Surprising Data on Neurodevelopment of Babies Born During the Pandemic

By Megan Brooks

January 06, 2022

NEW YORK (Reuters Health) - Babies born during the COVID-19 pandemic, irrespective of maternal infection, had slightly lower motor and social skills at age six months compared to babies born before the pandemic, researchers from New York City have found.

Yet "to our surprise, we saw absolutely no effect of maternal infection with SARS-CoV-2 on infant neurodevelopment at six months," Dr. Dani Dumitriu of Columbia University and New York State Psychiatric Institute told Reuters Health by email.

"Given data from other viral illnesses during pregnancy, we expected to see a negative impact on the development of infants who had been exposed to maternal COVID-19 disease in pregnancy," Dr. Dumitriu said.

The findings, published in JAMA Pediatrics, are based on data for 255 infants enrolled in the COVID-19 Mother Baby Outcomes Initiative at Columbia University Irving Medical Center in New York City, which is looking at potential long-term health effects of COVID-19 on both infants and mothers. Data were also available from a historical cohort of 62 infants born before the pandemic.

In utero exposure to maternal SARS-CoV-2 infection was not associated with significant differences on any subdomain of the Ages & Stages Questionnaire, 3rd Edition (ASQ-3), regardless of infection timing or severity, the study team reports.

However, compared with the historical cohort, babies born during the pandemic had significantly lower scores on gross motor (mean difference, -5.63; P<0.005), fine motor (mean difference, -6.61; P<0.005), and personal-social (mean difference, -3.71; P<0.05) subdomains in fully adjusted models.

ASQ-3 scores at age six months for the pandemic babies were "not dramatically different and in our sample of a few hundred infants this did not translate to an overall higher proportion of infants that 'failed' the screening test," Dr. Dumitriu told Reuters Health.

"These differences nevertheless warrant careful attention given the prevalence of this disease," she said.

"The scientific and medical communities have mostly speculated that infants born to mothers who contract COVID-19 during pregnancy might show neurodevelopmental decrements. This translates to potential impact on millions of children born worldwide over the last two years," Dr. Dumitriu told Reuters Health.

"Our study, however, points to potential impact on the neurodevelopment of infants born during the pandemic irrespective of maternal infection, which, if replicated, would translate to potential impact on hundreds of millions of children born since the onset of the pandemic," she said.

"While the effects we see are small, such small differences have potential for significant public-health consequences when such large population numbers are involved," she added.

The findings highlight the need for long-term monitoring of children born during the pandemic, with and without in utero exposure to the virus.

"We also need to now begin to investigate the mechanisms that contribute to the observed neurodevelopmental decrements, including maternal pre- and postnatal stress, changes in healthcare delivery and access, and worldwide socioeconomic changes," said Dr. Dumitriu.

She said it's important to note that the findings do not necessarily mean that these infants will suffer long-term consequences. First, the effects were small and scores on an assessment at six months are poor predictors of long-term outcomes.

"Most importantly, if our findings replicate and birth during the pandemic indeed negatively impacts neurodevelopment, because this is such an early time point there are lots of opportunities to intervene and get these babies onto the right developmental trajectory," Dr. Dumitriu said.

She cautioned that all infants in the pandemic and historic cohorts were born at term.

This is an important caveat, write the authors of an editorial in JAMA Pediatrics.

"Although it is tempting to find these results reassuring," the cohort of infants born during the pandemic did not include those born before 37 completed gestational weeks. Therefore, the study "only gives us an estimate of the effect of prenatal SARS-CoV-2 infection among those pregnancies that did progress to 37 weeks in spite of infection status," they point out.

Dr. Dumitriu said it's "hard to speculate on what the differences would be if we had been able to compare preterm pandemic versus historic infants. Maternal COVID-19 disease in pregnancy does increase risk of preterm delivery. Prematurity itself is a risk factor for adverse neurodevelopmental outcomes, and so far, babies born premature to moms with COVID-19 in pregnancy are not more sick than other preterm infants," she explained.

With larger studies, "we might find that at the population level there is a shift toward lower developmental scores for all babies born during the pandemic, including premature babies, and that this shift is mediated in part by earlier delivery of women with infection during pregnancy . . . without being due to other effects of the viral illness. But at this stage, this is purely speculative as we do not have enough data to know the answer," Dr. Dumitriu said.

SOURCE: https://bit.ly/3ETA6oY and https://bit.ly/3qQ7XtV JAMA Pediatrics, online January 4, 2022.

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