Kids exposed to COVID in utero may be at higher risk for autism, other brain problems

COVID-19
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A new study suggests that children of mothers who had COVID-19 during pregnancy are at 29% higher risk of neurodevelopmental conditions such as speech delays, motor disorders, and autism by age 3, although the overall odds are likely low and may well have ebbed since the pandemic peak.

Massachusetts General Hospital researchers analyzed data on 18,124 live births at Mass General Brigham from March 2020 through May 2021. 

The study authors noted that other types of infection in pregnant women have been tied to an elevated risk of a range of childhood neurodevelopmental disorders and that animal studies have found that immune-system activation in pregnancy can disrupt fetal brain development. 

The findings were published yesterday in Obstetrics & Gynecology.

Boys particularly vulnerable

A total of 8% of uninfected women had received at least one COVID-19 vaccine dose during pregnancy, compared with 2% of their infected counterparts. Only 13 infections were identified in women who had received at least one dose. Of all infections, 65.0% occurred in the third trimester of pregnancy.

Of the 861 children whose mothers had COVID-19 while pregnant, 16.3% were diagnosed as having at least one neurodevelopmental condition by age 3, compared with 9.7% of the 17,263 children from COVID-negative pregnancies. After adjusting for maternal age, race, insurance and hospital type, and preterm birth, COVID-19 infection in pregnancy was linked to a 29% higher risk of a neurodevelopmental disorder in children.

These findings highlight that COVID-19, like many other infections in pregnancy, may pose risks not only to the mother, but to fetal brain development.

Andrea Edlow, MD

Boys were at 43% higher risk than girls, and the risk was greatest (36%) when exposure occurred during the third trimester. Other risk factors were Hispanic ethnicity, public insurance, preterm birth, and delivery in an academic medical center rather than a community hospital.

The most common diagnoses were speech and language disorders, developmental motor-function disorder, autism, and disorders of psychological development disorders. COVID-19 infection during pregnancy was associated with a higher rate of preterm delivery (13.5% vs 10.0%) and slightly lower birth weights. 

"These findings highlight that COVID-19, like many other infections in pregnancy, may pose risks not only to the mother, but to fetal brain development," senior author Andrea Edlow, MD, of Mass General Brigham, said in a news release. "They also support the importance of trying to prevent COVID-19 infection in pregnancy and are particularly relevant when public trust in vaccines—including the COVID-19 vaccine—is being eroded."

Lead author Lydia Shook, MD, said that parents should be aware of potential adverse neurodevelopmental outcomes after COVID-19 infection during pregnancy: "By understanding the risks, parents can appropriately advocate for their children to have proper evaluation and support."

Risks may have waned over time

But Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy (CIDRAP, publisher of CIDRAP News) at the University of Minnesota, cautioned that the study findings may not apply today, just as the risk of other immune-related clinical phenomena seen in early COVID-19 cases (eg, myocarditis [inflammation of the heart muscle], multisystem inflammatory syndrome in children [MIS-C]) has plummeted. 

This may have been an early phenomenon, much like myocarditis or MIS-C.

Michael Osterholm, PhD, MPH

"Is it possible that we could be seeing initial COVID related to neurodevelopmental disorders and autism, but the subsequent years' worth of cases are not?" he said. "Meaning that if you compare the results of the first 18 months to the results of the last 18 months, I bet it doesn't necessarily hold."

Osterholm anticipates that mothers who get COVID-19 during pregnancy will worry that their child is at risk for neurodevelopmental disorders when "this may have been an early phenomenon, much like myocarditis or MIS-C."

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