In Utero COVID-19 Exposure not associated with Neurodevelopmental Delays in Children:JAMA

Previous studies have shown that in utero infection exposure is associated with abnormal neurodevelopment in offspring. The study was set to determine whether exposure to maternal COVID-19 infection in pregnancy impacts neurodevelopmental outcomes in children at 12, 18, and 24 months of age. The study was part of the ASPIRE (Assessing the Safety of Pregnancy in the Coronavirus Pandemic) trial, which included pregnant individuals from all 50 states and Puerto Rico, with neurodevelopmental development assessed by validated screening measures at multiple post-partum time points.

The cohort comprised 2,003 pregnant women who enrolled before 10 weeks of gestation and had a mean age of 33.3 years. Participation and enrollment were online from May 2020 to August 2021. Children who were below the cutoff in any one of these domains were classified as having an abnormal developmental screen; scores ranged from 0 to 60; the higher the score, the lower was the risk of delay.

• Abnormal developmental screens at 12 months were identified in 32.3% (64 of 198) of exposed children and in 29.4% (458 of 1,559) of unexposed children.

• At 18 months, abnormal screens were noted in 22.4% (36 of 161) of exposed children compared with 20.5% (279 of 1,361) of unexposed children.

• At 24 months, abnormal screens were found in 19.2% (29 of 151) of exposed children compared with 16.8% (230 of 1,372) of unexposed children.

• An adjusted mixed-effects logistic regression model found that exposed children did not have a significantly increased risk of abnormal neurodevelopmental screens at 12 months (adjusted risk ratio [ARR], 1.07; 95% CI, 0.85-1.34), 18 months (ARR, 1.15; 95% CI, 0.84-1.57), or 24 months (ARR, 1.01; 95% CI, 0.69-1.48). Additional analyses also did not find differential risk based on timing of infection in relation to pregnancy trimesters or based on the presence of fever. The infection was not more commonly a case of immunologic failure if it occurred after vaccination.

The study concludes that in utero exposure to maternal COVID-19 does not increase the risk for abnormal neurodevelopmental outcomes in children up to 24 months of age. The prevalence of abnormal screens for children exposed to COVID-19 was very slightly higher, differences that were not statistically significant, offering reassuring evidence that maternal infection with SARS-CoV-2 in pregnancy is unlikely to harm the neurodevelopment in early childhood.

Reference:

Jaswa, E. G., Huddleston, H. G., Lindquist, K. J., Wu, A. H. B., Bishop, S. L., Kim, Y.-S., Kaing, A., Prahl, M., Gaw, S. L., Corley, J., Hoskin, E., Cho, Y. J., Rogers, E. E., & Cedars, M. I. (2024). In utero exposure to maternal COVID-19 and offspring neurodevelopment through age 24 months. JAMA Network Open, 7(10), e2439792. https://doi.org/10.1001/jamanetworkopen.2024.39792