Cognitive and socioemotional development in infants exposed to SARS-CoV-2 in utero: a moderating role of prenatal psychosocial stress on infant outcomes

Immune activation during pregnancy is linked with neurodevelopmental disorders in offspring. Psychosocial stress and inflammation are also highly correlated, but whether stress exacerbates risks of gestational infection on infant development is largely known. The current study examines this question in infants exposed to SARS-CoV-2 in utero. One-hundred and forty-one pregnant mothers and infants (46% non-White; n = 61 females) were recruited in New York City, and were oversampled for prenatal SARS-CoV-2 exposure (n = 44 COVID+, n = 97 COVID-). Infant cognitive development was assessed at 6 months using a remote visual attention task and measures of infant regulatory function. Socioemotional outcomes and neurodevelopmental ¬risk were evaluated at 12 months using the BITSEA questionnaire. Results indicated that maternal psychosocial stress moderated effects of in utero SARS-CoV-2 exposure on infant development. In mothers reporting positive COVID-19 infection, higher prenatal stress was associated with lower infant attention at 6 months. Exploratory analyses indicated that infant attention predicted socioemotional outcomes and neurodevelopmental risk at 12 months, regardless of prenatal exposures or relevant sociodemographic factors. These findings provide evidence of phenotypic adaptations in early cognitive and socioemotional development in infants of mothers affected by the COVID-19 pandemic. Importantly, this work highlights maternal psychosocial stress and infant attention as relevant targets for translational work to reduce risk of negative long-term outcomes.