Infants exposed to COVID-19 in utero gain more weight during first year of life
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Key takeaways:
- Infants exposed to COVID-19 in utero have a lower weight at birth than those not exposed to COVID-19.
- Exposure to COVID-19 in utero is associated with larger BMI z score gain during the first year of life.
Mothers who contract COVID-19 during pregnancy are more likely to have infants with a lower birth weight and greater weight gain during the first year of life compared with mothers who did not have COVID-19, according to study data.
“Lower birth weight and accelerated postnatal weight gain are risk factors for obesity, diabetes and cardiovascular disease later in life,” Andrea G. Edlow, MD, MSc, associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and in the maternal-fetal medicine division at Massachusetts General Hospital, and Lindsay T. Fourman, MD, assistant professor of medicine at Harvard Medical School and in the metabolism unit at Massachusetts General Hospital, told Healio. “As such, our findings of lower birth weight followed by accelerated weight gain in the first year of life may suggest for the first time an increased risk of cardiometabolic outcomes in exposed children.”
Data were derived from Ockene MW, et al. J Clin Endocrinol Metab. 2023;doi:10.1210/clinem/dgad130.
Edlow, Fourman and colleagues conducted a longitudinal cohort study using data from the Mass General Brigham COVID-19 Perinatal Biorepository. Pregnant women aged 18 years and older who received care at Massachusetts General Hospital and gave birth before June 2021 were included. The COVID-19 group included infants of mothers who tested positive for COVID-19 during pregnancy, whereas the infants of mothers with no known history of COVID-19 were placed into a comparator group. Anthropometric data on infants were collected at birth, 2 months, 6 months and 1 year through electronic medical records. Raw data were used to calculate age- and sex-adjusted BMI, weight and length z scores.
The findings were published in The Journal of Clinical Endocrinology & Metabolism.
In utero exposure to COVID-19 linked to weight gain
The cohort included 149 infants exposed to COVID-19 in utero and 127 infants not exposed to COVID-19. Infants in the COVID-19 exposure group had a lower birth weight z score (–0.006 vs. 0.36; P = .006) and a lower BMI z score at birth (–0.19 vs. 0.22; P = .004) than the control group. No difference was observed between the two groups for length z score at birth.
Weight and BMI z score trajectories from birth to 1 year for infants exposed to COVID-19 in utero were different compared with infants in the control group. Infants exposed to COVID-19 had a BMI z score gain of 0.62 in the first year of life compared with a 0.05 BMI z score decrease for those in the control group (P = .001). Weight z score also increased more in the first year of life among the COVID-19 group compared with controls (mean increase, 0.75 vs. 0.2; P = .001).
Lower birth weight z score was associated with a greater change in BMI z score from birth to 1 year (r = –0.49; P < .0001). In a mediation analysis, birth weight z score mediates about 32% of the effect of COVID-19 exposure on change in BMI z score from birth to 1 year.
“It is increasingly recognized that the maternal environment during pregnancy shapes the development of a growing fetus, which in turn may influence that individual’s health trajectory over their life course,” Edlow and Fourman said. “In this regard, there is mounting evidence that maternal prenatal infections such as HIV and influenza may predispose to adverse long-term health outcomes in children, including an increased risk for cardiometabolic complications. COVID-19 is well known to cause multisystemic abnormalities, including inflammation, low oxygen levels and increased blood clotting. Such disturbances may alter fetal development with subsequent impacts on fetal metabolic organ programming and infant growth, though further studies are needed to fully elucidate these relationships.”
Studies with longer follow-up needed
Edlow and Fourman noted the study only analyzed participants for 1 year and was unable to analyze the risk for obesity, diabetes and other cardiometabolic disorders among children exposed to COVID-19 in utero. Future studies with a longer follow-up are needed to examine cardiometabolic risk.
“Our findings provide compelling evidence of the need for more research on long-term health sequelae among children born to mothers with COVID-19, including the assembly of large cohorts that can be followed for cardiometabolic outcomes over time, and prospective studies involving detailed cardiometabolic assessments in children,” Edlow and Fourman said. “Clinicians caring for children with in utero exposure to COVID-19 should be aware of this history and should view the child’s growth trajectory and metabolic risk factors as part of a holistic picture that includes this prenatal infection exposure.”
For more information:
Andrea G. Edlow, MD, MSc, can be reached at aedlow@mgh.harvard.edu.
Lindsay T. Fourman, MD, can be reached at lfourman@partners.org.
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