Scientific Reports (May 2024)

Neurodevelopmental delay in children exposed to maternal SARS-CoV-2 in-utero

  • Viviana Fajardo-Martinez,
  • Fatima Ferreira,
  • Trevon Fuller,
  • Mary Catherine Cambou,
  • Tara Kerin,
  • Sophia Paiola,
  • Thalia Mok,
  • Rashmi Rao,
  • Jyodi Mohole,
  • Ramya Paravastu,
  • Dajie Zhang,
  • Peter Marschik,
  • Sai Iyer,
  • Kalpashri Kesavan,
  • Maria da Conceição Borges Lopes,
  • José Augusto A. Britto,
  • Maria Elisabeth Moreira,
  • Patricia Brasil,
  • Karin Nielsen-Saines

DOI
https://doi.org/10.1038/s41598-024-61918-2
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 11

Abstract

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Abstract It is unclear if SARS CoV-2 infection during pregnancy is associated with adverse neurodevelopmental repercussions to infants. We assessed pediatric neurodevelopmental outcomes in children born to mothers with laboratory-confirmed SARS CoV-2 infection during pregnancy. Neurodevelopmental outcomes of in-utero exposed children were compared to that of pre-pandemic control children in Los Angeles (LA), CA, USA and Rio de Janeiro, Brazil. Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), the gold standard tool for evaluating neurodevelopment until 36 months of age and Ages and Stages Questionnaires (ASQ-3), a frequently used screening instrument for evaluating neurodevelopment in this same age group were the assessment tools used. Developmental delay (DD) was defined as having a score < − 2 SD below the norm (< 70) in at least one of three Bayley-III domains, (cognitive, motor or language) or a score below the cut-off (dark zone) in at least one of five ASQ-3 domains (communication, gross motor, fine motor, problem solving, personal-social). Exposed children were born between April 2020 and December 2022 while control children were born between January 2016 to December 2019. Neurodevelopmental testing was performed in 300 children total: 172 COVID-19 exposed children between 5–30 months of age and 128 control children between 6–38 months of age. Bayley-III results demonstrated that 12 of 128 exposed children (9.4%) had DD versus 2 of 128 controls (1.6%), p = 0.0007. Eight of 44 additional exposed children had DD on ASQ-3 testing. Fully, 20 of 172 exposed children (11.6%) and 2 of 128 control children (1.6%), p = 0.0006 had DD. In Rio, 12% of exposed children versus 2.6% of controls, p = 0.02 had DD. In LA, 5.7% of exposed children versus 0 controls, p = 0.12 had DD. Severe/critical maternal COVID-19 predicted below average neurodevelopment in the exposed cohort (OR 2.6, 95% CI 1.1–6.4). Children exposed to antenatal COVID-19 have a tenfold higher frequency of DD as compared to controls and should be offered neurodevelopmental follow-up.