Intrauterine SARS-CoV-2 exposure and infant neurodevelopment through 18 months of age: Findings from the 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 and 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 ASQ-3 (adjusted difference: -0.61, 95% CI: -10.03, 8.81) or ASQ-3 subdomains at 12 months, ASQ-SE at 18 months (adjusted difference: 0.19, 95% CI: -4.02, 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 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

Not available