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Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and
Lauren C Shuffrey1, Morgan R Firestein1, Margaret H Kyle2
1Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.
Insights
Birth during the COVID-19 pandemic, not in-utero SARS-CoV-2 exposure, was linked to differences in infant neurodevelopment at 6 months. Long-term monitoring is recommended for pandemic-born children.
Area of Science:
- Pediatric Neurodevelopment
- Infectious Disease Epidemiology
- Public Health
Background:
- Associations between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment remain largely unknown.
- The COVID-19 pandemic presents a unique environmental factor impacting child development.
Purpose of the Study:
- To investigate the relationship between maternal SARS-CoV-2 infection during pregnancy and infant neurodevelopment at 6 months.
- To assess neurodevelopmental outcomes in infants born during the COVID-19 pandemic compared to pre-pandemic cohorts.
Main Methods:
- A cohort study at Columbia University Irving Medical Center enrolled infants exposed and unexposed to maternal SARS-CoV-2 infection during pregnancy.
- Neurodevelopment was assessed at 6 months using the Ages & Stages Questionnaire, 3rd Edition (ASQ-3).
- Secondary analyses included a historical cohort of infants born before the pandemic.
Main Results:
- In-utero exposure to maternal SARS-CoV-2 infection was not associated with significant differences in any ASQ-3 subdomain at 6 months.
- Infants born during the COVID-19 pandemic showed significantly lower scores in gross motor, fine motor, and personal-social domains compared to a pre-pandemic historical cohort.
Conclusions:
- Birth during the COVID-19 pandemic, rather than maternal SARS-CoV-2 infection in utero, was associated with neurodevelopmental differences at 6 months.
- These findings highlight the need for ongoing surveillance and support for children born during the pandemic.
Importance:
Associations between in utero exposure to maternal SARS-CoV-2 infection and neurodevelopment are speculated, but currently unknown.
Objective:
To examine the associations between maternal SARS-CoV-2 infection during pregnancy, being born during the COVID-19 pandemic regardless of maternal SARS-CoV-2 status, and neurodevelopment at age 6 months.
Design, Setting, And Participants:
A cohort of infants exposed to maternal SARS-CoV-2 infection during pregnancy and unexposed controls was enrolled in the COVID-19 Mother Baby Outcomes Initiative at Columbia University Irving Medical Center in New York City. All women who delivered at Columbia University Irving Medical Center with a SARS-CoV-2 infection during pregnancy were approached. Women with unexposed infants were approached based on similar gestational age at birth, date of birth, sex, and mode of delivery. Neurodevelopment was assessed using the Ages & Stages Questionnaire, 3rd Edition (ASQ-3) at age 6 months. A historical cohort of infants born before the pandemic who had completed the 6-month ASQ-3 were included in secondary analyses.
Exposures:
Maternal SARS-CoV-2 infection during pregnancy and birth during the COVID-19 pandemic.
Main Outcomes And Measures:
Outcomes were scores on the 5 ASQ-3 subdomains, with the hypothesis that maternal SARS-CoV-2 infection during pregnancy would be associated with decrements in social and motor development at age 6 months.
Results:
Of 1706 women approached, 596 enrolled; 385 women were invited to a 6-month assessment, of whom 272 (70.6%) completed the ASQ-3. Data were available for 255 infants enrolled in the COVID-19 Mother Baby Outcomes Initiative (114 in utero exposed, 141 unexposed to SARS-CoV-2; median maternal age at delivery, 32.0 [IQR, 19.0-45.0] years). Data were also available from a historical cohort of 62 infants born before the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with significant differences on any ASQ-3 subdomain, regardless of infection timing or severity. However, compared with the historical cohort, infants born during the pandemic had significantly lower scores on gross motor (mean difference, -5.63; 95% CI, -8.75 to -2.51; F1,267 = 12.63; P<.005), fine motor (mean difference, -6.61; 95% CI, -10.00 to -3.21; F1,267 = 14.71; P < .005), and personal-social (mean difference, -3.71; 95% CI, -6.61 to -0.82; F1,267 = 6.37; P<.05) subdomains in fully adjusted models.
Conclusions And Relevance:
In this study, birth during the pandemic, but not in utero exposure to maternal SARS-CoV-2 infection, was associated with differences in neurodevelopment at age 6 months. These early findings support the need for long-term monitoring of children born during the COVID-19 pandemic.
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