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Meta-Analysis Systematic Review Journal Article Epublish 123 citations

PubMed: 36306133 DOI: 10.1001/jamanetworkopen.2022.38941

COVID-19 Pandemic and Infant Neurodevelopmental Impairment: A Systematic Review and Meta-analysis.

JAMA Netw Open 5(10):e2238941

Authors: Kamran Hessami, Amir Hossein Norooznezhad, Sonia Monteiro, Enrico R Barrozo, Abolfazl Shirdel Abdolmaleki, Sara E Arian, Nikan Zargarzadeh, Lara S Shekerdemian, Kjersti M Aagaard, Alireza A Shamshirsaz

Affiliations

  • Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  • Meyer Center for Developmental Pediatrics and Autism, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston.
  • Division of Maternal Fetal Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston.
  • Maternal Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
  • Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
  • School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Division of Critical Care, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston.

Abstract

Importance

Primary studies proposed that aberrant maternal antiviral immunity and/or giving birth in quarantine, such as during the ongoing COVID-19 pandemic, may be associated with the risk of neurodevelopmental impairment (NDI) in offspring.

Objectives

To evaluate the associations of birth and being raised during the COVID-19 pandemic with risk of NDI among infants and to assess the association of gestational exposure to SARS-CoV-2 with risk of NDI.

Data Sources

PubMed, Web of Science, Scopus, Embase, and preprint servers were systematically searched from inception to March 25, 2022.

Study Selection

Studies evaluating the neurodevelopment of infants born during the SARS-CoV-2 pandemic were included in this systematic review and meta-analysis. Studies using Ages and Stages Questionnaires, Third Edition (ASQ-3), were used for quantitative meta-analysis.

Data Extraction and Synthesis

Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, a random-effects model meta-analysis was used to pool the proportion and odds ratios (ORs) of overall NDI, as well as each developmental domain on ASQ-3 with the corresponding 95% CI.

Main Outcomes and Measures

The primary outcome was the risk of overall NDI among infants screened during the pandemic vs prepandemic. The secondary outcome was the comparison of NDI by ASQ-3 domain among infants born to women with known gestational exposure to SARS-CoV-2 vs no exposure.

Results

A total of 8 studies were included, including 21 419 infants (11 438 screened in pandemic and 9981 in prepandemic period). NDI was present in 330 of 8992 infants (7%; 95% CI, 4%-10%) screened during the COVID-19 pandemic from January 2020 to January 2021. Among the pandemic cohort, the prevalence of NDI among infants with gestational exposure to SARS-CoV-2 was 77 of 691 (12%; 95% CI, 6%-18%). Compared with the prepandemic cohort (2015-2019), the pandemic cohort was more likely to have communication impairment (OR, 1.70; 95% CI, 1.37-2.11; P < .001), without significant differences in other ASQ-3 domains (eg, gross motor, fine motor, personal-social, and problem-solving). In contrast, maternal SARS-CoV-2 infection was not associated with significant differences in any neurodevelopment domain in offspring, except for increasing the odds of fine motor impairment (OR, 3.46; 95% CI, 1.43-8.38; P < .001).

Conclusions and Relevance

In this systematic review and meta-analysis examining the association between COVID-19 pandemic and the risk of NDI, findings suggest that overall neurodevelopment in the first year of life was not changed by either being born or raised during the SARS-CoV-2 pandemic or by gestational exposure to SARS-CoV-2. Interestingly, the first year of life during the COVID-19 pandemic, regardless of maternal infection, was significantly associated with the risk of communication delay among the offspring.

MeSH

Parturition, Communication, Clinical Medicine, Covid-19, Pandemics, Infections, Infant, Neurodevelopment

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