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Published on: August 25, 2014
The association of in utero SARS-CoV-2 exposure on neurodevelopmental outcomes at 12 and 22 months
Ashraf Kharrat1,2, Erin Gleeson3, Vanessa Pippert3
1Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada. ashraf.kharrat@sinaihealth.ca.
Insights
Infants exposed to SARS-CoV-2 in utero showed typical development at 12 months but 52% had developmental delays by 22 months. Language delay was most common in these infants with prenatal SARS-CoV-2 exposure.
Area of Science:
- Neonatal Health
- Developmental Pediatrics
- Infectious Diseases
Background:
- Vertical transmission of SARS-CoV-2 is rare, but the long-term neurodevelopmental effects on infants exposed in utero require further investigation.
- Understanding the impact of maternal SARS-CoV-2 infection during pregnancy on infant neurodevelopment is crucial for early intervention.
Purpose of the Study:
- To assess neurodevelopmental outcomes in infants exposed to SARS-CoV-2 in utero at 12 and 22 months corrected age.
- To identify potential developmental delays and patterns following prenatal exposure to the virus.
Main Methods:
- Prospective cohort study of 142 infants born to mothers with SARS-CoV-2 infection during pregnancy (March 2020-December 2022).
- Neurodevelopmental assessments included virtual evaluations at 12 months (ASQ, CSBS) and in-person assessments at 22 months (BSID-IV).
- Data collected at birth, 1 month, 12 months, and 22 months.
Main Results:
- At 12 months, infants showed scores above developmental cut-offs; however, by 22 months, 52% exhibited developmental impairment (score <85).
- Specific delays at 22 months included motor (30%), language (39%), and cognitive (30%) domains, with 20% affected in all three.
- No independent relationship was found between trimester of SARS-CoV-2 acquisition or delivery test status and developmental delay.
Conclusions:
- Prenatal SARS-CoV-2 exposure may be associated with developmental delays emerging by 22 months, despite normal 12-month assessments.
- Language delay was the most frequent developmental concern identified in this cohort.
- High loss to follow-up rates may impact the interpretation of these findings, necessitating cautious conclusions.
Background:
Although vertical transmission of SARS-CoV-2 from mother to fetus is rare, the neurodevelopmental impact of in utero SARS-CoV-2 exposure on infants needs further elucidation.
Objective:
To investigate the neurodevelopmental outcomes at 12 and 22 corrected age among infants who had exposure to confirmed maternal SARS-CoV-2 infection during pregnancy.
Design/Methods:
We conducted a prospective cohort study of neonates born to women with SARS-CoV-2 infection in pregnancy, from March 2020 to December 2022 (COVID-19 waves 1-5). Infants were recruited from six (5 community and 1 tertiary) hospitals. Data were collected at birth and three subsequent time periods. A telephone call was made at one month to assess general health and wellness. A virtual neurodevelopmental assessment was conducted at 12 months using the Ages and Stages Questionnaire (ASQ) and the Communication and Symbolic Behavior Scales (CSBS). In-person neurodevelopmental assessment was conducted at 22 months using the Bayley Scales of Infant and Toddler Development-4th Edition (BSID-IV).
Results:
A total of 142 infants were recruited and included in the study. Of those, a one-month assessment was completed in 141 (99%), a 12-month assessment completed in 63 (44%), and a 22-month assessment completed in 44 (31%) infants. At one month, most infants had no medical concerns; 11 infants were re-admitted to the hospital within the first month of life, predominantly for hyperbilirubinemia. At 12 months, median ASQ and CSBS scores were above standardized cut-offs for development across all developmental domains. At 22 months, while the median standard cognitive, language, and motor scores were within the average classification (25-37th percentile), twenty-three (52%) infants presented with developmental impairment (score <85); 13 (30%) in motor, 17 (39%) in language, and 13 (30%) in cognitive domains. Nine (20%) infants were below cut-off for all three domains. Multivariable logistic modelling did not identify an independent relationship between trimester of SARS-CoV-2 acquisition or positive SARS-CoV-2 test at delivery and the presence of developmental delay on BSID-IV in any domain. No child had hearing impairment or blindness.
Conclusions:
Developmental delay at 22 months may be identified among infants with in utero exposure to SARS-CoV-2, despite typical developmental progress at 12 months. These findings may be impacted by the loss to follow-up rate. Of those with developmental diversity, language delay was most common.
