Intrauterine SARS-CoV-2 exposure and infant neurodevelopment through 18 months of age: Findings from the Researching COVID to Enhance Recovery (RECOVER) pregnancy study
Flaherman, VJ; Reeder, HT; Martin-Herz, SP; et al., The Journal of Pediatrics, January 2026
View Publication on PubMed
Short Summary
In this study, RECOVER researchers looked at whether getting COVID-19 during pregnancy affects a baby’s brain development. Researchers followed over 1,000 families across the US and compared babies up to 18 months in age who were exposed to COVID-19 during their mother’s pregnancy to those who were not. Researchers tracked the babies’ development at 12 and 18 months, looking at how they moved, talked, solved problems, and interacted with others. Researchers found that babies exposed to COVID-19, mostly during the Omicron wave of the pandemic, scored just as well as babies who were not exposed. Researchers also found no big differences in babies’ social skills or risk of delays in their brain development during their first 18 months of life. These findings are important because they can reassure mothers who get COVID-19 during pregnancy about the brain development of their child. However, doctors should continue to check children who were exposed to COVID-19 during their mother’s pregnancy as they grow to ensure their development stays on track.
This summary was prepared by the RECOVER Initiative.
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