Prental exposure to COVID and Neurodevelopment Issues:
A preprint study (not yet peer-reviewed) shows that prenatal exposure to COVID-19 may lead to neurodevelopment issues in the baby. Obviously wait till this is peer-reviewed before you run with it, but it’s still interesting research to consider. What happens when there is prenatal exposure to COVID? A few researchers tried to find out.
Researchers out of Mass General and Harvard Medical School analyzed pregnancy and both mom/baby data from electronic health records from 6 community hospitals. All babies born between March and September of 2020 were included in the analysis, so this was done before vaccines were available. The primary outcome was the diagnosis of a neurodevelopmental disorder in the first year of life. Exposure to COVID-19 was defined as the mother having a positive PCR test at any point during the pregnancy. The researchers also analyzed in which trimester the mother tested positive. The mean age of participants was 33 years old and the rate of high blood pressure and diabetes was similar for moms who tested positive for COVID-19 while pregnant and moms who did not.
Prenatal Exposure to COVID: What did they learn?
A total of 7,772 live births were included in the analysis. Of those, 222 were born to moms who had a positive PCR test during pregnancy. After adjusting for race, ethnicity, health insurance status, maternal age and preterm status, the odds of developing a neurodevelopment disorder was 1.86 higher for the babies born to COVID-positive moms. When only comparing moms who developed COVID in the 3rd trimester vs all uninfected moms, the effect was greater- there was a significantly higher odds (2.86) of developing a neurodevelopment disorder when you caught COVID in the 3rd trimester.
The researchers noted that preterm delivery was more likely in mothers who tested positive for COVID (14% vs 8.7%), and while the odds of developing a neurodevelopment disorder was high in preterm babies (3.39), the effect was still significant when only analyzing full-term babies.
The most common neurodevelopment issues seen in babies born to moms who had COVID during pregnancy were disorders with specific motor functions, expressive language and speech disorders.
What does this mean?
We are still learning how COVID-19 impacts pregnancy, for both the person who is pregnant and the fetus. History has shown us that infections can affect pregant people differently than the non-pregnant population. Research also shows that prenatal exposure to viruses is linked to the onset of neurodevelopment issues and even psychiatric disorders in the offspring so it’s logical that COVID-19 may do the same thing. We grow tired of reading those words “more research is needed” at the end of almost every paper…but in this case, more research is really needed.
I’ve read recent studies showing that COVID can significantly affect the placenta. This study out of Australia discusses how COVID-19 might bind to ACE2 receptors in the placenta, therefore creating issues for the fetus. This recent study out of Israel showed that COVID-19 can be passed from the mother to the placenta and lead to stillbirths. I do not know how common this is- we’re still learning.
We are also still learning how the COVID-19 vaccine impacts pregnant women. Right now the CDC recommends that pregnant people get the vaccine, because data shows that COVID-19 is more severe in pregnant people. If you look at this linked CDC chart on COVID-19 deaths in pregnant women by month, 41% of deaths happened during and after August’ 2021. That means the Delta variant was much more severe on pregnant people than the “original” virus.
There also does not appear to be an increase in miscarriages linked to the COVID vaccines, which was a fear circulating around the web. This case-control study published in the NEJM did not find a link. This case-control study in JAMA did not find an association between COVID vaccines and miscarriages. This third study, also published in the NEJM used pregnancy data from the CDC’s V-Safe App (designed specifically to collect data on pregnant people who get a COVID shot) and compared rates of miscarriages with two historical cohorts, one representing the lower rate of miscarriages and one representing the higher rate. Results showed that the miscarriage rate from the V-Safe data was within the expected range of the two cohorts, and therefore not significantly higher (or lower).
But here’s the deal:
When discussing the unique effects COVID-19 has in pregnancy or prenatal exposure to COVID, it brings me back to the piece I wrote on the importance of doing a targeted risk-benefit analysis for each segment of the population. When it comes to COVID and the COVID vaccines, the “pregnancy” risks vs benefits analysis will not be the same as that for a seventy-nine year old man nor that for a seven year old boy. I think it’s so important to keep that in mind and not throw advice around like a blanket. We are actively gathering evidence in real-time, which can be both reassuring and anxiety-provoking. This is especially true for the pregnant population, as they were not included in any of the vaccine trials. When healthcare providers or public health experts take the time to write out a risk-benefit analysis with someone it will empower a person and make them feel better about their health choices, no matter who they are.
Thanks for reading.
Here is the link to the full study. Remember it’s a preprint!