Key takeaways:
- Maternal COVID-19 infection during pregnancy was linked to a 29% increased risk of neurodevelopmental disorders in offspring aged up to 3 years.
- Third-trimester infections were associated with the highest adjusted odds of neurodevelopmental diagnoses.
- Children exposed in utero had a diagnosis rate of 16.3%, compared with 9.7% in unexposed children.
- Male offspring showed an additional increase in risk, with a higher adjusted odds ratio than female offspring.
- Experts emphasize the importance of parental awareness, early neurodevelopmental monitoring, and improving vaccine confidence to reduce maternal infection risk.
New data published in Obstetrics & Gynecology has highlighted increased odds of neurodevelopmental disorders in offspring aged up to 3 years whose mothers had COVID-19 during pregnancy.1
Maternal infections during pregnancy have been linked to multiple neurodevelopmental diseases during childhood. These results highlighted COVID-19 as an additional risk factor, leading to a 29% increase in neurodevelopmental disorder risk in children. Further increases in risk were observed from infection during the third trimester of pregnancy.1
“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 Andrea Edlow, MD, MSc, senior author and maternal-fetal medicine specialist at Mass General Brigham.1
Assessing offspring neurodevelopmental outcomes
The retrospective cohort study was conducted to evaluate the impact of in utero exposure to maternal COVID-19 infection on adverse neurodevelopmental outcomes in offspring aged up to 3 years.2 Live births within the Mass General Brigham health system from March 1, 2020, to May 31, 2021, were included in the analysis.
Maternal COVID-19 infection was the primary exposure, determined by a positive polymerase chain reaction test result during pregnancy. Any offspring neurodevelopmental diagnosis up to 36 months following birth was reported as the primary outcome.2
This outcome was determined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes. Logistic regression models were used to assess the link between the exposure and outcome, with covariates including maternal race and ethnicity, age, hospital type, insurance type, and preterm birth.2
Outcomes among exposed vs unexposed offspring
There were 861 patients infected with COVID-19 during pregnancy. Among offspring of these individuals, a neurodevelopmental disorder diagnosis within 36 months was reported in 16.3%. In comparison, this rate was 9.7% among unexposed offspring, indicating an unadjusted odds ratio of 1.80 and adjusted odds ratio (aOR) of 1.29.2
Third-trimester exposure had the greatest risks, with an aOR of 1.36. Additionally, male offspring had an aOR of 1.43, indicating an additional increase in risk.2
Overall, these results indicated increased odds of neurodevelopmental exposure among offspring of mothers infected with COVID-19 during pregnancy, with the greatest risks from third-trimester exposure. Investigators concluded that neurodevelopmental monitoring is vital in these offspring.2
“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,” said Lydia Shook, MD, maternal-fetal medicine specialist at Massachusetts General Hospital.1
The role of vaccine confidence in prevention
To reduce COVID-19 exposure, clinicians have a vital role of increasing vaccine confidence among their patients, as discussed by Kathleen Hall Jamieson, PhD, Annenberg Public Policy Center director, in an interview with Contemporary OB/GYN.3 During the discussion. Jamieson highlighted a decline in support for vaccination during pregnancy among the general public.
According to Jamieson, this hesitation may be caused by a lack of knowledge about vaccine safety and the benefits of immunization. This indicated potential for improving maternal and infant outcomes by increasing public understanding about the protective role of vaccines during pregnancy.3
“When [providers] make these recommendations, they potentially are saving individuals from serious health consequences, which can in some cases include dying,” said Jamieson.3
