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Viral infections in pregnancy and impact on offspring neurodevelopment: mechanisms and lessons learned

Pediatric Research volume 96, pages 64–72 (2024)Cite this article

Abstract

Pregnant individuals with viral illness may experience significant morbidity and have higher rates of pregnancy and neonatal complications. With the growing number of viral infections and new viral pandemics, it is important to examine the effects of infection during pregnancy on both the gestational parent and the offspring. Febrile illness and inflammation during pregnancy are correlated with risk for autism, attention deficit/hyperactivity disorder, and developmental delay in the offspring in human and animal models. Historical viral epidemics had limited follow-up of the offspring of affected pregnancies. Infants exposed to seasonal influenza and the 2009 H1N1 influenza virus experienced increased risks of congenital malformations and neuropsychiatric conditions. Zika virus exposure in utero can lead to a spectrum of abnormalities, ranging from severe microcephaly to neurodevelopmental delays which may appear later in childhood and in the absence of Zika-related birth defects. Vertical infection with severe acute respiratory syndrome coronavirus-2 has occurred rarely, but there appears to be a risk for developmental delays in the infants with antenatal exposure. Determining how illness from infection during pregnancy and specific viral pathogens can affect pregnancy and neurodevelopmental outcomes of offspring can better prepare the community to care for these children as they grow.

Impact

  • Viral infections have impacted pregnant people and their offspring throughout history.

  • Antenatal exposure to maternal fever and inflammation may increase risk of developmental and neurobehavioral disorders in infants and children.

  • The recent SARS-CoV-2 pandemic stresses the importance of longitudinal studies to follow pregnancies and offspring neurodevelopment.

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Fig. 1: Viral exposures in pregnancy impact offspring neurodevelopment.

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Funding

Sarah B. Mulkey receives research support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (grant number R01HD102445 [PI: S.B.M.] and R01HD107140 [Co-I: S.B.M.]) for studies on Zika virus and SARS-CoV-2, respectively. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA

    Emma F. Yates

  2. Children’s National Hospital, Washington, DC, USA

    Sarah B. Mulkey

  3. Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Sarah B. Mulkey

  4. Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Sarah B. Mulkey

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Contributions

Emma F. Yates—Performed the literature review, received mentorship from Sarah B. Mulkey in writing a review manuscript, wrote initial draft of the manuscript, edited the manuscript with feedback from her mentor, edited the format of the manuscript for Pediatric Research, designed the figure for the manuscript, reviewed and approved the final version of the manuscript. Sarah B. Mulkey—Received study funding in viral exposures in pregnancy and child outcomes, developed the concept for the review manuscript, mentored Emma F. Yates in performing a literature review, provided critical review of the manuscript draft and edited drafts and revised versions, edited the figure, reviewed and approved the final version of the manuscript. Submitted the final version of the manuscript to Pediatric Research.

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Correspondence to Sarah B. Mulkey.

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Competing interests

Sarah B. Mulkey receives grant funding from the National Institutes of Health as described in funding. Sarah B. Mulkey and Emma F. Yates do not have conflicts of interest to disclose.

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Yates, E.F., Mulkey, S.B. Viral infections in pregnancy and impact on offspring neurodevelopment: mechanisms and lessons learned. Pediatr Res 96, 64–72 (2024). https://doi.org/10.1038/s41390-024-03145-z

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