Infants prenatally exposed to SARS-CoV-2 show the absence of fidgety movements and are at higher risk for neurological disorders: A comparative study

Abstract

Congenital viral infections are believed to damage the developing neonatal brain. However, whether neonates exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) show manifestations of such damage remains unclear. For neurodevelopment evaluation, general movement assessments have been shown to be effective in identifying early indicators of neurological dysfunction, including the absence of fidgety movements. This study compared the early motor repertoire by general movement assessment at three to five months of age in neonates who were or were not prenatally exposed to SARS-CoV-2 to determine whether infants prenatally exposed to SARS-CoV-2 are at risk of developing neurological disorders. Fifty-six infants, including 28 in the exposed group of mothers without vaccination who had no need for intensive care and likely had SARS-CoV-2 infection close to the time of pregnancy resolution and 28 infants in the nonexposed group, were videotaped to compare their detailed early motor repertoires, in which a motor optimality score-revised (MOS-R) was calculated using Prechtl’s method by using the chi-square or Mann–Whitney U tests. In the exposed group, 3 (11%) infants showed the absence of fidgety movements with a total MOS-R<14 points, and 3 (11%) other infants showed abnormal fidgety movements. Between groups, atypical body symmetry (p = 0.009) and MOS-R values were significantly lower (Z = -3.08, p = 0.002), with a large size effect (Cohen’s d = 0.97). The consequences of this new virus go beyond the health of the pregnant mother, and these consequences in some of the infants in the exposed group are likely not transitory because of the absence of fidgety movements between 3–5 months; thus, these babies are at increased risk of developing a serious neurological disorder.

SARS-CoV-2 (COVID-19) as a possible risk factor for neurodevelopmental disorders

“…Interestingly, gross motor, problem solving, personal-social, and social-emotional were negatively linked with the amount of time mothers and babies were separated after birth. More recent studies with larger sample sizes provide additional insights (Aldrete-Cortez et al, 2022;Ayed et al, 2022;Edlow et al, 2022). A prospective cohort study conducted in Kuwait (N = 298) reported developmental delays in around 10% of infants whose mothers had COVID-19 during pregnancy using the ASQ-3 (Ayed et al, 2022), which is similar to rates of developmental delay in healthy children in a similar geographical and cultural setting (Charafeddine et al, 2019).…”

“…Aldrete-Cortez et al took a different approach using observations of early motor repertoires as their outcome. They showed that at 3-5 months of age, a motor optimality score was significantly lower in infants prenatally exposed to SARS-CoV-2 than unexposed controls, suggesting they are at higher risk for later neurological disorders (Aldrete-Cortez et al, 2022). Finally, Edlow et al 10.3389/fnins.2022.1021721 TABLE 1 Effect of maternal SARS-CoV-2 infection on offspring neurodevelopment.…”

“…Infants born during the SARS-CoV-2 pandemic had similar rates of neurodevelopmental issues compared to those born before the pandemic, regardless of whether they were exposed in utero. Communication impairments were more common in children born during the pandemic and fine motor deficits were more common in those with in utero exposure Hessami et al, 2022 Infants prenatally exposed to SARS-CoV-2 have low motor activity score and higher risk for later neurological disorders Aldrete-Cortez et al, 2022 10% of infants whose mothers had COVID-19 during pregnancy exhibited developmental delays, which is similar to rates of developmental delay in healthy children in a similar geographical and cultural setting Ayed et al, 2022 used electronic health records and a retrospective cohort design to test associations between SARS-CoV-2 exposure in utero and risk for neurodevelopmental disorders in the first year of offspring life (Edlow et al, 2022). This cohort included 7772 live births of which 222 were to SARS-Cov-2 positive mothers.…”

“…It provides a more detailed discussion of how altered levels of glucocorticoids in the context of SARS-CoV-2 could affect fetal neurodevelopment, and is the first, to our knowledge, to raise the possibility that SARS-CoV-2 induced hypocortisolism could be a risk factor for adverse neurodevelopmental outcomes. Finally, this review includes the most recent empirical studies on neurodevelopmental consequences of in utero exposure to SARS-CoV-2 including (Aldrete-Cortez et al, 2022;Hessami et al, 2022;Shuffrey et al, 2022).…”

Effectiveness of a third BNT162b2 mRNA COVID-19 vaccination during pregnancy: a national observational study in Israel

“…Research into the long-term consequences of COVID-19 in pregnancy for mothers and newborns is still scarce. Initial, preliminary reports of the long-term effects of maternal COVID-19 infection during pregnancy have suggested worrying adverse neurodevelopmental sequelae [24][25][26] . These cases highlight the urgent need for data on measures to limit maternal infection, which may have as yet unknown adverse consequences.…”