Kaiser Permanente study emphasizes importance of vaccination in pregnancy
Female children born after their mothers have COVID-19 in early pregnancy may have an increased chance of developing autism spectrum disorder, according to a Kaiser Permanente analysis.
The study, published in Translational Psychiatry, found no increased risk of autism for boys after their mothers have COVID-19 in pregnancy, nor did it find increased risk of other neurological conditions in boys or girls, such as delays in speech, language, or motor skills.
The findings need to be verified with additional research. But they also suggest a need for increased awareness of a child’s neurological development if the mother had COVID-19 in pregnancy, said lead author Lisa Croen, PhD, a research scientist with the Kaiser Permanente Division of Research. The study also points to the importance of COVID-19 vaccination during pregnancy.
“Our study reinforces the importance of protecting oneself from COVID-19 before and during pregnancy,” Croen said. “Pregnant people are themselves more at risk of hospitalization if they get COVID-19. We are also now finding the potential for neurodevelopmental health risks for their children when they are exposed to the virus in utero.”
The observational study included 69,987 children born to members of Kaiser Permanente Northern California in 2020 to 2021, early in the COVID-19 pandemic, and followed through December 2023. Overall, 3.9% of the children were diagnosed with autism spectrum disorder, 14.3% with a speech/language delay, and 3.9% with a motor delay.
About 4% of the mothers had a confirmed case of SARS-CoV-2 infection during pregnancy
The analysis found a 44% increased risk of an autism diagnosis in the female children, but no statistically significant elevated risk among the boys. Among all the children studied, there were 42 girls and 77 boys who were diagnosed with autism and whose mothers had COVID-19 in pregnancy.
The risk of autism showed the strongest association when the mother had a SARS-CoV-2 infection during the first or second trimester of the pregnancy.
Previous research on potential neurodevelopmental risks from prenatal exposure to COVID-19 have been mixed.
The inconsistent findings across studies suggest the need for additional research on risk of autism related to developmentally vulnerable time periods during pregnancy.
The Kaiser Permanente study team has found other prenatal exposures that had a differential effect on children by sex, including maternal obesity and asthma.
Pregnancies with female fetuses have higher levels of inflammatory cytokines, which affect early brain development and behavior in early childhood. The study authors suggested this pathway could be a potential explanation for why SARS-CoV-2 infection affects male and female babies differently.
However, all children whose mothers have had exposures such as COVID-19 in early pregnancy may benefit from enhanced developmental surveillance and screening by pediatricians.
Importance of vaccination
The study covered a period early in the pandemic when vaccination was either unavailable or just being introduced. Just 12.5% of pregnant individuals in the study group had been vaccinated. The study found no evidence the vaccine increased risk for autism. Autism rates in children were the same among women who had been vaccinated and those who had not.
“There is compelling evidence that maternal infection and inflammation are important risk factors for development of autism in children,” Croen said. “When a protective measure such as immunization is available during pregnancy, it should be encouraged as a simple way to reduce risk.”
The study was funded by the National Institute for Child Health and Human Development.
Additional co-authors were Yinge Qian, PhD, Luke Grosvenor, PhD, Jennifer Ames, PhD, and Stacey Alexeeff, PhD, of the Division of Research; and Judy Van de Water, PhD, Danielle H.J. Kim, PhD, and Paul Ashwood PhD, of the University of California, Davis; and Robert Yolken, MD, Johns Hopkins University.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org.
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