between SARS-CoV-2 infection and abnormal ASQ-3 scores among those aged 12 (adjusted risk ratio [aRR], 1.10; 95% CI, 0.88-1.38), 18 (aRR, 1.15; 95% CI, 0.84-1.57), or 24 (aRR, 0.99; 95% CI, 0.67-1.46) months.

Results remained even after stratifying by preterm delivery, infant sex, timing of infection during pregnancy, febrile status, and maternal vaccination.

Study limitations include the reduced generalizability of results to more vulnerable populations, potential selection bias, relatively small sample size, potentially underestimated incidence of asymptomatic infection, and missing data.

“Ongoing, long-term studies across diverse cohorts are necessary to clarify the full spectrum of sequelae that may have resulted from the COVID-19 pandemic,” the study authors concluded.

Disclosure: This research was supported by AbbVie and Ferring Pharmaceuticals. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the authors’ disclosures.