063 - Differences in Early Child Neurodevelopment Following Symptomatic and Asymptomatic Maternal SARS-CoV-2 Infection in Pregnancy

Publication Number: 63.4283

Daniella S. McCausland, Children's National Health System, Alexandria, VA, United States; Manuela Iglesias, Children's National Health System, Arlington, VA, United States; Malavika Mahendran, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Heather Gordish-Dressman, Children's National Health System, Washington, DC, United States; Lora D. Jackle, Inova Children's Hospital, Fairfax, VA, United States; Jessica Harkness, Inova Children's Hospital, Arlington, VA, United States; Renee Brenner, Inova, Falls Church, VA, United States; Miranda Newell, Inova, Falls Church, VA, United States; Robin Baker, Inova Children's Hospital, Washington, DC, United States; George Larry Maxwell, Inova Children's Hospital, washington, DC, United States; Gianluca Ursini, Lieber Institute for Brain Development, Johns Hopkins University, Baltimore, MD, United States; Sarah B. Mulkey, Children's National Health System, Washington, DC, United States

Background: Viral infections during pregnancy can impact child neurodevelopment. Neurodevelopmental outcomes following antenatal SARS-CoV-2 exposure are not fully understood.

Objective: To describe early child neurodevelopmental outcomes in children born to gestational parents with SARS-CoV-2 and whether these outcomes differ by symptomatic vs. asymptomatic infection.

Design/Methods: Parent-child dyads were prospectively enrolled from Inova Fairfax Hospital, VA. Eligible participant mothers had laboratory confirmed SARS-CoV-2 infection (n=87) or self-reported infection (n=1) during pregnancies completed between 2020 and 2022. Child neurodevelopment was assessed at 24-42 months of age using the Bayley-III Scales of Infant and Toddler Development and the Child Behavior Checklist (CBCL). Outcomes of interest were the Bayley-III domains of cognition, language, and motor function, and the CBCL DSM-5 Oriented Scales for Autism Spectrum Problems. Participants were grouped by maternal symptomatic or asymptomatic SARS-CoV-2 infection. Stratified analyses used Fisher’s exact test for categorical outcomes and Wilcoxon rank-sum tests for continuous outcomes.

Results: Eighty-eight parent-child dyads were enrolled, of which 65 (74%) were Hispanic/Latino. Fifty-four (61%) gestational parents had symptomatic infection at a mean gestational age of 26.3 ± 8.6 weeks (eight were hospitalized due to symptom severity) and 34 (39%) had asymptomatic infection at a mean gestational age of 35.3 ± 7.2 weeks (p < 0.001). Children were evaluated at a mean age of 35.6 ± 6.3 months (Table 1). Bayley-III scores were higher in children born to symptomatic parents, indicating better performance, compared to children in the asymptomatic group (all, p< 0.05)(Figure 1). More children born to asymptomatic parents had clinically elevated scores on the CBCL Autism Problems Scale compared to children born to symptomatic parents (24% vs. 10%; p=0.021)(Figure 2). No other significant differences were found between groups on the CBCL.

Conclusion(s): Further investigation is needed to understand how COVID-19 symptomaticity, gestational age at infection, social determinants of health, and vaccination mediate child neurodevelopmental outcomes in a larger sample. Future investigations will assess how COVID-19 infection and symptoms mediate neurodevelopment in a sample that includes SARS-CoV-2 negative controls. Longitudinal follow-up for children that are < 24 months will be performed to identify trends in early childhood development.

Table 1. Enrolled Participant Demographics


Figure 1. Median Bayley-III Percentile Scores of cognition, language, and motor skills across symptomatic and asymptomatic groups.
(*) Indicates significant difference (p < 0.05). Percentile scores range from 0-100 with scores <25 in at least one domain indicating developmental delay. Note: Two children in the symptomatic group did not complete Bayley-III evaluations.

Figure 2. Categorization of Autism Problems Scores from the Child Behavior Checklist (CBCL).
(*) Indicates significant difference (p < 0.05) between score categorizations of normal, borderline, and clinical between symptomatic and asymptomatic groups. Note: Two children in the symptomatic group did not complete the Child Behavior Checklist (CBCL).