Prenatal SARS-CoV-2 Infection Linked to Increased Autism Risk in Girls
A study of nearly 70,000 children found girls exposed to SARS-CoV-2 infection in utero had a 44% increased risk of autism spectrum disorder. The research showed 3.97% of pregnant women had COVID-19 infection, with most cases occurring in the third trimester. No increased risk was observed for boys or for speech/language and motor delays overall.
Girls exposed to SARS-CoV-2 infection in utero may have increased risk for autism spectrum disorder, according to study results published in Translational Psychiatry. Researchers conducted a prospective longitudinal cohort study to assess the effect of SARS-CoV-2 infection during pregnancy on neurodevelopment in offspring, enrolling 69,987 child participants aged 27-48 months from the Kaiser Permanente Northern California integrated health care system.
Maternal SARS-CoV-2 infection during pregnancy was associated with elevated risk for ASD among girls, with an adjusted hazard ratio of 1.44, compared to boys who showed no significant increased risk. Overall, 3.97% of pregnant women in the study had SARS-CoV-2 infection during pregnancy, with 20% during the first trimester, 29% in the second trimester, and 51% in the third trimester. Among child participants, 17.15% were diagnosed with neurodevelopmental disorders, 14.36% with speech/language delay, 3.89% with ASD, and 3.88% with motor delay.
Researchers noted an elevated risk for motor delay with maternal SARS-CoV-2 infection during the first trimester, but a decreased association during the second and third trimesters. However, they did not observe increased association with risk for speech/language or motor delay overall. Patients with versus without SARS-CoV-2 infection during pregnancy were more likely to be Hispanic, younger than 25 years at delivery, and multiparous.
Children with versus without neurodevelopmental disorders were more likely to have a non-White mother aged at least 35 years, primiparous, and with government health insurance. Of the participants with SARS-CoV-2 infection during pregnancy, 12.5% received the COVID-19 vaccine during pregnancy.
Study limitations include unmeasured socioeconomic confounders, lack of information on the severity of maternal infection, and not assessing risks specifically associated with the Delta variant. Future research, including study designs assessing familial confounding, is needed to evaluate impacts of prenatal SARS-CoV-2 infection severity, SARS-CoV-2 vaccination, and SARS-CoV-2 variants, as well as pandemic related stress on neurodevelopmental outcomes including those that emerge later in childhood.