Neurodevelopmental outcomes of infants exposed to maternal COVID-19 during pregnancy in Singapore.

OBJECTIVE: To evaluate the association between in-utero exposure to maternal COVID-19 and neurodevelopmental outcomes at 18 months of age in term infants born in Singapore during the Omicron-dominant period. STUDY DESIGN: In this multicenter case-control study, we compared 156 term infants with antenatal COVID-19 exposure to 145 matched unexposed controls. Cases were born between November 2021 and April 2022 at three tertiary hospitals. Neurodevelopmental outcomes were assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3), a validated screening tool. RESULTS: There were no significant differences in mean ASQ-3 domain scores between cases and control groups. However, with an adjusted linear regression model, COVID-19-exposed infants were more likely to fall below the cutoff for the problem-solving domain (adjusted OR 2.4; 95% CI: 1.2-4.7 using U.S. cutoffs and OR 2.8; 95% CI: 1.0-7.5 using Singaporean cutoffs). No significant differences were observed in other domains. CONCLUSION: Exposure to mild or asymptomatic maternal COVID-19 during pregnancy was not associated with abnormal neurodevelopmental screening results at 18 months. The increased incidence of delay in the problem-solving domain in exposed infants highlights the need for ongoing surveillance.