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Milestone delays in babies exposed to COVID in womb – US cohort study

Lags in basic milestones of infancy – rolling over, reaching for objects or babbling – have been observed in babies whose mothers caught COVID-19 during pregnancy, a study of medical records has found.

These babies faced nearly double the risk of being diagnosed with delayed speech or motor skills by their first birthday, researchers found.

While the risk of developmental delays was low overall, it rose to about 6% among babies exposed to COVID in the womb, while unexposed infants’ risk was about 3%, according to findings released in the journal JAMA Network Open.

COVID has already been shown to affect a wide variety of the body’s systems and organs, including the lungs, heart and nerves.

The study of electronic health records from more than 7,000 obstetric patients at Massachusetts hospitals, including those of 222 pregnant patients with COVID, along with their children’s, is another indication of the pandemic’s potential long-lasting impact.

“It’s going to be important to watch this cohort grow, to see how these children will look in 18 months and two years,” said senior author Roy Perlis, director of the Centre for Quantitative Health at Massachusetts General Hospital in Boston.

The study accounted for race, age and other factors that could explain the different rates of developmental delays. More research is needed to determine how much risk COVID poses to foetal brain development and how best to minimise it, according to an accompanying commentary in the journal.

The study could not assess the impact of vaccination because it examined records from pregnancies between March and September of 2020, before COVID vaccines were available. Most of the patients with COVID had mild cases, Perlis said, so the impact of disease severity could not be measured either.

The study did find that catching COVID during the third trimester – which is especially critical for brain development – appeared to add more risk than earlier in pregnancy.

The findings fit with previous studies linking various infections during pregnancy with increased risk of autism, schizophrenia and other brain conditions in offspring, as well as recent research showing that COVID affects brain cells.

Study details

Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy

Andrea Edlow, Victor Castro, Lydia Shook, et al

Published in JAMA Network Open on 9 June 2022.

Key Points
Question Is COVID-19 exposure in utero associated with increased risk for neurodevelopmental disorders in the first year of life?
Findings In this cohort study of 7,772 infants delivered during the COVID-19 pandemic, those born to the 222 mothers with a positive SARS-CoV-2 polymerase chain reaction test during pregnancy were more likely to receive a neurodevelopmental diagnosis in the first 12 months after delivery, even after accounting for preterm delivery.
Meaning These preliminary findings suggest that COVID-19 exposure may be associated with neurodevelopmental changes and highlight the need for prospective investigation of outcomes in children exposed to COVID-19 in utero.


Epidemiologic studies suggest maternal immune activation during pregnancy may be associated with neurodevelopmental effects in offspring.

To evaluate whether in utero exposure to SARS-CoV-2 is associated with risk for neurodevelopmental disorders in the first 12 months after birth.

Design, Setting, and Participants
This retrospective cohort study examined live offspring of all mothers who delivered between March and September 2020 at any of 6 Massachusetts hospitals across two health systems. Statistical analysis was performed from October to December 2021.

Maternal SARS-CoV-2 infection confirmed by a polymerase chain reaction test during pregnancy.

Main Outcomes and Measures
Neurodevelopmental disorders determined from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes over the first 12 months of life; sociodemographic and clinical features of mothers and offspring; all drawn from the electronic health record.

The cohort included 7772 live births (7,466 pregnancies, 96% singleton, 222 births to SARS-CoV-2 positive mothers), with mean (SD) maternal age of 32.9 (5.0) years; offspring were 9.9% Asian (772), 8.4% black (656), and 69.0% white (5363); 15.1% (1134) were of Hispanic ethnicity. Preterm delivery was more likely among exposed mothers: 14.4% (32) vs 8.7% (654) (P = .003). Maternal SARS-CoV-2 positivity during pregnancy was associated with greater rate of neurodevelopmental diagnoses in unadjusted models (odds ratio [OR], 2.17 [95% CI, 1.24-3.79]; P = .006) as well as those adjusted for race, ethnicity, insurance status, offspring sex, maternal age, and preterm status (adjusted OR, 1.86 [95% CI, 1.03-3.36]; P = .04). Third-trimester infection was associated with effects of larger magnitude (adjusted OR, 2.34 [95% CI, 1.23-4.44]; P = .01).

Conclusions and Relevance
This cohort study of SARS-CoV-2 exposure in utero found preliminary evidence that maternal SARS-CoV-2 may be associated with neurodevelopmental sequelae in some offspring. Prospective studies with longer follow-up duration will be required to exclude confounding and confirm these associations.


JAMA Network Open article – Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy (Open access)


See more from MedicalBrief archives:


Extensive placental damage in some unvaccinated women causes stillbirths


Pregnant women pass COVID antibodies to their babies — Weill Cornell


COVID doubles perinatal risk in pregnancy – Large Kaiser study


Maternal COVID infection increases preterm/low birth/stillbirth rate in unvaccinated women




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