Prenatal COVID-19 Exposure and Neurodevelopmental and Neurological Disorders in Children.

Importance: Previous studies suggest that children exposed to COVID-19 during pregnancy may have an increased risk of neurodevelopmental disorders. However, these studies had limited follow-up periods and primarily evaluated broad neurodevelopmental concerns. Objective: To examine whether exposure to maternal COVID-19 during pregnancy is associated with an increased risk of neurodevelopmental or neurological disorders among offspring. Design, Setting, and Participants: This cohort study was conducted between November 2025 and February 2026. The sample included all children born in Norway between March 1, 2020, and December 31, 2023, with 22 completed gestational weeks and a birth weight greater than 500 g. Data were obtained from national registries, including maternal background characteristics from Statistics Norway, birth characteristics from the Medical Birth Registry of Norway, prenatal exposure to COVID-19 from the Norwegian Surveillance System for Communicable Diseases, and neurodevelopmental and neurological disorders from the Norwegian Patient Registry. Exposure: Maternal COVID-19 during pregnancy, which was defined as a positive PCR result for SARS-CoV-2 infection between conception (date of birth minus the gestational duration in days) and the date of delivery. Main Outcomes and Measures: The 8 outcomes of interest were any neurodevelopmental disorders, pervasive neurodevelopmental disorders (autism), developmental speech or language disorders, developmental motor disorders, intellectual disorders, any neurological disorders, epilepsy, and sensory impairments. Diagnoses of neurodevelopmental disorders, neurological disorders, and sensory impairments were registered in the national patient registries. Risks were evaluated using Cox proportional hazards regression. Results: Among the 204 663 children (104 728 males [51.2%]) included in this study, 16 325 (8.0%) were exposed to maternal COVID-19 during pregnancy. Exposed children did not have increased risk of any neurodevelopmental disorders (adjusted hazard ratio [AHR], 0.97; 95% CI, 0.88-1.08), pervasive neurodevelopment disorders (AHR, 0.88; 95% CI, 0.67-1.15), developmental speech or language disorders (AHR 1.13; 95% CI, 0.80-1.59), developmental motor disorders (AHR, 0.83; 95% CI, 0.44-1.56), intellectual disorders (AHR, 1.19; 95% CI, 0.65-2.19), any neurological disorders (AHR, 0.97; 95% CI, 0.88-1.07), epilepsy (AHR, 1.14; 95% CI, 0.87-1.48), or sensory impairments (AHR, 1.09; 95% CI, 0.92-1.30). These findings were mostly robust across sensitivity analyses and did not vary according to trimester of exposure or the dominant circulating SARS-CoV-2 variant. The exception was an increased risk of speech or language disorders among exposed children, excluding children born after March 1, 2022 (AHR, 2.22; 95% CI, 1.44-3.41); this sensitivity analysis was performed to limit misclassification due to reduced availability of SARS-CoV-2 testing. Conclusions and Relevance: In this population-based cohort study, children exposed to maternal COVID-19 prenatally did not show an increased risk of neurodevelopmental disorders, aside from an increased risk of speech or language disorders among those exposed in the early phase of the pandemic. These findings should be replicated in other populations and settings.