Neurodevelopmental Outcomes of 3-Year-Old Children Exposed to Maternal Severe Acute Respiratory Syndrome SARS-CoV-2 Infection in Utero, 2025, Shook+

Chandelier

Chandelier

Senior Member (Voting Rights)
Full title: Neurodevelopmental Outcomes of 3-Year-Old Children Exposed to Maternal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Utero



Shook, Lydia L. MD; Castro, Victor MS; Ibanez-Pintor, Laura MD; Perlis, Roy H. MD, MSc; Edlow, Andrea G. MD, MSc

OBJECTIVE:​

To determine whether in utero exposure to maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with increased risk of adverse neurodevelopmental outcomes in children by age 3 years.

METHODS:​

We conducted a retrospective cohort study of 18,124 live births to individuals who delivered between March 1, 2020, and May 31, 2021, within the Mass General Brigham health system.
The exposure of interest was maternal SARS-CoV-2 infection, defined as a positive SARS-CoV-2 polymerase chain reaction test result during pregnancy.
The outcome of interest was presence of any neurodevelopmental diagnosis up to 36 months after birth, identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes.
To evaluate the association between SARS-CoV-2 exposure in pregnancy and these diagnoses, we used logistic regression models adjusting for maternal age, race and ethnicity, insurance type, hospital type, and preterm birth.

RESULTS:​

Among the 861 individuals with SARS-CoV-2-exposed pregnancies (4.8%), 140 offspring (16.3%) received a neurodevelopmental diagnosis by 36 months after birth, compared with 1,680 of 17,263 unexposed offspring (9.7%) (unadjusted odds ratio 1.80, 95% CI, 1.49–2.17; adjusted odds ratio [aOR] 1.29, 95% CI, 1.05–1.57, P=.01).
In sensitivity analyses, largest effects were observed in third-trimester exposures, overall (aOR 1.36, 95% CI, 1.07–1.72, P=.01), and among male offspring (aOR 1.43, 95% CI, 1.05–1.91, P=.02).

CONCLUSION:​

Maternal SARS-CoV-2 infection in pregnancy was associated with increased risk of adverse neurodevelopmental diagnoses by age 3 years, with effects most pronounced after third-trimester exposure and in male offspring.
These findings highlight the importance of long-term neurodevelopmental monitoring for SARS-CoV-2–exposed children.
 

AI summary:
Autism Risk Linked to Maternal Covid-19 Infection During Pregnancy

Study Overview
A study from Massachusetts General Hospital examined more than 18,000 births in the Mass General Brigham health system between March 2020 and May 2021. Researchers analyzed laboratory-confirmed Covid-19 infections among mothers and tracked neurodevelopmental diagnoses in their children up to age three.

Key Findings
Children born to mothers infected with Covid-19 during pregnancy were more likely to be diagnosed with neurodevelopmental disorders—over 16% compared with less than 10% among children of uninfected mothers. After adjusting for other factors, the risk was 1.3 times higher. The most common diagnoses were speech and motor function disorders and autism. About 2.7% of children with maternal infection were diagnosed with autism, compared with 1.1% of others.

Specific Risk Factors
The differences were greater among boys and in cases of infection during the third trimester, identified as a critical phase for brain development. Researchers noted that male fetal brains may be more sensitive to maternal immune responses.

Context and Implications
Over 90% of mothers in the study were unvaccinated, allowing the researchers to focus on the effects of infection itself. The authors emphasized that Covid-19 during pregnancy may affect fetal brain development and urged awareness and early evaluation for affected children.

Public Health Perspective
Experts highlighted the importance of preventing Covid-19 infection in pregnancy, especially amid declining public confidence in vaccines. The findings were published in Obstetrics and Gynecology on October 31, 2025.
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