COVID-19 During Pregnancy Linked to Higher Risk of Neurodevelopmental Disorders in Children

Children born to mothers who had COVID-19 while pregnant face an elevated risk of developmental disorders by the time they turn 3 years old, including speech delays, autism, motor disorders, and other developmental delays, according to new research by investigators at Mass General Brigham. The findings are published in Obstetrics & Gynecology.

“These findings highlight that COVID-19, like many other infections in pregnancy, may pose risks not only to the mother, but to fetal brain development,” said senior author Andrea Edlow, MD MSc, a Maternal-Fetal Medicine specialist in the Department of Obstetrics and Gynecology at Mass General Brigham. “They also support the importance of trying to prevent COVID-19 infection in pregnancy and are particularly relevant when public trust in vaccines—including the COVID-19 vaccine—is being eroded.”

Other maternal infections during pregnancy have been linked with risk for a range of neurodevelopmental diseases during childhood, and animal studies have shown that immune activation during pregnancy disrupts normal fetal brain development and offspring behavior. To assess the effects of SARS-CoV-2 infection during pregnancy, investigators analyzed data on 18,124 live births at Mass General Brigham within the peak COVID-19 window of March 2020 to May 2021.

The investigators studied 18,124 mother-child pairs. Among the 861 children whose mothers were SARS-CoV-2–positive during pregnancy, 140 (16.3%) received a neurodevelopmental diagnosis by 3 years of age, compared with 1,680 (9.7%) of the 17,263 remaining children from SARS-CoV-2–negative pregnancies. After adjusting for other influencing factors, SARS-CoV-2 infection during pregnancy was associated with 29% higher odds of a neurodevelopmental condition in children.

The investigators also found that males were at higher risk than females. Risk was greatest when infection occurred during the third trimester of pregnancy.

While reducing risk is important, co-senior author Roy Perlis, MD, MSc, of the Mass General Brigham Department of Psychiatry, noted, “The overall risk of adverse neurodevelopmental outcomes in exposed children likely remains low.”

First author and Maternal-Fetal Medicine specialist Lydia Shook, MD, added, “Parental awareness of the potential for adverse child neurodevelopmental outcomes after COVID-19 in pregnancy is key. By understanding the risks, parents can appropriately advocate for their children to have proper evaluation and support.”

Authorship: In addition to Edlow, Mass General Brigham authors include Lydia L. Shook, Victor Castro, Laura Ibanez-Pintor, and Roy H. Perlis.

Disclosures: Perlis reports payment for service on scientific advisory boards, outside the present work, from Alkermes, Circular Genomics, and Genomind. He holds equity in Circular Genomics. He is a paid editor at JAMA and JAMA Network Open. Edlow reports serving on the scientific advisory board for YourBio Health; as a consultant to Mirvie, Inc. and Merck & Co, Inc; and receiving research funding from Merck & Co., Inc, all outside the present work. The authors did not report any potential conflicts of interest.

Funding: This study was supported by the National Institute of Mental Health (RF1MH132336, R01 MH116270, and U54 MH118919), National Institute of Child Health and Human Development (R01 HD100022-02S2, K12 HD103096-03); SFARI (870754); and the Patricia and Scott Eston MGH Research Scholar Award from the MGH Executive Committee on Research.

Paper cited: Shook LL et al. “Neurodevelopmental Outcomes of 3-Year-Old Children Exposed to Maternal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Utero” Obstetrics & Gynecology DOI: 10.1097/AOG.0000000000006112