585 - Impact of COVID-19 in pregnancy on infant neurodevelopmental outcomes at 18 months: a case-control study

Publication Number: 585.5383

Wing Yee Tong, KK Women and Children's Hospital, Singapore, Singapore, N/A, Singapore; Alicia May Lim, KK Women's and Children's Hospital, Singapore, N/A, Singapore; Jia Ming Low, National University Hospital of Singapore, Singapore, N/A, Singapore; Rehena Sultana, Duke-NUS Medical School, Singapore, CCK, N/A, Singapore; Kee Thai Yeo, KK Women's & Children's Hospital, Singapore, N/A, Singapore; Alvin Ngeow, Singapore General Hospital, Singapore, N/A, Singapore

Background: Emerging evidence suggests that maternal infection with SARS-CoV-2 may have implications for infant neurodevelopment, with several studies highlighting adverse outcomes in specific developmental domains in younger infants. However, there is still a paucity of evidence on the long-term developmental outcomes of infants beyond 1 year of age born to mothers with gestational COVID-19.

Objective: To evaluate the association between in-utero exposure to COVID-19 and infant neurodevelopmental outcomes at 18 months of age using the Ages and Stages Questionnaire, Third Edition (ASQ-3).

Design/Methods: We conducted a prospective case-control study of infants in 3 tertiary-level public hospitals in Singapore. All term infants (gestational age > 37 weeks) born from November 2021 to April 2022 were included. Cases were defined as infants born to mothers with laboratory-confirmed COVID-19 in pregnancy based on positive SARS-CoV-2 polymerase chain reaction and/or serology test. Controls were infants born to mothers without COVID-19 in the same period. We also compared the ASQ-3 scores of the cases and controls as a whole cohort (the ‘pandemic cohort’) against a historical cohort of low-risk Singaporean infants born between November 2009 and May 2011.

Results: A total of 301 infants were included, with 156 infants exposed to maternal COVID-19 in pregnancy, and 145 unexposed (control) cases. There were no significant differences in mean ASQ-3 subdomain scores between the exposed and unexposed groups (Table 1) . This finding was consistent even after accounting for maternal age, maternal education, infant gender, postnatal COVID-19 and infant care attendance. However, a higher proportion of exposed infants had scores in the below the cutoff score (OR 2.2 (95th CI, 1.1, 4.3), p=0.01) for the problem solving domain.Interestingly, in comparison with historic cohort of infants, the pandemic cohort scored significantly higher in 3 subdomains (Table 2), namely communication (mean score 36.4 vs 40.5, p=0.0003), fine motor (mean score 44.94 vs 48.7, p=0.0001) and personal-social skills (mean score 44.5 vs 47.5, p=0.0001) .

Conclusion(s): Our study shows that in mothers exposed to COVID-19 during pregnancy, there is no clear association with adverse infant neurodevelopmental outcomes at 18 months, although there is a concern for abnormal problem-solving skills in exposed infants.

Table 1
Comparison of 18-month ASQ-3 scores between COVID-19 exposed and non-exposed infants

Table 2
Comparison of 18-month ASQ-3 domain scores with historical Singaporean cohort