Impact of SARS-Cov-2 exposure during pregnancy on child neurodevelopment: systematic review and meta-analysis.

Abstract

<h4>Objective</h4>The objective of this study was to investigate the impact of intrauterine exposure to SARS-CoV-2 on neurodevelopment in children up to 2 years of age.<h4>Data source</h4>A combination of keywords and truncations was adapted for five electronic databases: Excerpta Medica Database (EMBASE), Latin American and Caribbean Literature in Health Sciences (LILACS), PubMed/Medline, Scopus, and Web of Science. Additionally, gray literature sources were consulted, including the American Speech-Language-Hearing Association (ASHA), Google Scholar, and ProQuest Dissertations and Theses. The quality of evidence was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist. A random-effects meta-analysis was performed to evaluate the primary outcome using R in R Studio version 1.2.1335 (RStudio Inc., Boston, USA). Study weights were calculated using the Mantel-Haenszel method, and variance, expressed by Tau2 values, employed the DerSimonian-Laird estimator. The Freeman-Tukey double arcsine transformation was applied to approximate a normal data distribution, and 95% confidence intervals were calculated for each meta-analysis.<h4>Data synthesis</h4>Nine articles were included in the qualitative synthesis and eight in the quantitative analysis. There was no statistically significant difference in neurodevelopment between infants exposed and unexposed to SARS-CoV-2 during pregnancy [RR=5.10; 95%CI 0.36-71.85; I2=91%]. However, for the "fine motor" domain, the exposed group had a 2.38 times higher risk of deficit [95%CI 1.22-4.68] compared to the non-exposed group, with low heterogeneity in the analysis (I2=0%).<h4>Conclusions</h4>Exposure to the SARS-CoV-2 virus during the gestational period is not associated with neurodevelopmental delay up to 2 years of age, although it has been linked to an increased risk of delayed fine motor development. However, this evidence remains uncertain due to the limited number of studies on the topic and the heterogeneity of methodologies.