Neuromotor repertoires in infants exposed to maternal COVID-19 during pregnancy: a cohort study

Viviana Fajardo Martinez; Dajie Zhang; Sophia Paiola; Thalia Mok; Mary C Cambou; Tara Kerin; Rashmi Rao; Patricia Brasil; Fatima Ferreira; Trevon Fuller; Debika Bhattacharya; Suan-Sin Foo; Weiqiang Chen; Jae Jung; Christa Einspieler; Peter B Marschik; Karin Nielsen-Saines

doi:10.1136/bmjopen-2022-069194

Neuromotor repertoires in infants exposed to maternal COVID-19 during pregnancy: a cohort study

BMJ Open. 2023 Jan 23;13(1):e069194. doi: 10.1136/bmjopen-2022-069194.

Authors

Viviana Fajardo Martinez^#¹, Dajie Zhang^#^{2

3}, Sophia Paiola¹, Thalia Mok⁴, Mary C Cambou⁵, Tara Kerin¹, Rashmi Rao⁴, Patricia Brasil⁶, Fatima Ferreira⁷, Trevon Fuller^{8

9}, Debika Bhattacharya⁵, Suan-Sin Foo¹⁰, Weiqiang Chen¹⁰, Jae Jung¹⁰, Christa Einspieler³, Peter B Marschik^{2

3

11}, Karin Nielsen-Saines¹²

Affiliations

¹ Pediatrics, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
² Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen and Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany.
³ iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria.
⁴ Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
⁵ Internal Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
⁶ Acute Febrile Illnesses, FIOCRUZ, Rio de Janeiro, Brazil.
⁷ Pediatrics, Escola de Medicina, Universidade do Rio de Janeiro, Rio de Janeiro, Brazil.
⁸ FIOCRUZ, Rio de Janeiro, Brazil.
⁹ Institute for the Environment and Sustainability, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
¹⁰ Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
¹¹ Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
¹² Pediatrics, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA knielsen@mednet.ucla.edu.

^# Contributed equally.

Abstract

Objective: To evaluate neuromotor repertoires and developmental milestones in infants exposed to antenatal COVID-19.

Design: Longitudinal cohort study.

Setting: Hospital-based study in Los Angeles, USA and Rio de Janeiro, Brazil between March 2020 and December 2021.

Participants: Infants born to mothers with COVID-19 during pregnancy and prepandemic control infants from the Graz University Database.

Interventions: General movement assessment (GMA) videos between 3 and 5 months post-term age were collected and clinical assessments/developmental milestones evaluated at 6-8 months of age. Cases were matched by gestational age, gender and post-term age to prepandemic neurotypical unexposed controls from the database.

Main outcome measures: Motor Optimality Scores Revised (MOS-R) at 3-5 months. Presence of developmental delay (DD) at 6-8 months.

Results: 239 infants were enrolled; 124 cases (83 in the USA/41 in Brazil) and 115 controls. GMA was assessed in 115 cases and 115 controls; 25% were preterm. Median MOS-R in cases was 23 (IQR 21-24, range 9-28) vs 25 (IQR 24-26, range 20-28) in controls, p<0.001. Sixteen infants (14%) had MOS-R scores <20 vs zero controls, p<0.001. At 6-8 months, 13 of 109 case infants (12%) failed to attain developmental milestones; all 115 control infants had normal development. The timing of maternal infection in pregnancy (first, second or third trimester) or COVID-19 disease severity (NIH categories asymptomatic, mild/moderate or severe/critical) was not associated with suboptimal MOS-R or DD. Maternal fever in pregnancy was associated with DD (OR 3.7; 95% CI 1.12 to 12.60) but not suboptimal MOS-R (OR 0.25; 95% CI 0.04 to 0.96).

Conclusions: Compared with prepandemic controls, infants exposed to antenatal COVID-19 more frequently had suboptimal neuromotor development.

Keywords: COVID-19; Maternal medicine; Paediatric infectious disease & immunisation; Paediatric neurology.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Brazil
COVID-19*
Cohort Studies
Female
Humans
Infant
Infant, Newborn
Longitudinal Studies
Pregnancy
Pregnancy Complications, Infectious*

Abstract

Publication types

MeSH terms

Grants and funding