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Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy
Andrea G Edlow1, Victor M Castro2,3, Lydia L Shook1
1Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston.
Insights
Maternal SARS-CoV-2 infection during pregnancy may increase the risk of neurodevelopmental disorders in infants. Further research is needed to confirm these findings and understand long-term effects.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Infectious Diseases
Background:
- Maternal immune activation in pregnancy is linked to offspring neurodevelopmental issues.
- The impact of SARS-CoV-2 infection in utero on infant neurodevelopment requires investigation.
Purpose of the Study:
- To determine if in utero SARS-CoV-2 exposure is associated with neurodevelopmental disorders in infants within the first year of life.
Main Methods:
- Retrospective cohort study of live births from March to September 2020.
- Maternal SARS-CoV-2 infection confirmed via PCR testing during pregnancy.
- Neurodevelopmental disorders identified using ICD-10 codes from electronic health records.
Main Results:
- The study included 7772 live births, with 222 from mothers infected with SARS-CoV-2.
- Maternal SARS-CoV-2 infection was associated with a higher rate of neurodevelopmental diagnoses in offspring (adjusted OR, 1.86).
- Third-trimester infection showed a stronger association (adjusted OR, 2.34).
Conclusions:
- Preliminary evidence suggests a potential association between maternal SARS-CoV-2 infection in utero and infant neurodevelopmental sequelae.
- Prospective studies with extended follow-up are necessary to confirm these findings and rule out confounding factors.
Importance:
Epidemiologic studies suggest maternal immune activation during pregnancy may be associated with neurodevelopmental effects in offspring.
Objective:
To evaluate whether in utero exposure to SARS-CoV-2 is associated with risk for neurodevelopmental disorders in the first 12 months after birth.
Design, Setting, And Participants:
This retrospective cohort study examined live offspring of all mothers who delivered between March and September 2020 at any of 6 Massachusetts hospitals across 2 health systems. Statistical analysis was performed from October to December 2021.
Exposures:
Maternal SARS-CoV-2 infection confirmed by a polymerase chain reaction test during pregnancy.
Main Outcomes And Measures:
Neurodevelopmental disorders determined from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes over the first 12 months of life; sociodemographic and clinical features of mothers and offspring; all drawn from the electronic health record.
Results:
The cohort included 7772 live births (7466 pregnancies, 96% singleton, 222 births to SARS-CoV-2 positive mothers), with mean (SD) maternal age of 32.9 (5.0) years; offspring were 9.9% Asian (772), 8.4% Black (656), and 69.0% White (5363); 15.1% (1134) were of Hispanic ethnicity. Preterm delivery was more likely among exposed mothers: 14.4% (32) vs 8.7% (654) (P = .003). Maternal SARS-CoV-2 positivity during pregnancy was associated with greater rate of neurodevelopmental diagnoses in unadjusted models (odds ratio [OR], 2.17 [95% CI, 1.24-3.79]; P = .006) as well as those adjusted for race, ethnicity, insurance status, offspring sex, maternal age, and preterm status (adjusted OR, 1.86 [95% CI, 1.03-3.36]; P = .04). Third-trimester infection was associated with effects of larger magnitude (adjusted OR, 2.34 [95% CI, 1.23-4.44]; P = .01).
Conclusions And Relevance:
This cohort study of SARS-CoV-2 exposure in utero found preliminary evidence that maternal SARS-CoV-2 may be associated with neurodevelopmental sequelae in some offspring. Prospective studies with longer follow-up duration will be required to exclude confounding and confirm these associations.
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