Children exposed to maternal COVID-19 in utero were not at increased risk of neurodevelopmental delays through 24 months, according to adjusted analyses from a prospective cohort study.
The ASPIRE (Assessing the Safety of Pregnancy in the Coronavirus Pandemic) trial evaluated whether in utero exposure to maternal COVID-19 is associated with abnormal neurodevelopmental outcomes in children through 24 months. The study included 2,003 pregnant participants aged 18 years or older, recruited before 10 weeks' gestation from all 50 states and Puerto Rico, and their offspring. Children were assessed using the Ages & Stages Questionnaires, Third Edition (ASQ-3) at 12, 18, and 24 months postpartum.
Maternal SARS-CoV-2 infection was determined by self-report or dried blood spot cards collected during pregnancy. Notably, 87.4% of participants had earned a college degree, which may limit the study's generalizability.
Key findings include the following:
- At 12 months, 32.3% of exposed children (64 of 198) exhibited abnormal ASQ-3 scores, compared to 29.4% of unexposed children (458 of 1,559).
- At 18 months, 22.4% of exposed children (36 of 161) showed abnormal scores, compared to 20.5% of unexposed children (279 of 1,361).
- At 24 months, 19.2% of exposed children (29 of 151) had abnormal scores, compared to 16.8% of unexposed children (230 of 1,372).
In the adjusted mixed-effects logistic regression analysis, the adjusted risk ratios for abnormal neurodevelopmental screens were:
- 1.07 (95% confidence interval [CI], 0.85-1.34) at 12 months,
- 1.15 (95% CI, 0.84-1.57) at 18 months,
- 1.01 (95% CI, 0.69-1.48) at 24 months.
No statistically significant differences were observed in the risk of neurodevelopmental impairment between children exposed to SARS-CoV-2 in utero and those unexposed. Additional analyses revealed no variation in outcomes based on the trimester of infection, presence of fever, or breakthrough infections following vaccination.
These results, published in JAMA Network Open, indicated that maternal COVID-19 infection during pregnancy was not associated with an increased risk of abnormal neurodevelopmental outcomes through 24 months.
The study's strengths include its prospective nature, large scale, and early gestational enrollment. However, limitations such as volunteer recruitment and potential selection bias were noted. The researchers suggest that continued study across diverse cohorts is necessary to fully understand potential sequelae from the COVID-19 pandemic.
The study was supported by various grants and foundations, including the Start Small Foundation, the California Breast Cancer Research Program, and the COVID Catalyst Award, among others.
Full disclosures can be found in the published study.