608 - Intrauterine programming: Prenatal COVID exposure and offspring outcomes

Poster Number: 608
Publication Number: 608.1181

Background: Prenatal exposures, including viral exposures like SARS-COV-2, may influence early brain development and predispose offspring to neuropsychiatric conditions later in life. While vertical transmission is rare, secondary effects of maternal COVID-19 infection in pregnancy on offspring neurodevelopment, however, remain largely unknown.

Objective: To determine early neurodevelopmental outcomes for offspring exposed to maternal SARS-CoV-2 infection in utero compared to unexposed infants.

Design/Methods: We prospectively enrolled infants in an observational study to determine the impact of prenatal COVID-19 exposure on offspring neurodevelopment. Maternal COVID-19 infection and intrauterine exposure were determined by laboratory testing during prenatal care or at delivery, along with parental reports of known or potential exposures using the Coronavirus Perinatal Experiences – Impact Survey and Update (COPE-IS/COPE-IU). Neurodevelopment was assessed at 18 months using the Bayley Scales of Infant Development-III (BSID-III).

Results: We evaluated 156 infants: 98 pre-pandemic controls, 26 infants of COVID-19 unexposed mothers and 32 infants of COVID-19 positive mothers. While mean BSID-III scores were within the normal distribution for both groups, COVID-19 exposed infants scored significantly lower on the cognitive, language and motor domains of the BSID-III compared to both contemporary unexposed and pre-pandemic cohorts (Figure 1). Furthermore, COVID-19 exposed infants were more likely to demonstrate mild language delays (composite < 85 or 1 SD below the mean) compared to unexposed (Table 2).

Conclusion(s): It is increasingly recognized that effects of intrauterine exposures on offspring wellness and in particular, neurobehavioral outcomes, may not manifest until later in life. Despite the low intrauterine transmission rates of COVID-19, we found significant differences of offspring neurodevelopment in infants of COVID-19 positive mothers compared to unexposed infants. These findings warrant ongoing follow-up to determine if significant neurobehavioral differences persist through school-age and young adulthood.