Maternal SARS-CoV-2 infection and early child growth and development: A nationwide cohort study

Objective: The COVID-19 pandemic raised concerns regarding the effects of maternal SARS-CoV-2 infection during pregnancy on infant growth and neurodevelopment. Prior evidence has been inconsistent, limited by small sample sizes, short follow-up, and confounding by prematurity. We evaluated growth and developmental outcomes through 24 months among term-born children exposed in utero to maternal SARS-CoV-2 infection compared with unexposed controls. Methods: We conducted a nationwide retrospective matched cohort study including 66,285 term infants born in Israel between March 2020 and March 2022. Maternal SARS-CoV-2 infection during pregnancy defined exposure, with exposed infants (n=22,096) matched to unexposed controls by delivery date. National registries provided standardized growth and developmental data. Outcomes included infant growth and attainment of 31 developmental milestones up to 24 months, analyzed using adjusted stratified Cox regression models. Results: Infant growth trajectories, developmental milestone attainment, and referral rates were similar between exposed and unexposed children. Findings were consistent across sub-analyses by sex, trimester of infection, maternal disease severity, and during the pre-vaccine period. Conclusion: This large nationwide study did not identify a significant association between maternal SARS-CoV-2 infection during pregnancy and early childhood growth or development among term neonates. Based on nationwide data with two-year follow-up, these findings offer reassuring evidence regarding outcomes.