Children born to mothers with mild or asymptomatic COVID-19 during pregnancy are not at increased risk of neurodevelopmental delay in early life, according a study from Singapore.
In a cohort of 301 term infants (mean gestational age 38.7 weeks, mean birth weight 3.1 kg, 55.1 percent male) born between November 2021 and April 2022 at three public hospitals in Singapore, performance on the Ages and Stages Questionnaire Third Edition (ASQ-3) at 18 months did not significantly differ between those with in-utero exposure to COVID-19 and those who were unexposed, reported principal investigator Dr Wing Yee Tong from the KK Women’s and Children’s Hospital and colleagues.
Mean scores were 39.6 vs 41.5 for the ASQ-3 domain of communication (p=0.4), 56 vs 57.1 for gross motor (p=0.09), 47.7 vs 49.8 for fine motor (p=0.07), 40.5 vs 42.7 for problem solving (p=0.2), and 46.8 vs 48.3 for personal-social (p=0.13). [Pediatr Neonatol 2026;doi:10.1016/j.pedneo.2026.04.010]
However, when using standardized cutoff scores to identify possible developmental delays, a higher proportion of infants in the exposed vs unexposed group scored below the threshold in the problem-solving domain, noted Tong and colleagues. This finding was consistent when applying the US cutoff (adjusted odds ratio [aOR], 2.4, 95 percent confidence interval [CI], 1.2–4.7; p=0.01) and the Singaporean cutoff (aOR, 2.8, 95 percent CI, 1.0–7.5; p=0.04).
“One possible explanation for [the observed difference in the problem-solving domain] could be differences in exposure to childcare and other formal interactions in the first year of life, potentially limiting exposure to skill-building opportunities such as object manipulation or imitation,” according to Tong and colleagues.
The investigators also pointed out that the ASQ-3 problem-solving domain, while reflecting early cognitive development, has shown limited concurrent validity with the cognitive score of the Bayley Scales of Infant and Toddler Development (BSID-III) and limited ability to predict cognitive delay at 5 years. [Pediatr Res 2023;94:1465-1471]
“Furthermore, as the ASQ-3 is parent-reported, tangible developmental milestones (eg, speech and motor skills) may be more reliably reported than abstract cognitive skills,” they added.
Overall, “the findings are reassuring in the context of the global impact of COVID-19 and align with the generally mild course of illness associated with the Omicron variant, which predominated during the study period,” Tong and colleagues said.
Nevertheless, they highlighted the need for continued surveillance among infants who are exposed to COVID-19 in utero.
“The timing of the ASQ-3 assessment at 18 months is a relatively early point in a child’s life. Many key developmental milestones, particularly in the domains of communication and social skills, are acquired after the age of 18 months; hence, an initially normal ASQ-3 screening in infants born to COVID-19 positive mothers does not necessarily predict later developmental outcomes,” according to Tong and colleagues.
Of the infants included in the study, 156 were in the exposed group (mean age of mothers 32.9 years, 47.4 percent Chinese) and 145 were in the unexposed group (mean age of mothers 33.5 years, 60.7 percent Chinese). Infant characteristics, including gestational age, birth weight, gender, and mode of delivery, were similar between the two groups. Additionally, there were no significant differences in the number of siblings, postnatal infant COVID-19 diagnoses, or family history of childhood hearing problems. A higher proportion of infants in the unexposed group attended childcare within the first year of life (45.5 percent vs 32.1 percent; p=0.02).