Rates of Positive M-CHAT-R Screenings by Pandemic Birth and Prenatal SARS-CoV-2 Exposure (preprint)

Maternal stress and viral illness during pregnancy are associated with neurodevelopmental conditions in offspring. Children born during the COVID-19 pandemic, including those exposed prenatally to maternal SARS-CoV-2 infections, are reaching the developmental age for the assessment of risk for neurodevelopmental conditions. We examined associations between birth during the COVID-19 pandemic, prenatal exposure to maternal SARS-CoV-2 infection, and rates of positive screenings on the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). Data were drawn from the COVID-19 Mother Baby Outcomes (COMBO) Initiative. Participants completed the M-CHAT-R as part of routine clinical care (COMBO-EHR cohort) or for research purposes (COMBO-RSCH cohort). Maternal SARS-CoV-2 status during pregnancy was determined through electronic health records. The COMBO-EHR cohort includes n=1664 children (n=442 historical cohort, n=1222 pandemic cohort; n=997 SARS-CoV-2 unexposed prenatally, n=130 SARS-CoV-2 exposed prenatally) who were born at affiliated hospitals between 2018-2023 and who had a valid M-CHAT-R score in their health record. The COMBO-RSCH cohort consists of n=359 children (n=268 SARS-CoV-2 unexposed prenatally, n=91 SARS-CoV-2 exposed prenatally) born at the same hospitals who enrolled into a prospective cohort study that included administration of the M-CHAT-R at 18-months. Birth during the pandemic was not associated with greater likelihood of a positive M-CHAT-R screen in the COMBO-EHR cohort. Maternal SARS-CoV-2 was associated with lower likelihood of a positive M-CHAT-R screening in adjusted models in the COMBO-EHR cohort (OR=0.40, 95% CI=0.22 - 0.68, p=0.001), while analyses in the COMBO-RSCH cohort yielded similar but non-significant results (OR=0.67, 95% CI=0.31-1.37, p=0.29).These results suggest that children born during the first 18 months of the COVID-19 pandemic and those exposed prenatally to a maternal SARS-CoV-2 infection are not at greater risk for screening positive on the M-CHAT-R.

Birth during the COVID-19 pandemic, but not maternal SARS-CoV-2 infection during pregnancy, is associated with lower neurodevelopmental scores at 6-months (preprint)

The intrauterine environment strongly influences development. Neurodevelopmental effects of in utero exposure to maternal SARS-CoV-2 infection are widely speculated but currently unknown. The COVID-19 Mother Baby Outcomes (COMBO) initiative was established at Columbia University Irving Medical Center (CUIMC) in New York City to prospectively study the health and wellbeing of infants with and without in utero exposure to maternal SARS-CoV-2 infection. We report findings on 6-month neurodevelopmental outcomes using the parental-report Ages & Stages Questionnaire, 3rd Edition (ASQ-3), from 107 in utero exposed and 131 unexposed full-term infants born between March and December, 2020. We compare these infants to a historical cohort comprised of 62 infants born at CUIMC at least two months prior to the onset of the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with differences on any ASQ-3 subdomain regardless of infection timing or severity, however, infants born during the pandemic had significantly lower scores on gross motor, fine motor, and personal-social subdomains when compared to the historical cohort. Infants born to women who were in the first trimester of pregnancy during the peak of the pandemic in NYC had the lowest personal-social scores. Birth during the pandemic, but not maternal SARS-CoV-2 infection, was associated with differences in neurodevelopmental outcomes at 6-months. These early findings suggest significantly higher public health impact for the generation born during the COVID-19 pandemic than previously anticipated.

Racial/ethnic disparities in sleep in mothers and infants during the Covid-19 pandemic (preprint)

Study Objectives: To quantify the association between race/ethnicity and maternal and infant self-reported sleep health at 4 months, exploring the role of maternal depression, stress and symptoms of trauma related to the COVID-19 pandemic as potential mediators. Methods: Participants were recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) cohort at Columbia University (N=71 non-Hispanic White, N=14 African American (AA), N=113 Hispanic, N=40 other/declined). Data on infant sleep were collected at 4 months postpartum. A subset of 149 women also completed questionnaires assessing maternal mental health and sleep. Multivariable regressions were used to separately estimate associations of race/ethnicity and mental health with multiple sleep domains for infants and mothers adjusting for individual-level covariates. Results: Compared to non-Hispanic White, Hispanic infants slept less at night ({beta}=-101.7{+/-}17.6, p<0.0001) and AA and Hispanic infants went to bed later (respectively {beta} =1.9{+/-}0.6, p<0.0001, {beta}=1.7{+/-}0.3, p<0.0001). Hispanic mothers were less likely to perceive infant sleep as a problem ({beta}=1.0{+/-}0.3, p=0.006). Compared to non-Hispanic White mothers, Hispanic mothers reported worse maternal sleep latency ({beta}=1.2{+/-}0.4, p=0.002), and efficiency ({beta}=0.8{+/-}0.4, p=0.03), but better subjective sleep quality ({beta}=-0.7{+/-}0.4, p=0.05), and less daytime dysfunction ({beta}=-0.8{+/-}0.4, p=0.04). Maternal mental health scores were statistically significant predictors of multiple domains of maternal sleep but did not mediate the association between race/ethnicity and sleep. Conclusions: Racial/ethnic disparities in maternal and infant sleep are observable at 4 months post-partum. Maternal stress, depression and symptoms of trauma related to the COVID-19 pandemic did not mediate these associations.