Risk of neurodevelopmental changes in 18-month-old children born to mothers infected with SARS-CoV-2

Silva, Livia Maria; Melo, Maria Luisa de Oliveira; Alpes, Matheus Francoy; Santos, Carla Manfredi dos

doi:10.1590/2317-6431-2024-2963pt

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Original Article • Audiol., Commun. Res. 30 • 2025 • https://doi.org/10.1590/2317-6431-2024-2963en linkcopy

Risk of neurodevelopmental changes in 18-month-old children born to mothers infected with SARS-CoV-2

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose To investigate the risk of child development in 18-month-old children born to mothers who were infected by the SARS-CoV-2 virus during pregnancy and identify possible delays in development indicators.

Methods Children who were born between January 2021 and August 2021, whose mothers tested positive for COVID-19 during pregnancy, participated in the research. To investigate linguistic, motor, cognitive and social development, the Ages & Stages Questionnaires (ASQ-3) was used in the five domains: Communication, Gross motor coordination, Fine motor coordination, Problem solving and Personal/social. Data were described using absolute and percentage frequencies and using mean, standard deviation, minimum, median and maximum. To analyze the association between the variables of interest, the Poisson regression model was used. Tukey's post-test was used for multiple comparisons.

Results The Personal-Social domains, followed by Fine motor coordination and Problem Solving were the best performing. The worst performance was observed in the Communication domain, followed by Gross motor coordination. Prematurity, birth weight, Apgar score and need for hospitalization of the child after birth were variables associated with low performance in the domains assessed.

Conclusion A risk of developmental delay was observed in 18-month-old children born to mothers who were infected with the SARS-CoV-2 virus during pregnancy. The domain with the greatest loss was Communication, followed by changes in Gross Motor Coordination.

Keywords:
Triage; Early diagnosis; Post-acute Covid-19 syndrome; Language development; Speech, language and hearing sciences

Variable	Total number of cases	Percentage (%)
MOTHER’S AGE
< 30 years	24	58.54
>= 30 years	17	41.46
TYPE OF DELIVERY
Cesarean	18	43.9
Vaginal	23	56.1
MOTHER’S COVID – PREGNANCY
1^st trimester (0-12 weeks)	5	12.2
2^nd trimester (12-26 weeks)	9	21.95
3^rd trimester (26 weeks-birth)	27	65.85
CHILD’S SEX
Females	21	51.22
Males	20	48.78
PREMATURITY
No	34	82.93
Yes	7	17.07
1-MINUTE APGAR
< 7	4	9.76
>= 7	37	90.24
BIRTH WEIGHT
< 2500 grams	5	12.2
>= 2500 grams	36	87.8
CHILD’S HOSPITALIZATION
No	33	80.49
Yes	8	19.51
COVID-19 SEROLOGY
Negative	9	21.95
Not tested	32	78.05
COMORBIDITIES
Cardiological	3	7.32
Cardiological and pulmonary	2	4.88
Neurological	1	2.44
Pulmonary	8	19.51
Absent	27	65.85
BREASTFEEDING DURATION
No breastfeeding	5	12.5
< 6 months	5	12.5
6 months to 1 year	15	37.5
Over 1 year	15	37.5
Frequency Missing = 1

Variable	ASQ-3 Communication		Relative risk (95% CI)	p-value *
Variable	Below	Above	Communication “below”	p-value *
SEX
Females	10 (47.62%)	11 (52.38%)	0.79 (0.45; 1.41)	0.43
Males	12 (60%)	8 (40%)	ref.

MOTHER’S COVID – PREGNANCY
1^st trimester	2 (40%)	3 (60%)	0.72 (0.19; 2.77)	0.84
2^nd trimester	5 (55.56%)	4 (44.44%)	1 (0.45; 2.24)	0.99
3^rd trimester	15 (55.56%)	12 (44.44%)	ref.

MOTHER’S AGE
< 30 years	16 (66.67%)	8 (33.33%)	1.89 (0.94; 3.82)	0.08
>= 30 years	6 (35.29%)	11 (64.71%)	ref.

PREMATURITY
No	16 (47.06%)	18 (52.94%)	ref.
Yes	6 (85.71%)	1 (14.29%)	1.82 (1.14; 2.91)	0.01

CHILD’S HOSPITALIZATION
No	15 (45.45%)	18 (54.55%)	ref.
Yes	7 (87.5%)	1 (12.5%)	1.92 (1.22; 3.04)	<0.01

1-MINUTE APGAR
< 7	3 (75%)	1 (25%)	1.46 (0.76; 2.79)	0.25
>= 7	19 (51.35%)	18 (48.65%)	ref.

BIRTH WEIGHT
< 2500 grams	5 (100%)	0 (0%)	2.12 (1.5; 2.99)	<0.01
>= 2500 grams	17 (47.22%)	19 (52.78%)	ref.

BREASTFEEDING DURATION
No breastfeeding	4 (80%)	1 (20%)	2 (0.74; 5.41)	0.28
< 6 months	2 (40%)	3 (60%)	1 (0.2; 5.08)	0.99
6 months to 1 year	9 (60%)	6 (40%)	1.5 (0.57; 3.98)	0.71
Over 1 year	6 (40%)	9 (60%)	ref.

Variable	ASQ-3 Fine Motor Coordination		Relative risk (95% CI)	p-value *
Variable	Below	Above	Fine Motor Coordination “below”	p-value *
SEX
Females	4 (19.05%)	17 (80.95%)	3.81 (0.46; 31.23)	0.21
Males	1 (5%)	19 (95%)	ref.

MOTHER’S COVID – PREGNANCY
1^st trimester	1 (20%)	4 (80%)		0.47**
2^nd trimester	0 (0%)	9 (100%)
3^rd trimester	4 (14.81%)	23 (85.19%)

MOTHER’S AGE
< 30 years	3 (12.5%)	21 (87.5%)	1.06 (0.2; 5.69)	0.94
>= 30 years	2 (11.76%)	15 (88.24%)	ref.

PREMATURITY
No	2 (5.88%)	32 (94.12%)	ref.
Yes	3 (42.86%)	4 (57.14%)	7.28 (1.48; 35.86)	0.01

CHILD’S HOSPITALIZATION
No	3 (9.09%)	30 (90.91%)	ref.
Yes	2 (25%)	6 (75%)	2.75 (0.55; 13.81)	0.22

1-MINUTE APGAR
< 7	1 (25%)	3 (75%)	2.31 (0.33; 15.98)	0.40
>= 7	4 (10.81%)	33 (89.19%)	ref.

BIRTH WEIGHT
< 2500 grams	2 (40%)	3 (60%)	4.8 (1.04; 22.06)	0.04
>= 2500 grams	3 (8.33%)	33 (91.67%)	ref.

BREASTFEEDING DURATION
No breastfeeding	2 (40%)	3 (60%)		0.09**
< 6 months	0 (0%)	5 (100%)
6 months to 1 year	2 (13.33%)	13 (86.67%)
Over 1 year	0 (0%)	15 (100%)

Variable	ASQ-3 Gross Motor Coordination		Relative risk (95% CI)	p-value *
Variable	Below	Above	Gross Motor Coordination “Below”	p-value *
SEX
Females	11 (52.38%)	10 (47.62%)	1.31 (0.67; 2.57)	0.43
Males	8 (40%)	12 (60%)	ref.

MOTHER’S COVID – PREGNANCY
1^st trimester	2 (40%)	3 (60%)	0.83 (0.21; 3.26)	0.95
2^nd trimester	4 (44.44%)	5 (55.56%)	0.92 (0.34; 2.49)	0.98
3^rd trimester	13 (48.15%)	14 (51.85%)	ref.

MOTHER’S AGE
< 30 years	8 (33.33%)	16 (66.67%)	0.52 (0.26; 1)	0.06
>= 30 years	11 (64.71%)	6 (35.29%)	ref.

PREMATURITY
No	15 (44.12%)	19 (55.88%)	ref.
Yes	4 (57.14%)	3 (42.86%)	1.3 (0.62; 2.73)	0.50

CHILD’S HOSPITALIZATION
No	14 (42.42%)	19 (57.58%)	ref.
Yes	5 (62.5%)	3 (37.5%)	1.47 (0.76; 2.87)	0.26

1-MINUTE APGAR
< 7	3 (75%)	1 (25%)	1.73 (0.88; 3.41)	0.11
>= 7	16 (43.24%)	21 (56.76%)	ref.

BIRTH WEIGHT
< 2500 grams	3 (60%)	2 (40%)	1.35 (0.6; 3.02)	0.46
>= 2500 grams	16 (44.44%)	20 (55.56%)	ref.

BREASTFEEDING DURATION
No breastfeeding	4 (80%)	1 (20%)	2 (0.74; 5.41)	0.28
< 6 months	4 (80%)	1 (20%)	2 (0.74; 5.41)	0.28
6 months to 1 year	4 (26.67%)	11 (73.33%)	0.67 (0.17; 2.62)	0.87
Over 1 year	6 (40%)	9 (60%)	ref.

Variable	ASQ-3 Problem-Solving		Relative risk (95% CI)	p-value *
Variable	Below	Above	Problem-Solving “below”	p-value *
SEX
Females	8 (38.1%)	13 (61.9%)	0.95 (0.44; 2.05)	0.90
Males	8 (40%)	12 (60%)	ref.

MOTHER’S COVID – PREGNANCY
1^st trimester	1 (20%)	4 (80%)	0.39 (0.05; 3.28)	0.55
2^nd trimester	1 (11.11%)	8 (88.89%)	0.21 (0.02; 2.04)	0.24
3^rd trimester	14 (51.85%)	13 (48.15%)	ref.

MOTHER’S AGE
< 30 years	10 (41.67%)	14 (58.33%)	1.18 (0.53; 2.62)	0.68
>= 30 years	6 (35.29%)	11 (64.71%)	ref.

PREMATURITY
No	10 (29.41%)	24 (70.59%)	ref.
Yes	6 (85.71%)	1 (14.29%)	2.91 (1.6; 5.32)	<0.01

CHILD’S HOSPITALIZATION
No	11 (33.33%)	22 (66.67%)	ref.
Yes	5 (62.5%)	3 (37.5%)	1.88 (0.91; 3.86)	0.09

1-MINUTE APGAR
< 7	3 (75%)	1 (25%)	2.13 (1.04; 4.37)	0.04
>= 7	13 (35.14%)	24 (64.86%)	ref.

BIRTH WEIGHT
< 2500 grams	3 (60%)	2 (40%)	1.66 (0.72; 3.84)	0.23
>= 2500 grams	13 (36.11%)	23 (63.89%)	ref.

BREASTFEEDING DURATION
No breastfeeding	5 (100%)	0 (0%)	3.75 (1.25; 11.27)	0.01
< 6 months	3 (60%)	2 (40%)	2.25 (0.53; 9.55)	0.47
6 months to 1 year	3 (20%)	12 (80%)	0.75 (0.13; 4.2)	0.97
Over 1 year	4 (26.67%)	11 (73.33%)	ref.

Variable	ASQ-3 Personal/Social		Relative risk (95% CI)	p-value *
Variable	Below	Above	Personal/Social “below”	p-value *
SEX
Females	3 (14.29%)	18 (85.71%)	2.86 (0.32; 25.24)	0.35
Males	1 (5%)	19 (95%)	ref.

MOTHER’S COVID – PREGNANCY
1^st trimester	1 (20%)	4 (80%)		0.41**
2^nd trimester	0 (0%)	9 (100%)
3^rd trimester	3 (11.11%)	24 (88.89%)

MOTHER’S AGE
< 30 years	3 (12.5%)	21 (87.5%)	2.13 (0.24; 18.73)	0.50
>= 30 years	1 (5.88%)	16 (94.12%)	ref.

PREMATURITY
No	2 (5.88%)	32 (94.12%)	ref.
Yes	2 (28.57%)	5 (71.43%)	4.86 (0.82; 28.89)	0.08

CHILD’S HOSPITALIZATION
No	3 (9.09%)	30 (90.91%)	ref.
Yes	1 (12.5%)	7 (87.5%)	1.37 (0.16; 11.54)	0.77

1-MINUTE APGAR
< 7	2 (50%)	2 (50%)	9.25 (1.75; 48.97)	<0.01
>= 7	2 (5.41%)	35 (94.59%)	ref.

BIRTH WEIGHT
< 2500 grams	1 (20%)	4 (80%)	2.4 (0.31; 18.85)	0.41
>= 2500 grams	3 (8.33%)	33 (91.67%)	ref.

BREASTFEEDING DURATION
No breastfeeding	2 (40%)	3 (60%)		0.17**
< 6 months	0 (0%)	5 (100%)
6 months to 1 year	1 (6.67%)	14 (93.33%)
Over 1 year	1 (6.67%)	14 (93.33%)

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[2] Source: Developed by the authors, 2023