Autism diagnoses remain flat among children born during the COVID-19 pandemic

Key takeaways:

• Children born before and during the COVID-19 pandemic had similar autism screening positivity rates.
• Prenatal exposure to maternal SARS-CoV-2 infection was tied to a lower rate of positivity in one cohort.

Positive screenings for autism spectrum disorders did not increase to a significant degree among children born during the COVID-19 pandemic, according to results of a cohort study published in JAMA Network Open.

Notably, positive autism screening rates remained similar to their pre-pandemic levels among children exposed to mothers with SARS-CoV-2 infection as newborns, researchers reported..

“Autism risk is known to increase with virtually any kind of insult to mom during pregnancy, including infection and stress,” Dani Dumitriu, MD, PhD, an associate professor of pediatrics and psychiatry at Columbia University, said in a press release. “The scale of the COVID pandemic had pediatricians, researchers, and developmental scientists worried that we would see an uptick in autism rates. But reassuringly, we didn’t find any indication of such an increase in our study.”

In the analysis, Dumitriu and colleagues compared the data from two cohorts from the COVID-19 Mother Baby Outcomes (COMBO) Initiative — one being an electronic health record group (COMBO-EHR) and the other a prospective research group (COMBO-RSCH).

The COMBO-EHR cohort comprised 1,664 children born in New York City between January 2018 and September 2021.

Meanwhile, the COMBO-RSCH cohort included 385 children born between February 2020 and September 2021.

The researchers determined autism risk based on responses to the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) autism screener. Screenings occurred between 16 and 30 months of age.

All children were screened between 16 and 30 months of age.

Dumitriu and colleagues found that there were no differences in the proportion of M-CHAT-R-positive screenings between children born before the pandemic and those born during the pandemic in either cohort.

“COVID is still quite prevalent, so this is comforting news for pregnant individuals who are worried about getting sick and the potential impact on autism risk,” Dumitriu said.

Researchers reported a link between exposure to maternal SARS-CoV-2 infection and a lower rate of M-CHAT-R positivity in the COMBO-EHR group (adjusted OR = 0.4; 95% CI, 0.22-0.68). They also observed a similar but insignificant association in the COMBO-RSCH cohort.

“We suspect that having COVID during pregnancy may have influenced parents’ assessment of their child’s behaviors,” Dumitriu said. “Parents who did not have COVID may have experienced higher stress — due to the constant worry of getting sick and the vigilance around preventing infection — and may have been more likely to report concerning child behaviors.”

She pointed out that the study did not look at autism diagnoses, only the risk for developing autism.

“It’s too early to have definitive diagnostic numbers,” she said. “But this screener is predictive, and it’s not showing that prenatal exposure to COVID or the pandemic increases the likelihood of autism.”

Dumitriu also added that she thinks it is unlikely that increases in autism diagnoses related to COVID-19 will occur as the children continue to grow.

“Children who were in the womb early in the pandemic are now reaching the age when early indicators of autism would emerge, and we’re not seeing them in this study,” she said in the release. “And because it’s well-known that autism is influenced by the prenatal environment, this is highly reassuring.”

References:

• Firestein M, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.35005.
• Pandemic-era babies do not have higher autism risk, finds study. Available at: https://www.cuimc.columbia.edu/news/pandemic-era-babies-do-not-have-higher-autism-risk-finds-study. Published Sept. 23, 2024. Oct. 8, 2024.