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

Authors

• 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.

APA Citation

Flaherman, Valerie J.; Reeder, Harrison T.; Martin-Herz, Susanne P.; Gallagher, Richard; Cohen, Alison K.; Brown, Heather-Elizabeth; Clifton, Rebecca G.; Fischbein, Nicole; Foulkes, Andrea S.; Jacoby, Vanessa L.; Jain, Nita; Beamon, Carmen J.; Bahtiyar, Mert Ozan; Chang, Ann; Costantine, Maged M.; Irving, Angelique Cruz; Gibson, Kelly S.; Hoffman, M Camille; Hoffman, Matthew K.; Hughes, Brenna L.; Katz, Stuart D.; Laleau, Victoria; Mendez-Figueroa, Hector; Monteiro, Jonathan; Okumura, Megumi; Pacheco, Luis D.; Palomares, Kristy T.; Parry, Samuel; Plunkett, Beth A.; Reddy, Uma M.; Rouse, Dwight J.; and Saade, George R., "Intrauterine SARS-CoV-2 Exposure and Infant Neurodevelopment through 18 Months of Age: Findings from the RECOVER Pregnancy Study" (2026). GW Authored Works. Paper 8549.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8549

Department

Epidemiology