P1.208: Association between maternal SARS-CoV-2 exposure and neurodevelopment in neonates during the first two years of life

Background: The SARS-CoV-2 pandemic has resulted in over 700 million cases and 6 million deaths worldwide (WHO, 2023). Pregnant women and their infants are particularly vulnerable due to increased risks of severe infection and potential neurodevelopmental effects following maternal COVID-19 infection. Existing studies on maternal COVID-19 exposure and offspring neurodevelopment have yielded inconsistent findings. A study from China reported potential delays in fine motor and communication development at one year among infants exposed, while a recent meta-analysis found no significant differences between exposed and unexposed infants. However, most studies assessed neurodevelopmental until the first year of life, potentially missing subtle delays at later ages. Motor delays can typically be identified at 9 months, but language delays often become apparent around 18 months. The American Academy of Pediatrics recommends neurodevelopmental screening at multiple ages to detect subtle developmental delays early. Therefore, our study conducted in an underserved population at a center heavily impacted by COVID-19, investigates the association between in utero COVID-19 exposure and neurodevelopment up to 2 years of age. By extending the follow-up period, we aim to identify potential developmental delays.

Methods: This retrospective study analyzed live-born neonates born between July 1, 2021, and June 30, 2022. We excluded infants with congenital defects, metabolic diseases, perinatal asphyxia, or without Ages and Stages Questionnaire (ASQ) data within the first 2 years. Maternal COVID-19 infection was confirmed via polymerase chain reaction (PCR) at any gestational stage, recorded in electronic medical records. We compared overall ASQ-3 results between exposed and unexposed groups in years 1 and 2 using Chi-Square or Fisher's Exact Tests. Mann-Whitney U Tests examined differences in ASQ-3 subdomain scores (communication, gross motor, fine motor, problem-solving, and personal-social). Significance was set at P < 0.05.

Results: A total of 381 infants met the inclusion criteria. Demographic matching between exposed and non-exposed groups was generally comparable, except for gender distribution (Table 1). No significant association was found between maternal COVID-19 infection and overall ASQ-3 results in year 1 (χ² = 1.13, df = 2, p-value = 0.57) or year 2 (χ² = 4.04, df = 2, p-value = 0.13). However, in year 1, median scores for Gross Motor and Fine Motor domains differed significantly (p < 0.01), with maternal COVID-19-exposed children scoring higher. By year 2, these were no significant differences among each domains, suggesting early developmental disparities may have normalized over time. (Table 2)

Conclusion: Our study found no significant difference in overall ASQ-3 scores between COVID-19-exposed and non-exposed groups over 2 years. Although Gross and Fine Motor domain scores were significantly higher in the exposed group at year 1, these differences disappeared by year 2. Ultimately, we observed no meaningful association between prenatal SARS-CoV-2 exposure and child neurodevelopmental outcomes over 2 years.