Related Experiment Video
Updated: Aug 3, 2025
Induction of Maternal Immune Activation in Mice at Mid-gestation Stage with Viral Mimic PolyI:C
Published on: March 25, 2016
Assessment of Neurodevelopment in Infants With and Without Exposure to Asymptomatic or Mild Maternal SARS-CoV-2
Morgan R Firestein1, Lauren C Shuffrey1, Yunzhe Hu1
1Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.
Insights
Prenatal exposure to SARS-CoV-2 (the virus that causes COVID-19) in mothers was not associated with differences in infant neurodevelopmental outcomes. This finding was confirmed using telehealth-adapted observational assessments in infants aged 5 to 11 months.
Area of Science:
- Neuroscience
- Public Health
- Pediatrics
Background:
- Associations between prenatal SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) exposure and infant neurodevelopment are of significant public health interest.
- Previous research indicated no link between maternal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes.
- Standardized observational assessments are crucial to validate these findings.
Purpose of the Study:
- To determine if maternal SARS-CoV-2 infection, mild or asymptomatic, during pregnancy is associated with neurodevelopmental differences in infants aged 5 to 11 months.
- To compare neurodevelopmental outcomes between infants exposed and unexposed to SARS-CoV-2 in utero.
Main Methods:
- A cohort study involving mother-infant dyads from the COVID-19 Mother Baby Outcomes (COMBO) Initiative and the Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy (ESPI) study.
- Infant neurodevelopment was assessed using the telehealth-adapted Developmental Assessment of Young Children, second edition (DAYC-2).
- The primary outcome was age-adjusted standard scores on DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language.
Main Results:
- Maternal SARS-CoV-2 infection during pregnancy was not associated with significant differences in infant cognitive, gross motor, fine motor, expressive language, or receptive language scores on the DAYC-2.
- No association was found between the trimester of exposure or maternal symptom status and infant neurodevelopmental outcomes.
- This study included 407 infants and assessed neurodevelopment between March 2021 and June 2022.
Conclusions:
- This study's findings, using a novel telehealth-adapted observational assessment, corroborate previous research indicating no association between prenatal SARS-CoV-2 exposure and infant neurodevelopment.
- These data provide valuable information for pregnant individuals experiencing mild or asymptomatic SARS-CoV-2 infections, given the ongoing prevalence of COVID-19.
- The results suggest that maternal SARS-CoV-2 infection during pregnancy does not adversely impact infant neurodevelopmental trajectories as measured by the DAYC-2.
Importance:
Associations between prenatal SARS-CoV-2 exposure and neurodevelopmental outcomes have substantial public health relevance. A previous study found no association between prenatal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes, but standardized observational assessments are needed to confirm this finding.
Objective:
To assess whether mild or asymptomatic maternal SARS-CoV-2 infection vs no infection during pregnancy is associated with infant neurodevelopmental differences at ages 5 to 11 months.
Design, Setting, And Participants:
This cohort study included infants of mothers from a single-site prospective cross-sectional study (COVID-19 Mother Baby Outcomes [COMBO] Initiative) of mother-infant dyads and a multisite prospective cohort study (Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI]) of pregnant individuals. A subset of ESPI participants was subsequently enrolled in the ESPI COMBO substudy. Participants in the ongoing COMBO study were enrolled beginning on May 26, 2020; participants in the ESPI study were enrolled from May 7 to November 3, 2021; and participants in the ESPI COMBO substudy were enrolled from August 2020 to March 2021. For the current analysis, infant neurodevelopment was assessed between March 2021 and June 2022. A total of 407 infants born to 403 mothers were enrolled (204 from Columbia University Irving Medical Center in New York, New York; 167 from the University of Utah in Salt Lake City; and 36 from the University of Alabama in Birmingham). Mothers of unexposed infants were approached for participation based on similar infant gestational age at birth, date of birth, sex, and mode of delivery to exposed infants.
Exposures:
Maternal symptomatic or asymptomatic SARS-CoV-2 infection.
Main Outcomes And Measures:
Infant neurodevelopment was assessed using the Developmental Assessment of Young Children, second edition (DAYC-2), adapted for telehealth assessment. The primary outcome was age-adjusted standard scores on 5 DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language.
Results:
Among 403 mothers, the mean (SD) maternal age at delivery was 32.1 (5.4) years; most mothers were of White race (240 [59.6%]) and non-Hispanic ethnicity (253 [62.8%]). Among 407 infants, 367 (90.2%) were born full term and 212 (52.1%) were male. Overall, 258 infants (63.4%) had no documented prenatal exposure to SARS-CoV-2 infection, 112 (27.5%) had confirmed prenatal exposure, and 37 (9.1%) had exposure before pregnancy or at an indeterminate time. In adjusted models, maternal SARS-CoV-2 infection during pregnancy was not associated with differences in cognitive (β = 0.31; 95% CI, -2.97 to 3.58), gross motor (β = 0.82; 95% CI, -1.34 to 2.99), fine motor (β = 0.36; 95% CI, -0.74 to 1.47), expressive language (β = -1.00; 95% CI, -4.02 to 2.02), or receptive language (β = 0.45; 95% CI, -2.15 to 3.04) DAYC-2 subdomain scores. Trimester of exposure and maternal symptom status were not associated with DAYC-2 subdomain scores.
Conclusions And Relevance:
In this study, results of a novel telehealth-adapted observational neurodevelopmental assessment extended a previous finding of no association between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment. Given the widespread and continued high prevalence of COVID-19, these data offer information that may be helpful for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections.
