Prenatal exposure to SARS-CoV-2, early relational health, and child socio-emotional functioning in the first 6 months

Abstract Importance Parent/caregiver-infant early relational health (ERH) is known to play a critical role in the promotion of socio-emotional functioning and wellbeing across the life course. The negative impact of the COVID-19 pandemic on maternal mental health and secondarily on ERH and child socio-emotional functioning is clear. However, the direct impact of maternal viral exposure during pregnancy on ERH has not been investigated. Objective The goal of this study was to determine the impact of prenatal SARS-CoV-2 exposure on ERH and infant socio-emotional functioning in the first 6 months of life. Design Mothers with and without SARS-CoV-2 exposure during pregnancy who gave birth from 02/2020 to 09/2021 were enrolled from 05/2020 to 09/2021 in one of two parallel prospective studies (the COVID-19 Mother Baby Outcomes COMBO Initiative or the Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy ESPI COMBO sub-study). Mothers reported on their health and the socioemotional functioning of their infant via online surveys (REDCap) at enrollment, 1, 2, 4, and 6 months. At 4 to 6 months, dyads were invited to participate in a video-based, remote assessment of ERH. Participants 884 mother-infant dyads from three U.S. States (Alabama, New York, and Utah). Exposure Prenatal SARS-CoV-2. Main Outcomes and Measures Maternal-reported ERH (parental stress, parenting confidence and bonding) and observer-based ERH (video-coded quality of maternal caregiving behaviors and mother-infant emotional connection). Infant socio-emotional development assessed using the 6-month Ages and Stages Questionnaire: Socio-Emotional 2 nd Edition (ASQ:SE-2). Results 316 (36%) mothers had a positive prenatal SARS-CoV-2 exposure. Prenatal SARS-CoV-2 exposure was associated with an adjusted estimate of ∼5% reduction (incidence rate ratio=0.95, 95% confidence interval 0.90, 1.00, p=0.03) in observed maternal caregiving quality, after accounting for postnatal maternal mental health and sociodemographic factors. We found no evidence of effect on other ERH constructs or infant socio-emotional functioning. Conclusions and Relevance In this large prospective cohort study, prenatal SARS-CoV-2 was associated with a small decrement in caregiving quality, but not other ERH constructs or infant socioemotional functioning. These findings should be interpreted as hypothesis generating and will require replication in independent studies. Key Points Question : Is SARS-CoV-2 exposure during pregnancy associated with maternal-reported and observer-based measures of early relational health (ERH) and infant socio-emotional functioning at 4-6 months postpartum? Findings : Prenatal SARS-CoV-2 exposure was associated with a ∼5% reduction in observed quality of maternal caregiving after accounting for postnatal mental health symptomatology and sociodemographic factors. Meaning : A small reduction in maternal caregiving quality, but not other ERH constructs (parental stress, parenting confidence, bonding and emotional connection) or infant socio-emotional functioning, was associated with prenatal SARS-CoV-2 exposure. Results should be interpreted as hypothesis generating and will require replication in independent studies.