Assessment of Neurodevelopment in Infants With and Without Exposure to Asymptomatic or Mild Maternal SARS-CoV-2 Infection During Pregnancy

Gabriella Newes-Adeyi, Tyler Morrill, Abt Global; Lawrence Reichle (formerly Abt Global); Morgan R Firestein, Lauren C Shuffrey, Yunzhe Hu, Margaret Kyle, Maha Hussain, Violet Hott, Sabrina P Hyman, Mia Kyler, Cynthia Rodriguez, Melanie Tejeda Romero, Helen Tzul Lopez, Judy Austin, Jennifer M Bain, Jennifer Barbosa, Rachel Marsh, Rebecca Muhle, Kally C O'Reilly, Anna A Penn, Ayesha Sania, Grace Smotrich, Martha G Welch, William P Fifer, Melissa S Stockwell, Catherine Monk, Dani Dumitriu, Sharon Ettinger, Pam Factor-Litvak, Sylvie Goldman, Mirella Mourad, Wendy G Silver, Noelia Zork, Columbia University Irving Medical Center; Catherine Bianco, Carmela Alcántara, Dima Amso, Nim Tottenham, Kimberly G Noble, Columbia University; Ashley N Battarbee, Alan T Tita, University of Alabama; Ann Bruno, Michael Varner, University of Utah; Suzanne Gilboa, Panagiotis Maniatis, Vera Semenova, Fatimah Dawood, Centers for Disease Control and Prevention; Cynthia Gyamfi-Bannerman, University of California San Diego; Donna Garey, Creighton University School of Medicine

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May 1, 2023

This study, which used a novel telehealth-adapted observational neurodevelopmental assessment, confirmed a previous finding that prenatal exposure to maternal SARS-CoV-2 infection had no association with infant brain development. The continued widespread prevalence of COVID-19 may make the finding comforting for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections.

The study analyzed infant neurodevelopment scores of 407 infants aged five to 11 months on cognitive, gross motor, fine motor, expressive language, and receptive language domains.

Previous data on this topic relied on parental reporting. This study is the first to use standardized observational measures. That avoids the potential bias from parental reporting, such as parental stress during the height of the pandemic. The study included some mothers who were infected during pregnancy and some who weren’t. The mothers participated in one of two ongoing studies: the COVID-19 Mother Baby Outcomes [COMBO] Initiative or Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy (ESPI).

The study's strengths include its geographically diverse cohort and the use of the telehealth-adapted neurodevelopmental assessment tool. The study's limitations include the relatively small sample size, the study's observational nature, and the limited age range of the infants. Unmeasured variables such as psychosocial factors may have affected the results. And since the mothers were asymptomatic or had mild COVID-19 cases, it’s not possible to generalize about any developmental effects of moderate or severe cases.

Few documented cases of SARS-CoV-2 transmission from mother to infant have been reported. This suggests fetuses have strong protection against infection. But there are other mechanisms, such as maternal immune activation, that can affect brain development. Assessing whether maternal COVID-19 affects infants in other ways required longitudinal follow-up of children born to individuals who had asymptomatic or mild cases of COVID-19 during pregnancy.

Further studies are needed to assess the long-term effects of prenatal SARS-CoV-2 exposure on infant brain development.