The Need for Life-Course Study of Children Born to Mothers With Prior COVID-19 Infection

Abstract

The Need for Life-Course Study of Children Born to Mothers With Prior COVID-19 Infection Of the pandemics faced by the US in the 20th century, none were more severe than the influenza A/PR/8/34 (H1N1) outbreak of 1918-the so-called Spanish influenza.Emerging during World War I, this pandemic is estimated to have infected nearly one-third of the global population and killed approximately 50 million people, including 675 000 people in the US.While the pandemic was brief, some individuals experienced reaching effects.Women infected with the flu during pregnancy had children found to have higher rates of heart disease, kidney disease, and diabetes throughout their life course. 1The implications of such findings hold relevance today, as the novel coronavirus SARS-CoV-2 has spread throughout the world.Given the effects observed in the 1918 pandemic and reported birth outcomes related to maternal COVID-19 infection, it is prudent to use the lessons and epidemiology of the 1918 pandemic to inform practice and follow-up of potential long-term health effects associated with maternal COVID-19 infection.The 1918 influenza was unusual in the vigor with which it affected young adults, but other populations were not spared-including fetuses in utero.Birth rates declined along with an increased rate in stillbirths, but carrying a pregnancy to birth did not ensure that born children avoided the effects of influenza.Rates of congenital malformation and premature birth increased during all waves of the pandemic, contributing to increased infant mortality rates during the spring 1919 wave. 2 Premature birth from any cause is a risk for associated conditions, such as kidney or heart disease, later in life, 3,4 compounded by any risk that may be associated with in utero exposure to maternal infection.Like the influenza of 1918, maternal COVID-19 infection during pregnancy has been associated with increased risk of neonatal and perinatal complications.Notably, premature birth rates in mothers infected with COVID-19 have been observed to be significantly elevated from their pre-COVID-19 rate, and low birth weight in children of mothers infected with COVID-19 has also been observed, 5 although little evidence has supported that neonates are at major risk of direct harm through processes like vertical transmission. 6owever, such outcomes could have long-term effects even in the absence of direct neonatal infection.The Barker hypothesis postulates that interruptions in normal in utero development can have lasting health effects specific to the organ systems developing at that time. 3For example, the heart develops during the first trimester, and as such, children of mothers infected with a disease during this time may bear a higher risk of cardiovascular disease later in life.Conversely, children of mothers infected with a disease in their third trimester, VIEWPOINT

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