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. 2024 Sep 3;7(9):e2435005.
doi: 10.1001/jamanetworkopen.2024.35005.

Positive Autism Screening Rates in Toddlers Born During the COVID-19 Pandemic

Morgan R Firestein  1 , Angela Manessis  2 , Jennifer M Warmingham  3 , Ruiyang Xu  2 , Yunzhe Hu  1 , Morgan A Finkel  3   4 , Margaret Kyle  3 , Maha Hussain  3 , Imaal Ahmed  3 , Andréane Lavallée  3 , Ana Solis  3 , Vitoria Chaves  3 , Cynthia Rodriguez  3 , Sylvie Goldman  5 , Rebecca A Muhle  1   4   6 , Seonjoo Lee  1   5   6 , Judy Austin  7 , Wendy G Silver  3   4   8 , Kally C O'Reilly  1   6 , Jennifer M Bain  3   4   8 , Anna A Penn  3   4 , Jeremy Veenstra-VanderWeele  1   3   4   6 , Melissa S Stockwell  3   4   7 , William P Fifer  1   3 , Rachel Marsh  1   8 , Catherine Monk  1   6   9 , Lauren C Shuffrey  10 , Dani Dumitriu  1   3   4
Affiliations

Positive Autism Screening Rates in Toddlers Born During the COVID-19 Pandemic

Morgan R Firestein et al. JAMA Netw Open. .

Abstract

Importance: Stress and viral illness during pregnancy are associated with neurodevelopmental conditions in offspring. Autism screening positivity for children born during the pandemic remains unknown.

Objective: To examine associations between prenatal exposure to the pandemic milieu and maternal SARS-CoV-2 infection with rates of positive Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) screenings.

Design, setting, and participants: Data for this cohort study were drawn from the COVID-19 Mother Baby Outcomes (COMBO) Initiative. M-CHAT-R scores obtained from children aged 16 to 30 months during routine clinical care at Columbia University Irving Medical Center in New York City were abstracted from electronic health records (EHRs) for children born between January 2018 and September 2021 (COMBO-EHR cohort). Separately, the M-CHAT-R was administered at 18 months for children born between February 2020 and September 2021 through a prospective longitudinal study (COMBO-RSCH cohort). Prenatal pandemic exposure (birth after March 1, 2020) and maternal SARS-CoV-2 status during pregnancy was determined through EHRs. Data were analyzed from March 2022 to June 2024.

Exposures: Prenatal exposures to the pandemic milieu and maternal SARS-CoV-2 infection.

Main outcomes and measures: The primary outcome was rate of positive M-CHAT-R screenings. For all primary analyses, unadjusted χ2 tests and adjusted logistic regression models were performed.

Results: The COMBO-EHR cohort included 1664 children (442 born before the pandemic and 1222 born during the pandemic; 997 SARS-CoV-2 unexposed, 130 SARS-CoV-2 exposed, and 95 with unknown SARS-CoV-2 exposure status), of whom 266 (16.0%) were Black, 991 (59.6%) were Hispanic, 400 (24.0%) were White, 1245 (74.8%) were insured through Medicaid, 880 (52.9%) were male, and 204 (12.3%) were born prematurely. The COMBO-RSCH cohort included 385 children (74 born before the pandemic and 311 born during the pandemic; 201 SARS-CoV-2 unexposed, 101 SARS-CoV-2 exposed, and 9 with unknown SARS-CoV-2 exposure status), of whom 39 (10.1%) were Black, 168 (43.6%) were Hispanic, 157 (40.8%) were White, 161 (41.8%) were insured through Medicaid, 222 (57.7%) were male, and 38 (9.9%) were born prematurely. Prenatal pandemic exposure was not associated with a higher positive M-CHAT-R screening rate in either the COMBO-EHR or COMBO-RSCH cohort. Prenatal exposure to maternal SARS-CoV-2 infection was associated with a lower rate of M-CHAT-R positivity in the COMBO-EHR cohort (12.3% [16 children] vs 24.0% [239 children]; adjusted odds ratio, 0.40; 95% CI, 0.22-0.68; P = .001), but no association was found in the COMBO-RSCH cohort (12.9% [13 children] vs 19.9% [40 children]; adjusted odds ratio, 0.51; 95% CI, 0.24-1.04; P = .07).

Conclusions and relevance: In this cohort study of 2 groups of children with prenatal pandemic exposure and/or exposure to maternal SARS-CoV-2 infection, neither exposure was associated with greater M-CHAT-R positivity.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Firestein reported receiving grants from National Institute of Child Health and Human Development during the conduct of the study. Dr Warmingham reported receiving grants from Health Resources and Services Administration during the conduct of the study. Dr Muhle reported receiving grants from the National Institute of Mental Health and the Simons Foundation during the conduct of the study. Dr Veenstra-VanderWeele reported receiving trial contracts from Roche, Janssen, Acadia, MapLight, and Yamo; grants from Simons Foundation and the National Institutes of Health (NIH); personal fees from Wiley and Springer; and payment to employer from Roche Advisory board outside the submitted work. Dr Stockwell reported receiving grants from the US Centers for Disease Control and Prevention (CDC) related to SARS-CoV-2 infection outside the submitted work. Dr Dumitriu reported receiving grants from the NIH and W.K. Kellogg Foundation and funding from Einhorn Collaborative Gift Funds during the conduct of the study; and receiving grants from the CDC outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Percentage of Children Screening Positive on the Modified Checklist for Autism in Toddlers, Revised in the Electronic Health Record (COMBO-EHR) and Research (COMBO-RSCH) Datasets
Dashed black lines indicate previously reported rates of positivity in low-risk (approximately 10%), US samples.
See this image and copyright information in PMC

References

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