SARS-CoV-2 infection during pregnancy and neurodevelopmental outcomes in early childhood

SARS-CoV-2 infection in pregnancy has become common, yet very little is known about the impact of prenatal exposure on child development. Our objective was to examine the impact of infection with SARS-CoV-2 during pregnancy on child neurodevelopment in the first years of life. We conducted a longitudinal prospective cohort study among a diverse population of 69,987 children born January 2020-September 2021 in Northern California to members of an integrated healthcare system. Maternal SARS-CoV-2 infection during pregnancy was confirmed by polymerase chain reaction (PCR) test. All neurodevelopmental disorders (NDD) diagnosed in children by December 2023 were identified, including autism spectrum disorder (ASD), speech/language delay, and motor delay. Cox proportional hazards regression models estimated hazard ratios (HR) and 95% confidence intervals (CIs), with adjustment for maternal sociodemographic and clinical characteristics, SARS-CoV-2 vaccination status during pregnancy, and child sex. A total of 2777 (3.97%) pregnant individuals had PCR-confirmed SARS-CoV-2 infection during pregnancy. Among 69,987 children aged 27-48 months, 12,006 (17.15%) were diagnosed with NDD; 2724 (3.89%) with ASD, 10,047 (14.36%) with speech/language delay, and 2716 (3.88%) with motor delay. Maternal infection with SARS-CoV-2 during pregnancy was not associated with an increased risk of speech/language delay or motor delay but was associated with an elevated risk of ASD among females (aHR = 1.44, 95% CI 1.05-1.97) but not males (aHR = 1.04, 95% CI 0.83-1.31). Prenatal exposure to SARS-CoV-2 infection may increase risk for autism spectrum disorders among females. Future studies are needed to confirm and extend these findings.