Association between prenatal COVID-19 exposure and neurodevelopment

Association between prenatal COVID-19 exposure and neurodevelopment | Image Credit: © sebra - © sebra - stock.adobe.com.

Exposure to maternal mild or asymptomatic COVID-19 during pregnancy does not impact infant neurodevelopment, according to a recent study published in JAMA Network Open.

A high burden of COVID-19 has been observed among pregnant individuals, indicating a need to understand the association between prenatal COVID-19 exposure and neurodevelopmental outcomes in infants. While vertical transmission of COVID-19 has rarely been reported, other mechanisms such as maternal immune activation may impact infant neurodevelopment.

To determine whether prenatal COVID-19 exposure impacts neurodevelopmental outcomes in infants aged 5 to 11 months, investigators conducted a standardized observer-based assessment as part of the COVID-19 Mother Baby Outcomes (COMBO) Initiative.

There were 2 parallel studies conducted, the first being a single-site prospective cross-sectional study for the COMBO Initiative. The second was the CDC Epidemiology of SARS-CoV-2 in Pregnancy and Infancy (ESPI) Network multisite prospective cohort study. 

Mother-infant dyads were enrolled in the COMBO study, while pregnant women were enrolled in the EPSI study. An EPSI COMBO study was also conducted and was a prospective cohort study using COMBO protocol to perform follow-up assessments in participants from the EPSI study.

Enrollment for the COMBO study began on May 26, 2020, while ESPI enrollment lasted from May 7 to November 3, 2021. Some participants in the ESPI study also enrolled in the EPSI COMBO study from August 2020 to March 2021. Assessment of infant neurodevelopment occurred from March 2021 to June 2022.

Clinical universal nasopharyngeal polymerase chain reaction testing was used to determine COVID-19 infection in patients delivering on March 22, 2020, while universal serological testing was used for patients delivering on July 20, 2020. Infant exposure was determined through positive maternal testing during pregnancy or at delivery.

Electronic health records were consulted to determinesymptom status and date of onset, which was used to determine the trimester exposed. For the ESPI COMBO cohort, maternal self-report of COVID-19 exposure and molecular and serological testing were used to identify infant COVID-19 exposure.

The Developmental Assessment of Young Children, second edition (DAYC-2), a standardized assessment used in research and clinical settings, was used to evaluate infant neurodevelopment.Assessment was completed by 152 dyads from the COMBO study and 299 dyads from the EPSI COMBO study.

There were 407 infants in the sample, 258 unexposed, 112 exposed during pregnancy, and 37 exposed before pregnancy or during an intermediate time. Mothers were aged a mean 32.1 years at delivery, and 3.2% were Asian, 11.2% Black, 1.5% Native American or Alaska Native, 0.7% Pacific Islander, 59.6% White, 11.2% other or multiple races, and 12.7% unknown race.

Of mothers, 35.7% were Hispanic, 62.8% non-Hispanic, and 1.5% unknown ethnicity. Full-term birth was seen in 90.2% of infants, and 47.9% of infants were female.

Infants exposed during pregnancy less often had White mothers, with a higher proportion of mothers who were other race or Hispanic ethnicity.Prepregnancy or indeterminate time of prenatal exposure was also more common in infants with Hispanic mothers, and prevalence of infection was 15.3% for Hispanic mothers and 5.5% for non-Hispanic mothers.

DAYC-2 scores for gross motor, fine motor, expressive language, and receptive language did not differ for infants exposed to COVID-19 infection during pregnancy compared to those unexposed. Exposure before pregnancy or at an intermediate time also did not impactDAYC-2 scores.

The trimester of exposure was not associated with DAYC-2 scores, nor was maternal symptom status. However, higher DAYC-2 gross motor scores were seen in infants exposed to asymptomatic COVID-19 during pregnancy compared to nonexposed infants.

Reference

Firestein MR, Shuffrey LC, Hu Y, et al. Assessment of neurodevelopment in infants with and without exposure to asymptomatic or mild maternal SARS-CoV-2 infection during pregnancy. JAMA Netw Open. 2023;6(4):e237396. doi:10.1001/jamanetworkopen.2023.7396