Maternal COVID-19 During Pregnancy and Offspring Neurodevelopmental Disorders: A Nationwide Birth Cohort Study

Maternal coronavirus disease 2019 (COVID-19) during pregnancy was common during the pandemic. However, its potential risks for clinically diagnosed neurodevelopmental disorders in offspring, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID), remain uncertain in Asian populations. We examined the association between maternal COVID-19 during pregnancy and diagnoses of neurodevelopmental disorders in offspring.

This nationwide birth cohort study included 108,148 singleton children, contributing 224,965 person-years, using a nationwide administrative claims database from 2020 to 2024. We investigated the association between maternal COVID-19 during pregnancy and offspring neurodevelopmental outcomes, including ADHD, ASD, ID and a composite outcome, using Cox proportional hazards models, with primary analyses based on time-dependent propensity score (PS) matching. The robustness of the primary findings was evaluated through adjusted models, sibling comparison, trimester-specific analyses and sensitivity analyses for outcome misclassification.

Among 108,148 children, 7797 (7.2%) were exposed to maternal COVID-19 during pregnancy; PS matching yielded 7679 matched pairs contributing 22,360 person-years with well-balanced covariates. In PS-matched analyses, maternal COVID-19 was not associated with composite neurodevelopmental outcomes (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.56-1.66), ADHD (HR, 0.75; 95% CI, 0.32-1.78), ASD (HR, 0.79; 95% CI, 0.40-1.55), or ID (HR, 1.06; 95% CI, 0.55-2.01). Adjusted models, sibling comparisons, trimester-specific analyses and sensitivity analyses addressing outcome misclassification yielded similar null findings.

We found no evidence of an increased risk of offspring neurodevelopmental disorders following maternal COVID-19 during pregnancy during the available follow-up period.