Pregnancy and pediatric studies work together to learn how COVID affects mothers and their babies
Both mothers and their babies contribute data, allowing researchers to answer specific questions—for example, whether a mother’s Long COVID symptoms might impact her child’s development.
Nearly 30,000 adults and children have contributed to RECOVER’s observational study. As part of the adult study, over 2,000 pregnant women are helping RECOVER researchers learn more about the relationship between pregnancy and Long COVID.
Findings from the RECOVER pregnancy study have already been published and shared with the Long COVID community. In 2024, RECOVER published a paper that outlined how often pregnant women in the study developed Long COVID and shared symptoms that pregnant women with Long COVID commonly experience. Last year, RECOVER published findings that suggested pregnant women did not have a higher risk of developing Long COVID than women who were not pregnant.
To date, most of the findings from RECOVER’s pregnancy study have been focused on the pregnant women themselves. However, these women’s babies can also help answer important questions about COVID and Long COVID. Pregnant participants had the option to enroll their baby in RECOVER’s pediatric study after they were born. Researchers call this group of babies the “in utero cohort,” babies who were not yet born when their mothers experienced SARS-CoV-2 infection (the virus that causes COVID-19) or joined the study. These babies can help RECOVER answer specific questions about how a mother having COVID during pregnancy may affect the baby.
“When a mother has COVID, there is increased inflammation [the body's response to infection], and the maternal environment changes for her unborn baby,” said Torri Metz, MD, MS, a RECOVER researcher and obstetrician (a doctor specializing in pregnancy) who helps lead the RECOVER pregnancy study.
Also, because RECOVER studies include people who had COVID and people who did not have COVID, the pregnancy study also includes women who did not have COVID during pregnancy—and the pediatric study includes their babies once born. The women taking part in the study who did not have COVID and their babies can help researchers make stronger comparisons and identify which changes in mother and child may be associated with the exposure to SARS-CoV-2.
Dr. Metz explained that each mother and child pair is called a “dyad.” Having data from both participants in each dyad will help researchers better understand interactions between mother and child. For example, researchers could examine how a mother’s Long COVID symptoms might impact her child’s development.
“We know that other viruses [that the mother has] can cause neurodevelopmental effects in the fetus [unborn baby],” said Valerie Flaherman, MD, MPH, a pediatrician and another leader in the RECOVER pregnancy study. “Given that SARS-CoV-2 [the virus that causes COVID-19] can cause cognitive changes, we knew that it was critical to learn more about how maternal cases of COVID could impact the brain and nervous system of the fetus.”
As the babies whose mothers were part of the pregnancy study grow up, researchers will conduct tests that are commonly used to measure child development to understand whether they are meeting expected developmental milestones. Children will participate in these tests at specific ages, such as 12 months and 18 months.
When children in the study are ages 2 and 3, researchers will conduct full assessments that look at abilities like motor skills (how the body moves) and communication. Researchers will also interview the children’s parents at specific time points to better understand all aspects of the children’s behaviors.
In 2025, Dr. Flaherman presented an abstract that shared initial findings from screening children who were 12 months old. These results showed no differences between babies whose mothers had COVID while pregnant and babies whose mothers did not have COVID while pregnant. RECOVER researchers recently published a manuscript sharing these results. The paper also found no differences between the two groups when children were 18 months old.
Despite these results at 12 and 18 months, differences might appear when the children are older, Dr. Flaherman said.
“One challenge of this work is that neurodevelopment is difficult to assess in infancy and early toddlerhood,” she noted. “For example, testing a 12-month-old’s communication may not tell us much, as it’s normal for babies to have few words at this age. We have to keep in mind that testing neurodevelopment at a very young age can’t always be predictive of a child’s future. However, as they get a little older, these tools become more reliably predictive of how a child will do in the future.”
The dyads and the data they can contribute can help researchers answer other important questions.
“This cohort [group of people] represents a unique resource,” Dr. Flaherman said. “For most of the moms who were infected in 2021 or 2022, it was their first COVID case. We’ll never get this cohort again because in future studies, researchers won’t know how many times a mother had COVID before she got pregnant. We consider this ‘clean’ data that can help us answer very specific questions.”
Soon, Dr. Metz said, RECOVER researchers hope to answer some of the questions that are important to people trying to grow their families. For example, she said, RECOVER Patient Representatives have expressed a desire to understand what happens when a woman with Long COVID gets pregnant.
“We have work to do now, in both the observational and the electronic health record studies,” Dr. Metz said. “We don’t have information about [how Long COVID impacts pregnancy] outcomes such as high blood pressure or preterm birth. That’s hard for people who may be impacted by Long COVID but are also trying to navigate family planning.”
