Maternal COVID-19 Exposure Linked to Neurodevelopmental Risk in Children

Children exposed to maternal COVID-19 (SARS-CoV-2 infection) in utero had a higher likelihood of receiving a neurodevelopmental diagnosis by age 3 years, with the strongest associations observed following third-trimester exposure and among male offspring, according to a large retrospective cohort study published in Obstetrics & Gynecology.

In the study, researchers analyzed electronic health record (HER) data from 18,124 live births within the Mass General Brigham health system between March 2020 and May 2021. Maternal COVID-19 exposure during pregnancy—defined as a positive polymerase chain reaction test result—occurred in 861 participants. The primary endpoint was the presence of at ≥1 neurodevelopmental diagnosis by age 36 months, identified using International Classification of Diseases (ICD-10) codes. Multivariable logistic regression models adjusted for maternal age, race and ethnicity, insurance type, hospital type, offspring sex, preterm birth, and vaccination status were used to estimate associations.

Key findings include the following:

• Neurodevelopmental diagnoses occurred in 16.3% of children exposed to maternal COVID-19 (n=140) compared with 9.7% of unexposed children (n=1680) (adjusted odds ratio [aOR], 1.29; 95% CI, 1.05 to 1.57).
• Third-trimester maternal exposure was associated with a higher risk of neurodevelopmental diagnosis than no exposure (aOR, 1.36; 95% CI, 1.07 to 1.72).
• Among male offspring, third-trimester exposure was associated with an increased risk of neurodevelopmental diagnosis (aOR, 1.43; 95% CI, 1.05 to 1.91), whereas the association was not statistically significant among female offspring.
• The most commonly identified diagnoses included speech and language disorders, developmental motor disorders, and autism spectrum disorder.

The authors note that the observational design limits causal inference and that diagnostic ascertainment relied on clinical records rather than standardized assessments. The findings support continued neurodevelopmental monitoring of children exposed to maternal COVID-19 during pregnancy.

Source: Shook, Lydia L. MD; Castro, Victor MS; Ibanez-Pintor, Laura MD; Perlis, Roy H. MD, MSc; Edlow, Andrea G. MD, MSc. Neurodevelopmental Outcomes of 3-Year-Old Children Exposed to Maternal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Utero. Obstetrics & Gynecology 147(1):p 11-20, January 2026. | DOI: 10.1097/AOG.0000000000006112