Congenital TORCH Infections Linked to Intellectual Disability and Autism in Neonates: JAMA
Sweden: Researchers have found in a new study that congenital TORCH infections, although rare, were associated with intellectual disability and autism, along with broader adverse cognitive outcomes in neonates. The findings highlight the importance of preventing vertically transmitted infections through vaccination and other preventive strategies.
The findings were reported in an original investigation published in JAMA Pediatrics by Hugo Sjöqvist, MSc, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden, and colleagues. The researchers examined whether congenital infections caused by toxoplasmosis, syphilis, rubella, cytomegalovirus (CMV), or herpes simplex virus (HSV) were associated with later neurodevelopmental and psychiatric outcomes.
The nationwide cohort study used linked Swedish health, birth, insurance, education, and mortality registers. It included 3,666,002 individuals born in Sweden between 1987 and 2021, who were followed from birth until death, emigration, or December 31, 2023. Among them, 975 had a clinically diagnosed congenital TORCH infection. The investigators also conducted sibling comparisons to account for potential familial factors.
Outcomes assessed included autism, intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder, Tourette and chronic tic disorders, nonaffective psychosis, and academic performance at age 16 years.
The following were the key findings:
- Congenital TORCH infections were associated with a higher risk of intellectual disability (HR, 7.22), with a stronger association in sibling comparisons (HR, 11.28).
- Autism risk was also higher among exposed individuals (HR, 3.10), with similar findings in sibling analyses (HR, 3.19).
- The risk of intellectual disability increased with severity, from HR 3.01 for mild disability to HR 23.51 for severe to profound disability.
- Autism with co-occurring intellectual disability showed a stronger association (HR, 6.23) than autism without intellectual disability (HR, 1.97).
- Individuals with congenital TORCH infections had lower adolescent school grades, with an estimated reduction of 1.50 points.
- No consistent association was found with obsessive-compulsive disorder, while the association with ADHD weakened after sibling adjustment.
The study was limited by reliance on clinically diagnosed symptomatic infections, lack of routine newborn TORCH screening, potential surveillance and diagnostic coding biases, and absence of data on other congenital infections and treatment effects. Pregnancy and birth complications may also have contributed to the observed outcomes.
Overall, the findings support an association between symptomatic congenital TORCH infections and intellectual disability, particularly severe forms, while the association with autism was largely observed among children who also had ID. The study also suggests that the impact may extend to academic performance beyond diagnosed neurodevelopmental disorders. The authors emphasized continued research into both symptomatic and asymptomatic congenital infections and the importance of preventive strategies, particularly for CMV.
Reference:
Sjöqvist H, Dalman C, Mataix-Cols D, Gardner RM, Karlsson H. Congenital TORCH Infections and Neurodevelopmental Outcomes. JAMA Pediatr. Published online September 21, 2026. doi:10.1001/jamapediatrics.2026.4229
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