Birth during the COVID-19 pandemic, but not maternal SARS-CoV-2 infection during pregnancy, is associated with lower neurodevelopmental scores at 6-months

Abstract

The intrauterine environment strongly influences development. Neurodevelopmental effects of in utero exposure to maternal SARS-CoV-2 infection are widely speculated but currently unknown. The COVID-19 Mother Baby Outcomes (COMBO) initiative was established at Columbia University Irving Medical Center (CUIMC) in New York City to prospectively study the health and wellbeing of infants with and without in utero exposure to maternal SARS-CoV-2 infection. We report findings on 6-month neurodevelopmental outcomes using the parental-report Ages & Stages Questionnaire, 3rd Edition (ASQ-3), from 107 in utero exposed and 131 unexposed full-term infants born between March and December, 2020. We compare these infants to a historical cohort comprised of 62 infants born at CUIMC at least two months prior to the onset of the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with differences on any ASQ-3 subdomain regardless of infection timing or severity, however, infants born during the pandemic had significantly lower scores on gross motor, fine motor, and personal-social subdomains when compared to the historical cohort. Infants born to women who were in the first trimester of pregnancy during the peak of the pandemic in NYC had the lowest personal-social scores. Birth during the pandemic, but not maternal SARS-CoV-2 infection, was associated with differences in neurodevelopmental outcomes at 6-months. These early findings suggest significantly higher public health impact for the generation born during the COVID-19 pandemic than previously anticipated.

Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy

“… 22 In a recent study in which 272 mothers of infants born during the pandemic (both exposed and nonexposed to SARS-CoV-2 during pregnancy) completed a questionnaire at 6 months, the authors argue that observed neurodevelopmental deficits in both groups may be the product of pregnancy during the pandemic itself, rather than SARS-CoV-2 exposure per se. 23 The biological basis or mechanism by which maternal pandemic-associated stress would be a more dominant driver of offspring neurodevelopment than maternal viral illness in pregnancy remains unclear, and this putative association also requires validation in larger and longer-term studies. Our findings identifying an association between prenatal SARS-CoV-2 exposure and neurodevelopmental diagnoses at 12 months are consistent with a large body of literature including human and animal studies linking maternal viral infection and maternal immune activation with offspring neurodevelopmental disorders later in life, 6 , 7 , 8 , 9 some of which can be foreshadowed as early as the first year of life.…”

The effect of coronavirus disease 2019 on newborns

“…Potential pandemic-associated deficits may also extend beyond children exposed to SARS-CoV-2 in utero : population-level reports have shown that the generation born during the 1918 Spanish flu pandemic had lower educational attainment during childhood and lower socioeconomic status as adults [ 50 ]. Preliminary reports on early development in infants born during the COVID-19 pandemic suggest the potential for similar generation-wide effects [ 51 , 52 ]. Recently, our group found no differences between in utero SARS-CoV-2 exposed versus unexposed infants in scores on the Ages and Stages Questionnaire, 3rd Edition (ASQ-3) neurodevelopmental screening tool at 6 months of age, but significantly lower gross motor, fine motor, and personal–social scores in the overall pandemic-born cohort when compared with a prepandemic cohort born at the same medical center who completed the ASQ-3 at the same age [ 52 ].…”

“…Preliminary reports on early development in infants born during the COVID-19 pandemic suggest the potential for similar generation-wide effects [ 51 , 52 ]. Recently, our group found no differences between in utero SARS-CoV-2 exposed versus unexposed infants in scores on the Ages and Stages Questionnaire, 3rd Edition (ASQ-3) neurodevelopmental screening tool at 6 months of age, but significantly lower gross motor, fine motor, and personal–social scores in the overall pandemic-born cohort when compared with a prepandemic cohort born at the same medical center who completed the ASQ-3 at the same age [ 52 ]. These differences were most pronounced in infants whose mothers were in the first trimester of pregnancy during the peak of the pandemic in New York City, suggesting a potential role of COVID-19-related maternal stress early in gestation in mediating pandemic-associated effects on development, which is consistent with other studies on prenatal stress during natural disasters and child neurodevelopment [ 8 , 9 ].…”

Can Suboptimal Visual Environments Negatively Affect Children’s Cognitive Development?

“…The pandemic's unprecedented period of indoor isolation is most likely to have played a key role. Despite the limitations of the two cited studies [1,2], serious questions are raised.…”

“…For most, the following was a surprising finding: a recent American study indicated that children born during the COVID-19 pandemic have significantly reduced motor, verbal, and overall cognitive performance compared to those born before the pandemic [1], with scores showing a significant reduction on the Early Learning Composite (ELC). While the above study is still under review, another supporting study has appeared [2]. These are genetically normal children that had not been infected, so the discussion about adults who have recovered from COVID-19 with their IQ negatively impacted [3] is completely separate.…”