Maternal COVID-19 vaccination safe from perspective of early offspring neurodevelopment: JAMA

The cohort study of 2261 and 1940 infants aged 12 and 18 months, respectively, showed that in utero exposure to COVID-19 vaccination was not associated with abnormal neurodevelopmental scores on the Ages and Stages Questionnaire, third edition, (ASQ-3) at 12 or 18 months of life.

Previous studies have shown that the uptake of COVID-19 vaccines among pregnant individuals is hampered by safety concerns around potential risks that the vaccine poses to unborn children. There is a lack of data clarifying early neurodevelopmental outcomes of offspring exposed to COVID-19 vaccination in utero. To fill this knowledge gap, Eleni G. Jaswa, University of California, San Francisco, San Francisco, and colleagues aimed to determine whether in utero exposure to maternal COVID-19, vaccination was associated with differences in scores on the ASQ-3 at 12 and 18 months of age in a prospective cohort study, Assessing the Safety of Pregnancy During the Coronavirus Pandemic (ASPIRE).

The study enrolled pregnant participants from May 2020 to August 2021; follow-up of children from these pregnancies is ongoing. Participants which included pregnant women and their offspring from all 50 states were self-enrolled online. Study activities were performed remotely.

A comparison was drawn between In utero exposure of the fetus to maternal COVID-19 vaccination during pregnancy and with those unexposed.

The main outcomes were neurodevelopmental scores on validated ASQ-3, completed by birth mothers at 12 and 18 months. A score below the established cutoff in any of five subdomains (social skills, problem-solving, fine motor, gross motor, communication) constituted an abnormal screen for developmental delay.

2487 pregnant individuals (mean age, 33.3 years) were enrolled at less than 10 weeks gestation and completed research activities, yielding a total of 2261 and 1940 infants aged 12 and 18 months, respectively, with neurodevelopmental assessments.

The study revealed the following findings:

• In crude analyses, 30.6% of exposed infants screened abnormally for developmental delay at 12 months versus 28.2% of unexposed infants; the corresponding prevalences at 18 months were 20.1% versus 23.2%, respectively (χ2 = 2.35).
• In multivariable mixed-effects logistic regression models adjusting for maternal age, race, ethnicity, education, income, maternal depression, and anxiety, no difference in risk for abnormal ASQ-3 screens was observed at either time point (12 months: adjusted risk ratio [aRR], 1.14; 18 months: aRR, 0.88).
• Further adjustment for preterm birth and infant sex did not affect results (12 months: aRR, 1.16; 18 months: aRR, 0.87).

"These data suggest that maternal vaccination against COVID-19 during pregnancy was safe from the perspective of offspring neurodevelopment through 18 months of age," the researchers wrote, adding that, "additional longer-term research should be conducted to corroborate these findings and buttress clinical guidance with a strong evidence base."

Reference:

Jaswa EG, Cedars MI, Lindquist KJ, et al. In Utero Exposure to Maternal COVID-19 Vaccination and Offspring Neurodevelopment at 12 and 18 Months. JAMA Pediatr. Published online January 22, 2024. doi:10.1001/jamapediatrics.2023.5743