Kids’ Neurodevelopment Appears Unharmed by Maternal COVID Infection

Exposure to maternal COVID-19 was not associated with abnormal neurodevelopmental screening results through 24 months’ postpartum, according to a cohort study in JAMA Network Open.

In this video interview, researcher Eleni Greenwood Jaswa, MD, MSc, of the University of California San Francisco, discusses the study’s findings and implications.

The following is a transcript of her remarks:

The objective of our study was to examine neurodevelopmental outcomes among children up to 2 years old following pandemic pregnancies. So, we wanted to look to understand whether children whose mothers got COVID-19 illness or infection during pregnancy had different neurodevelopmental scores as compared to children whose mothers did not have COVID infection during their pregnancies.

When we compared children’s neurodevelopmental scores on something called the Ages & Stages Questionnaires, Third Edition, or ASQ-3, which is a validated screening tool that looks at age-appropriate milestones for achievements in development, like gross motor skills, fine motor skills, social skills, communication, and problem solving.

We looked at scores among kids out to 24 months old among moms who had COVID during pregnancy versus those who did not. And we found absolutely no difference in the developmental scores between the two groups, the exposed versus the unexposed children, at any time point.

We looked at 12 months, we looked at 18 months, we looked at 24 months, and the scores were no different on the basis of whether moms had COVID infection during pregnancy.

We looked further to see if there was a difference when the mom had COVID following a vaccination, so perhaps a milder infection, versus no preceding vaccination and saw no signal for any changes.

We looked to see if a mom had a fever with her infection versus no fever, were there any differences in scores? We found nothing there.

And we even looked, because the women who were pregnant were enrolled so early, before 10 weeks of pregnancy — which is incredibly early for a research study — and we looked to see if the infection occurred during the first trimester versus second versus third, was there any signal for perhaps a critical window of infection and these neurodevelopmental scores? And again, nothing at all.

So we found all of this pretty reassuring that there was no alteration in the children’s neurodevelopment on the basis of maternal SARS-CoV-2 infection.

Why is this study important? Well, it kind of goes without saying that pregnancy is a uniquely stressful time in a woman’s or family’s lifespan. An infection is one thing if it’s just you, but when you have a baby in utero, women feel a little bit more stressed and want to do anything they can to protect that child. There are a lot of rules around what you can and can’t eat or drink or do, exercise, how, when, and what, and so I think infection is another one that’s really stressful.

And indeed there are big epidemiologic studies suggesting something like the influenza epidemic was followed by a spike in schizophrenia rates. There’s a large body of literature from national registry studies looking at maternal infection overall, and you’ll see the children are at high risk for neurodevelopmental disorders like autism. So there is this precedent information that certain infections do predispose to abnormal neurodevelopment in the children.

And because COVID is so new, we just knew if we didn’t check, we might not know right away. So we found it really important to get the study off the ground and take a look.

Based on our findings, what are the next steps? Where do we go from here? I think first and foremost what we’re learning is that it’s really important to continue to follow these children. Right now, they are only 2, right? Anyone who’s seen a human child knows childhood is a very dynamic developmental time with leaps and bounds of development, and so continuing to follow diverse cohorts of children longitudinally is super important. Not just our cohort, but also other cohorts from across the country or around the world to check on their development as they grow older.

I think also, even though we’re really reassured that COVID infection itself is not derailing development at this time point, we’re really interested in looking at other things like social determinants of health and perhaps public policy that we implemented during the pandemic, along the lines of school closures, masking, etc., to see what might help and what might hinder children’s development as we can learn from our past and in preparation for any future pandemic.

I think also just as a pregnant individual who will certainly be around COVID, which is now an endemic infection, at least this is a kernel of reassurance that there does not seem to be some immediate strong signal for future risk for the baby’s childhood development is important to understand here.