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COVID exposure in the womb linked to neurodevelopmental disorders

June 10, 2022 – Infants exposed to SARS-CoV-2 in the womb are at increased risk for neurodevelopmental disorders in the first year of life, new research shows.

But it’s unclear whether it’s exposure to the pandemic or maternal exposure to the virus itself that can harm early childhood neurodevelopment, warn investigators, led by Roy Perlis, MD, of Massachusetts General Boston Hospital.

“In this analysis of 222 offspring of SARS-CoV-2 infected mothers, compared to the offspring of 7,550 control group (uninfected) mothers who gave birth during the same period, we observed that neurodevelopmental diagnoses were significantly more common in exposed offspring, particularly those exposed to maternal infection in the third trimester,” they write.

The study was published online June 9 to Open JAMA Network.

Speech and language disorders

The study included 7,772 mostly single live births at six Massachusetts hospitals between March and September 2020, including 222 (2.9%) births to SARS-CoV-2 infected mothers confirmed by reaction testing in polymerase chain reaction (PCR) during pregnancy.

A total of 14 of 222 children born to mothers infected with SARS-CoV-2 (6.3%) were diagnosed with a neurodevelopmental disorder in the first year of life compared to 227 of 7550 unexposed children (3%) .

When factors such as preterm birth, race, ethnicity, insurance status, child’s sex and mother’s age were taken into account, COVID-exposed babies were significantly more likely to receive a neurodevelopmental diagnosis in the first year of life.

The association with neurodevelopmental disorders was even greater with SARS-CoV-2 infection in the third trimester.

The majority of these diagnoses reflected developmental disorders of movement or speech and language.

The researchers note that the finding of an association between prenatal exposure to SARS-CoV-2 and neurodevelopmental diagnoses at 12 months is consistent with a “large body of literature” linking maternal viral infection and maternal immune response. mother to neurodevelopmental disorders of infants later in life.

They caution, however, that whether there is a definitive link between prenatal exposure to SARS-CoV-2 and adverse neurodevelopment in babies is not yet known, in part because children born to infected women during the first wave of the pandemic have not reached their second birthday, a time when neurodevelopmental disorders such as autism are commonly diagnosed.

It’s also possible that the results are skewed because infected mothers who were sick during pregnancy may be more likely to seek a medical evaluation, and clinicians may be more inclined to diagnose them or refer them for an evaluation, note the researchers.

Nonetheless, the study findings support those of research published in a similar study at the 2022 Congress of the European Psychiatric Association. These results also showed an association between maternal SARS-CoV-2 infection and impaired neurodevelopment in 6-week-old infants.

“Questions remain”

In a accompanying commentaryTorri D. Metz, MD, of the University of Utah Health in Salt Lake City, says Perlis and her colleagues’ preliminary findings are “crucially important, but many questions remain.”

“Essentially everything we know now about the effects of in utero exposure to maternal SARS-CoV-2 infection comes from children who were exposed to early and alpha variants of SARS-CoV-2, because they are the only children now old enough to undergo rigorous neurodevelopmental assessments,” Metz points out.

Ultimately, Metz says it’s no surprise that the pandemic and in utero exposure to maternal SARS-CoV-2 infection may have a negative effect on neurodevelopmental outcomes in young children.

Yet, since this type of study only looks at data from the past, it can only show associations, not cause and effect.

“This type of work is intended to generate hypotheses, and this goal has been achieved because these preliminary results generate many additional research questions to explore,” writes Metz.

Among them: Are there genetic predispositions to adverse effects? Will we see different effects depending on which variant of SARS-CoV-2 the mother was infected with, the severity of her infection, and the trimester of infection? Is it the virus itself or all of the societal changes that have occurred during this time, including differences in how these changes have been experienced among those with and without SARS-CoV-2?

“Perhaps the most important question is how to intervene to help mitigate the adverse effects of the pandemic on young children,” notes Metz.

Studies where mothers are followed and observed over a period of time are needed “to validate these results, disentangle certain nuances and identify those most at risk”, she adds.

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