In Utero COVID Exposure Tied to Developmental Differences in Infants

Liam Davenport

June 08, 2022

COVID-19 in during pregnancy has been linked to a small but significant effect on infant neurodevelopment, suggests a small-scale analysis that points to the need for further study and monitoring during pregnancy.

The study included 24 pregnant women, half of whom had COVID-19 during pregnancy, and their offspring. It showed impairments at 6 weeks of age on the social interactive dimension of a neonatal assessment.

"Not all babies born to mothers infected with COVID show neurodevelopmental differences, but our data show that their risk is increased in comparison to those not exposed to COVID in the womb. We need a bigger study to confirm the exact extent of the difference," said lead researcher Rosa Ayesa Arriola, PhD, Valdecilla Research Institute (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain, in a release.

The findings were presented at the virtual European Psychiatric Association (EPA) 2022 Congress.

Differing Responses to Cuddling

Co-author Águeda Castro Quintas, PhD student, Network Centre for Biomedical Research in Mental Health, University of Barcelona, Spain, explained that the tests showed the children born to mothers who had COVID-19 during pregnancy reacted "slightly differently to being held, or cuddled."

"We need to note that these are preliminary results, but this is part of a project following a larger sample of 100 mothers and their babies," she added. The authors plan to compare their results with those from a similar study.

The group will also monitor infant language and motor development between 18 and 42 months of age.

"This is an ongoing project, and we are at an early stage," Castro Quintas said. "We don’t know if these effects will result in any longer-term issues," but longer-term observation "may help us understand this."

"Of course, in babies who are so young, there are several things we just can’t measure, such as language skills or cognition," added co-investigator Nerea San Martín González, Department of Evolutionary Biology, Ecology and Environmental Sciences, University of Barcelona, Spain.

While emphasizing the need for larger sample sizes, she said that "in the meantime, we need to stress the importance of medical monitoring to facilitate a healthy pregnancy."

The researchers note that the consequences of the COVID-19 pandemic for the newborns of affected mothers remain "unknown."

However, previous studies of other infections during pregnancy suggest that offspring could be "especially vulnerable", as the pathophysiologic mechanisms of the infection, such as cytokine storms and microcoagulation, "could clearly compromise fetal neurodevelopment."

To investigate further, they examined the neurodevelopment of infants born both immediately before and during the COVID-19 pandemic, from 2017 to 2021.

Twenty-one women who had COVID-19 during pregnancy were matched with 21 healthy controls. They were studied both during pregnancy and in the postpartum period, completing hormonal and other biochemical tests, salivary tests, movement assessments, and psychological questionnaires, adjusted for various factors.

The team also administered the Brazelton Neonatal Behavioural Assessment Scale (NBAS) to the offspring at 6 weeks of age to evaluate neurologic, social, and behavioral aspects of function.

"We have been especially sensitive in how we have conducted these tests," said Castro Quintas. "Each mother and baby were closely examined by clinicians with expert training in the field and in the tests."

Among those offspring exposed to COVID-19 during pregnancy, there was a significant decrease in scores on the social interactive dimension of the NBAS, particularly if infection occurred before week 20 of gestation.

Other NBAS subscales were not associated with maternal COVID-19 during pregnancy.

More Research Needed

Commenting on the findings, Livio Provenzi, PhD, a psychologist and researcher in developmental psychobiology at the University of Pavia, Italy, noted there is a "great need" to study the direct and indirect effect of the COVID-19 pandemic on parents and their children.

"Pregnancy is a period of life which shapes much of our subsequent development, and exposure to adversity in pregnancy can leave long-lasting biological footprints."

Provenzi, who was not involved in the study, added in the release that the findings reinforce "evidence of epigenetic alterations in infants born from mothers exposed to pandemic-related stress during pregnancy."

"It shows we need more large-scale, international research to allow us to understand the developmental effects of this health emergency and to deliver better quality of care to parents and infants."

The study was funded by the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III through the University of Barcelona multicenter project and the Government of Cantabria.

No relevant financial relationships declared.

European Psychiatric Association (EPA) 2022 Congress. Abstract: The Impact of Maternal SARS-COV-2 Infection in Early Stages of Newborn Neurodevelopment: Preliminary Results in a Multicenter Spanish Study. Presented June 6, 2022.

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