Prenatal COVID-19 pandemic-related traumatic stress and risk of child neurodevelopmental disorders: a cohort study

AI Summary

Higher prenatal pandemic-related traumatic stress was associated with increased risk of any child neurodevelopmental disorder (HR per point 1.02).
Higher PTS was also associated with increased ASD risk per point (HR 1.04); high versus low PTS showed elevated but not statistically significant ASD risk.
Associations did not differ by child sex and persisted after adjustment; further research is needed to investigate potential biological mechanisms.

TL;DR (AI Generated)

Prenatal stress has been associated with greater risk of neurodevelopmental disorders (NDD), warranting investigation of prenatal pandemic-related traumatic stress (PTS) as a risk factor for NDD.

We fit Cox regression models adjusted for maternal age, race and ethnicity, insurance type, SARS-CoV-2 infection, pre-pregnancy BMI, pre-pregnancy depression, child birthyear and sex to estimate hazard ratios (HR) for any NDD and separately for autism spectrum disorder (ASD) associated with PTS and evaluated effect modification by child sex.

CONCLUSIONS: Among this cohort of mothers who were pregnant during the COVID-19 pandemic, higher PTS was associated with greater risk of child NDD diagnoses.

Basic summary

BMC Med. 2026 Jul 29;24(1):590. doi: 10.1186/s12916-026-05090-6.

ABSTRACT

BACKGROUND: The COVID-19 pandemic was a prolonged period of traumatic stress with potentially lasting health impacts, especially for vulnerable groups including pregnant individuals. Prenatal stress has been associated with greater risk of neurodevelopmental disorders (NDD), warranting investigation of prenatal pandemic-related traumatic stress (PTS) as a risk factor for NDD.

METHODS: We surveyed Kaiser Permanente Northern California (KPNC) members who were ≥ 12 weeks pregnant between June 2020 and September 2022. PTS was measured using the 10-item PTS Scale and modeled as a continuous total symptom score (range: 0-10) and binary exposure (high, ≥ 9; low, < 9). We prospectively followed children through July 2025 and linked to sociodemographic and medical characteristics, including NDD diagnoses, in KPNC electronic records. We fit Cox regression models adjusted for maternal age, race and ethnicity, insurance type, SARS-CoV-2 infection, pre-pregnancy BMI, pre-pregnancy depression, child birthyear and sex to estimate hazard ratios (HR) for any NDD and separately for autism spectrum disorder (ASD) associated with PTS and evaluated effect modification by child sex.

RESULTS: Of 13,859 mothers, 21.1% identified as Asian, 3.0% as Black, 19.6% as Hispanic, 4.6% as Multiracial, < 1.0% as Native American or Pacific Islander, 49.0% as White, and 1.7% were of Unknown race. The mean (SD) PTS score was 3.9 (2.6) and 722 (5.2%) mothers had high PTS (≥ 9); 2,750 (19.8%) children were diagnosed with any NDD and 651 (4.7%) with ASD. Higher PTS symptom score was associated with significantly greater risk of any NDD (HR = 1.02, 95% CI = 1.01-1.04) and ASD (HR = 1.04 [1.01-1.07]) per 1-point increase in continuous score. High compared to low PTS was associated with greater risk of NDD diagnoses (HR = 1.18 [1.01-1.37]) and ASD (HR = 1.20 [0.89-1.62]), although not statistically significant for ASD. Associations did not differ by sex for NDD (HR_Females= 1.20 [0.92-1.56], HR_Males= 1.17 [0.96-1.41]; interaction P = 0.78) or ASD (HR_Females= 1.31 [0.73-2.34], HR_Males= 1.17 [0.82-1.65]; interaction P = 0.60).

CONCLUSIONS: Among this cohort of mothers who were pregnant during the COVID-19 pandemic, higher PTS was associated with greater risk of child NDD diagnoses. Further research is needed to investigate the potential biologic mechanisms underlying this association.

PMID:42928291 | DOI:10.1186/s12916-026-05090-6

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