Intrauterine SARS-CoV-2 exposure and infant neurodevelopment through 18 months of age: Findings from the Researching COVID to Enhance Recovery (RECOVER) pregnancy study

• January 2026
• The Journal of Pediatrics

Publication Details

DOI: 10.1016/j.jpeds.2026.114997

Abstract

Objective: To assess associations between exposure to intrauterine SARS-CoV-2 and subsequent child neurodevelopment in a large, diverse cohort with confirmation of maternal SARS-CoV-2 status.

Study design: The Researching COVID to Enhance Recovery (RECOVER) Pregnancy Cohort enrolled adults with and without SARS-CoV-2 during pregnancy and their offspring born January 2020 through December 2023 at 23 sites across the US. Neurodevelopment was assessed at 12 months with the Ages & Stages Questionnaire, 3rd edition (ASQ-3) and at 18 months with the ASQ Social-Emotional (ASQ-SE) and the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). We compared exposed and unexposed infants' ASQ-3 total and subdomain scores, ASQ-SE and M-CHAT-R scores, and proportions meeting published referral thresholds, using multivariable linear and logistic regression.

Results: Among 1,179 participants enrolled, 1,008 (85.5%) had exposure, with 806 (80.0%) exposed during Omicron predominance. Of those with known timing, 349 (41.4%) and 295 (35.0%) were exposed in the second and third trimesters of pregnancy, respectively. Exposure was not associated with differences in the ASQ-3 (adjusted difference -0.61, 95% CI -10.03 to 8.81) or ASQ-3 subdomains at 12 months, ASQ-SE at 18 months (adjusted difference 0.19, 95% CI -4.02 to 4.41), or M-CHAT-R scores. Findings were similar for proportions meeting referral thresholds and when stratified by variant or by trimester.

Conclusions: In this multicenter cohort largely exposed since Omicron and in second or third trimester, intrauterine SARS-CoV-2 exposure was not associated with neurodevelopmental screening outcomes through 18 months of age. Further assessments of the impact of intrauterine SARS-CoV-2 on neurodevelopment beyond 18 months of age are needed.

Authors

Valerie J Flaherman, Harrison T Reeder, Susanne P Martin-Herz, Richard Gallagher, Alison K Cohen, Heather-Elizabeth Brown, Rebecca G Clifton, Nicole Fischbein, Andrea S Foulkes, Vanessa L Jacoby, Nita Jain, Carmen J Beamon, Mert Ozan Bahtiyar, Ann Chang, Maged M Costantine, Angelique Cruz Irving, Kelly S Gibson, M Camille Hoffman, Matthew K Hoffman, Brenna L Hughes, Stuart D Katz, Victoria Laleau, Hector Mendez-Figueroa, Jonathan Monteiro, Megumi J Okumura, Luis D Pacheco, Kristy T S Palomares, Samuel Parry, Beth A Plunkett, Uma M Reddy, Dwight J Rouse, George R Saade, Grecio J Sandoval, Hyagriv N Simhan, Daniel W Skupski, Amber Sowles, John M Thorp, Alan T N Tita, Steven J Weiner, Samantha Wiegand, Lynn M Yee, Rachel S Gross, Torri D Metz, RECOVER-Pregnancy Consortium

Keywords

COVID-19; SARS-CoV-2; infectious disease; intrauterine exposure; neurodevelopment