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COVID-19 Pandemic and Infant Neurodevelopmental Impairment: A Systematic Review and Meta-analysis
Kamran Hessami1, Amir Hossein Norooznezhad2, Sonia Monteiro3
1Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Infants born during the COVID-19 pandemic showed increased communication delays, but overall neurodevelopment was not significantly impacted by pandemic birth or maternal SARS-CoV-2 infection. This study highlights pandemic-related risks for infant communication development.
Area of Science:
- Neuroscience
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic raised concerns about potential neurodevelopmental impairments (NDI) in infants due to factors like maternal antiviral immunity and birth during quarantine.
- Previous studies suggested a possible link between pandemic conditions and risks to infant neurodevelopment.
Approach:
- A systematic review and meta-analysis was conducted, searching multiple databases for studies on infant neurodevelopment during the SARS-CoV-2 pandemic.
- Included studies utilized the Ages and Stages Questionnaires, Third Edition (ASQ-3) for neurodevelopmental assessment.
- A random-effects model meta-analysis pooled data from 8 studies involving 21,419 infants.
Key Points:
- Infants born during the pandemic (Jan 2020-Jan 2021) had a higher likelihood of communication impairment (OR, 1.70) compared to prepandemic cohorts (2015-2019).
- Gestational exposure to SARS-CoV-2 was associated with increased odds of fine motor impairment (OR, 3.46).
- Overall neurodevelopment and other ASQ-3 domains (gross motor, personal-social, problem-solving) were not significantly different between pandemic and prepandemic infants.
Conclusions:
- Being born or raised during the COVID-19 pandemic, or gestational SARS-CoV-2 exposure, did not significantly alter overall infant neurodevelopment in the first year of life.
- The pandemic period was significantly associated with an increased risk of communication delay in infants, irrespective of maternal infection status.
- Findings underscore the specific vulnerability of infant communication development to pandemic-related environmental factors.
Importance:
Primary studies proposed that aberrant maternal antiviral immunity and/or giving birth in quarantine, such as during the ongoing COVID-19 pandemic, may be associated with the risk of neurodevelopmental impairment (NDI) in offspring.
Objectives:
To evaluate the associations of birth and being raised during the COVID-19 pandemic with risk of NDI among infants and to assess the association of gestational exposure to SARS-CoV-2 with risk of NDI.
Data Sources:
PubMed, Web of Science, Scopus, Embase, and preprint servers were systematically searched from inception to March 25, 2022.
Study Selection:
Studies evaluating the neurodevelopment of infants born during the SARS-CoV-2 pandemic were included in this systematic review and meta-analysis. Studies using Ages and Stages Questionnaires, Third Edition (ASQ-3), were used for quantitative meta-analysis.
Data Extraction And Synthesis:
Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, a random-effects model meta-analysis was used to pool the proportion and odds ratios (ORs) of overall NDI, as well as each developmental domain on ASQ-3 with the corresponding 95% CI.
Main Outcomes And Measures:
The primary outcome was the risk of overall NDI among infants screened during the pandemic vs prepandemic. The secondary outcome was the comparison of NDI by ASQ-3 domain among infants born to women with known gestational exposure to SARS-CoV-2 vs no exposure.
Results:
A total of 8 studies were included, including 21 419 infants (11 438 screened in pandemic and 9981 in prepandemic period). NDI was present in 330 of 8992 infants (7%; 95% CI, 4%-10%) screened during the COVID-19 pandemic from January 2020 to January 2021. Among the pandemic cohort, the prevalence of NDI among infants with gestational exposure to SARS-CoV-2 was 77 of 691 (12%; 95% CI, 6%-18%). Compared with the prepandemic cohort (2015-2019), the pandemic cohort was more likely to have communication impairment (OR, 1.70; 95% CI, 1.37-2.11; P < .001), without significant differences in other ASQ-3 domains (eg, gross motor, fine motor, personal-social, and problem-solving). In contrast, maternal SARS-CoV-2 infection was not associated with significant differences in any neurodevelopment domain in offspring, except for increasing the odds of fine motor impairment (OR, 3.46; 95% CI, 1.43-8.38; P < .001).
Conclusions And Relevance:
In this systematic review and meta-analysis examining the association between COVID-19 pandemic and the risk of NDI, findings suggest that overall neurodevelopment in the first year of life was not changed by either being born or raised during the SARS-CoV-2 pandemic or by gestational exposure to SARS-CoV-2. Interestingly, the first year of life during the COVID-19 pandemic, regardless of maternal infection, was significantly associated with the risk of communication delay among the offspring.
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