Birth During the Pandemic May Affect Neurodevelopment
Birth during the COVID-19 pandemic was linked to lower neurodevelopment scores at 6 months, a cohort study showed.
Compared with a historical cohort of infants, children born during the 2020 pandemic had significantly lower gross motor, fine motor, and personal-social scores on the Ages & Stages Questionnaire, 3rd Edition (ASQ-3), reported Dani Dumitriu, MD, PhD, of Columbia University Irving Medical Center in New York City, and co-authors in JAMA Pediatrics.
In utero exposure to maternal SARS-CoV-2 infection was not associated with significant differences on any neurodevelopment domain, however, regardless of infection timing or severity.
“The scientific and medical communities have mostly speculated that infants born to mothers who contract COVID-19 during pregnancy might show neurodevelopmental decrements,” Dumitriu told MedPage Today. “Given data from other viral illnesses during pregnancy, we expected to see a negative impact on the development of infants who had been exposed to maternal COVID-19 disease in pregnancy.”
“However, to our surprise, we saw absolutely no effect of maternal infection with SARS-CoV-2 on infant neurodevelopment at 6 months, assessed through the ASQ-3,” she noted.
“Our study, however, points to potential impact on the neurodevelopment of infants born during the pandemic irrespective of maternal infection, which — if replicated — would translate to potential impact on hundreds of millions of children born since the onset of the pandemic, with potential for significant public health consequences,” Dumitriu said.
“These were not large differences, meaning we did not see a higher rate of actual developmental delays in our sample of a few hundred babies, just small shifts in average scores between the groups,” she added. “But these small shifts warrant careful attention because at the population level, they can have a significant public health impact. We know this from other pandemics and natural disasters.”
Cohort studies of the generation born during the 1918 H1N1 pandemic, for example, found lower educational level attainment in childhood and lower socioeconomic status as adults. Other research has linked viral illnesses like HIV during pregnancy with higher risks for neurodevelopmental deficits, including motor delays. Previous work showed little evidence for vertical transmission among newborns of mothers with SARS-CoV-2.
Dumitriu and colleagues assessed 255 infants born in New York from March to October 2020 participating in the prospective COVID-19 Mother Baby Outcomes (COMBO) study. The cohort included 114 exposed and 141 unexposed pregnancies matched on infant sex, gestational age at delivery, date of birth, and mode of delivery. Most mothers experienced asymptomatic (34%) or mild (62%) COVID-19 and were infected in the second (47%) or third (31%) trimester. Median maternal age at delivery was 32.
Data also were available from a historical cohort of 62 infants born at the same institution from November 2017 to January 2020. To match the historical sample, 17 infants born preterm and 11 hospitalized in the neonatal intensive care unit were removed when pandemic and historical cohorts were compared.
Development measures assessed by the ASQ-3 included five domains: communication, fine and gross motor skills, problem solving, and personal-social skills. Mothers completed the ASQ-3 when infants were 6 months old.
Across domains, mean developmental scores of infants with and without prenatal exposure to SARS-CoV-2 were nearly identical. But compared with the historical cohort, infants born during the pandemic had significantly lower scores on gross motor (mean difference -5.63, 95% CI -8.75 to -2.51, P<0.005), fine motor (mean difference -6.61, 95% CI -10.00 to -3.21, P<0.005), and personal-social (mean difference -3.71, 95% CI -6.61 to -0.82, P<0.05) domains, in fully adjusted models.
“Although it is tempting to find these results reassuring, one study design choice deserves further attention: the cohort of infants born during the pandemic did not include those born before 37 completed gestational weeks,” noted Mollie Wood, PhD, MPH, of the University of North Carolina at Chapel Hill, and co-authors in an accompanying editorial. “This fact is puzzling, as accumulating evidence suggests that infants born to women with SARS-CoV-2 infection are more often preterm, particularly for instances of severe maternal illness.”
“In other words: we would like to know the effect of prenatal SARS-CoV-2 infection if we could ensure that all pregnancies progressed to 37 weeks, but the current study only gives us an estimate of the effect of prenatal SARS-CoV-2 infection among those pregnancies that did progress to 37 weeks in spite of infection status,” the editorialists pointed out.
The study had several limitations, Dumitriu and co-authors noted. Early gestational exposure is most likely to be linked to adverse neurodevelopmental outcomes and only 25 maternal SARS-CoV-2 infections occurred in the first trimester. The analysis used data from the first hard-hit COVID-19 epicenter in the U.S., and results may be different in other areas.
The results suggest stress felt by pregnant mothers may have played a role, Dumitriu observed. The findings do not necessarily mean infants born during the pandemic will suffer long-term consequences, she emphasized.
“First, the effects we saw were small,” she said. “Second, this is still a very early developmental timepoint and because a lot happens in the first few years of life, scores on an assessment at 6 months are poor predictors of long-term outcomes.”
“Third and most importantly, if our findings replicate and birth during the pandemic indeed negatively impacts neurodevelopment, because this is such an early timepoint there are lots of opportunities to intervene and get these babies onto the right developmental trajectory,” Dumitriu continued. “The brains of 6-month-old infants are very plastic, very malleable, so by talking, singing, playing, and interacting with them and finding safe ways to take them out of the home more often, parents can absolutely help mitigate potential issues down the road.”
Last Updated January 04, 2022
The study was supported by grants from the NIH, Rita G. Rudel Foundation, and the Society for Research in Child Development.
Dumitriu reported relationships with the National Institute of Mental Health, CDC, and Medela during the conduct of the study. Co-authors reported relationships with Medela, Hologic, CDC, Einhorn Collaborative, Mary Dexter Stephenson, the Fleur Fairman Family, and NIH.
The editorialists reported no disclosures.
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