Intrauterine SARS-CoV-2 Exposure and Infant Neurodevelopment through 18 Months of Age: Findings from the RECOVER Pregnancy Study

Valerie J. Flaherman, Department of Pediatrics, Division of General Pediatrics, University of California San Francisco, San Francisco, CA, USA. Electronic address: valerie.flaherman@ucsf.edu.
Harrison T. Reeder, Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
Susanne P. Martin-Herz, Departments of Pediatrics and Psychiatry, Division of Developmental Medicine, University of California San Francisco, San Francisco, CA, USA.
Richard Gallagher, Department of Child and Adolescent Psychiatry, Child Study Center, NYU Grossman School of Medicine, New York, NY, USA.
Alison K. Cohen, Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA; Patient-Led Research Collaborative, Washington, DC, USA; RECOVER Patient, Caregiver, or Community Advocate Representative, New York, NY, USA.
Heather-Elizabeth Brown, RECOVER Patient, Caregiver, or Community Advocate Representative, New York, NY, USA.
Rebecca G. Clifton, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Nicole Fischbein, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
Andrea S. Foulkes, Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Vanessa L. Jacoby, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
Nita Jain, Timeless Biosciences, Atlanta, GA, USA; RECOVER Patient, Caregiver, or Community Advocate Representative, New York, NY, USA.
Carmen J. Beamon, Department of Maternal Fetal Medicine, WakeMed Health and Hospitals, Raleigh, NC, USA.
Mert Ozan Bahtiyar, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
Ann Chang, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
Maged M. Costantine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, OH, USA.
Angelique Cruz Irving, Department of Population Health, Clinical Science Core for RECOVER, NYU Grossman School of Medicine, New York, NY, USA.
Kelly S. Gibson, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, USA.
M Camille Hoffman, Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA.
Matthew K. Hoffman, Department of Obstetrics and Gynecology, ChristianaCare, Wilmington, DE, USA.
Brenna L. Hughes, Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.
Stuart D. Katz, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
Victoria Laleau, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
Hector Mendez-Figueroa, Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, USA.
Jonathan Monteiro, Department of Biostatistics, Massachusetts General Hospital, Boston, MA, USA.
Megumi Okumura, University of California San Francisco, San Francisco, CA, USA.
Luis D. Pacheco, Department of Obstetrics and Gynecology, Division of Perinatal Research, University of Texas at Medical Branch, Galveston, TX, USA.
Kristy T. Palomares, Department of Obstetrics and Gynecology, St. Peter's University Hospital, New Brunswick, NJ, USA.
Samuel Parry, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
Beth A. Plunkett, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Endeavor Health, Evanston, IL, USA.
Uma M. Reddy, Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA.
Dwight J. Rouse, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Brown University, Providence, RI, USA.
George R. Saade, Department of Obstetrics and Gynecology, Division of Perinatal Research, University of Texas at Medical Branch, Galveston, TX, USA.

Document Type

Journal Article

Publication Date

1-19-2026

Journal

The Journal of pediatrics

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, 3 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 1179 participants enrolled, 1008 (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.

Department

Epidemiology

Link to Full Text

Share

COinS