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Neurodevelopmental delay in children exposed to maternal SARS-CoV-2 in-utero
Viviana Fajardo-Martinez1, Fatima Ferreira2, Trevon Fuller3
1David Geffen, UCLA School of Medicine, Los Angeles, CA, USA.
Insights
Children exposed to SARS-CoV-2 infection during pregnancy showed a significantly higher frequency of developmental delay. Antenatal COVID-19 exposure warrants neurodevelopmental follow-up for infants.
Area of Science:
- Pediatric Neurodevelopment
- Infectious Diseases
- Maternal Health
Background:
- The impact of SARS-CoV-2 infection during pregnancy on infant neurodevelopment remains largely unknown.
- Assessing potential long-term effects is crucial for understanding and managing risks associated with prenatal viral exposure.
Purpose of the Study:
- To evaluate pediatric neurodevelopmental outcomes in infants exposed to SARS-CoV-2 in-utero.
- To compare these outcomes with a pre-pandemic control group.
Main Methods:
- Utilized Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) and Ages and Stages Questionnaires (ASQ-3) for neurodevelopmental assessment.
- Compared 172 infants exposed to SARS-CoV-2 during pregnancy with 128 unexposed control infants from Los Angeles and Rio de Janeiro.
- Defined developmental delay (DD) based on standardized scores below -2 SD on Bayley-III or below the cut-off on ASQ-3.
Main Results:
- Infants exposed to SARS-CoV-2 in-utero exhibited a significantly higher incidence of developmental delay (11.6%) compared to controls (1.6%).
- Specific findings showed 9.4% DD in exposed vs. 1.6% in controls on Bayley-III, and 12% vs. 2.6% in Rio de Janeiro.
- Severe or critical maternal COVID-19 during pregnancy was associated with poorer neurodevelopmental outcomes in exposed infants (OR 2.6).
Conclusions:
- Children exposed to SARS-CoV-2 infection in-utero demonstrate a tenfold increased frequency of developmental delay.
- Routine neurodevelopmental follow-up should be considered for infants with antenatal COVID-19 exposure.
- Prenatal SARS-CoV-2 exposure poses a significant risk for adverse infant neurodevelopmental outcomes.
Abstract:
It is unclear if SARS CoV-2 infection during pregnancy is associated with adverse neurodevelopmental repercussions to infants. We assessed pediatric neurodevelopmental outcomes in children born to mothers with laboratory-confirmed SARS CoV-2 infection during pregnancy. Neurodevelopmental outcomes of in-utero exposed children were compared to that of pre-pandemic control children in Los Angeles (LA), CA, USA and Rio de Janeiro, Brazil. Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), the gold standard tool for evaluating neurodevelopment until 36 months of age and Ages and Stages Questionnaires (ASQ-3), a frequently used screening instrument for evaluating neurodevelopment in this same age group were the assessment tools used. Developmental delay (DD) was defined as having a score < - 2 SD below the norm (< 70) in at least one of three Bayley-III domains, (cognitive, motor or language) or a score below the cut-off (dark zone) in at least one of five ASQ-3 domains (communication, gross motor, fine motor, problem solving, personal-social). Exposed children were born between April 2020 and December 2022 while control children were born between January 2016 to December 2019. Neurodevelopmental testing was performed in 300 children total: 172 COVID-19 exposed children between 5-30 months of age and 128 control children between 6-38 months of age. Bayley-III results demonstrated that 12 of 128 exposed children (9.4%) had DD versus 2 of 128 controls (1.6%), p = 0.0007. Eight of 44 additional exposed children had DD on ASQ-3 testing. Fully, 20 of 172 exposed children (11.6%) and 2 of 128 control children (1.6%), p = 0.0006 had DD. In Rio, 12% of exposed children versus 2.6% of controls, p = 0.02 had DD. In LA, 5.7% of exposed children versus 0 controls, p = 0.12 had DD. Severe/critical maternal COVID-19 predicted below average neurodevelopment in the exposed cohort (OR 2.6, 95% CI 1.1-6.4). Children exposed to antenatal COVID-19 have a tenfold higher frequency of DD as compared to controls and should be offered neurodevelopmental follow-up.
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