EXPOSURE to maternal SARS-CoV-2 infection in utero is not associated with an increased risk of abnormal neurodevelopmental outcomes in children, according to new research.
Maternal infections during pregnancy are known to influence foetal neurodevelopment, and the widespread impact of the COVID-19 pandemic made it critical to assess its potential developmental implications.
The prospective cohort study aimed to explore whether in utero exposure to maternal SARS-CoV-2 infection affected neurodevelopmental outcomes in children through age 24 months. Using data from the Assessing the Safety of Pregnancy in the Coronavirus Pandemic (ASPIRE) trial, the team enrolled 2,003 pregnant individuals aged ≥18 years and their children. Neurodevelopmental outcomes were assessed at 12, 18, and 24 months using the Ages & Stages Questionnaires, Third Edition (ASQ-3), which screens for developmental delays across several domains.
The study included 1,757 children at 12 months, 1,522 at 18 months, and 1,523 at 24 months. Neurodevelopmental outcomes, measured by the ASQ-3, showed no significant differences between children exposed to maternal SARS-CoV-2 infection in utero and those unexposed. The prevalence of abnormal developmental screens at 12 months was 32.3% among exposed children compared to 29.4% in unexposed children; at 18 months, it was 22.4% versus 20.5%, and at 24 months, it was 19.2% versus 16.8%.
After adjusting for potential confounding factors, no significant differences in neurodevelopmental risks were observed at age 12, 18, or 24 months. Additional analyses did not identify differential risk based on trimester of infection, presence versus absence of fever, or breakthrough infection following vaccination versus primary infection.
The findings suggest that maternal COVID-19 infection during pregnancy does not increase the risk of neurodevelopmental impairment in children up to 24 months old, offering reassurance to pregnant individuals and healthcare providers. However, ongoing research is necessary to monitor long-term neurodevelopmental outcomes, particularly in diverse populations and considering potential influences like maternal immune activation during pregnancy.
Reference
Jaswa EG et al. In utero exposure to maternal COVID-19 and offspring neurodevelopment through age 24 months. JAMA Netw Open. 2024;7(10):e2439792.
