Prenatal COVID-19 pandemic-related traumatic stress and risk of child neurodevelopmental disorders: a cohort study.
7 affiliations
- 1Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA. [email protected].
- 2Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA.
- 3University of California at Davis, Davis, CA, USA.
- 4The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA.
- 5Johns Hopkins University, Baltimore, MD, USA.
- 6Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, USA. [email protected].
- 7Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA. [email protected].
Abstract
Background
The COVID-19 pandemic was a prolonged period of traumatic stress with potentially lasting health impacts, especially for vulnerable groups including pregnant individuals. Prenatal stress has been associated with greater risk of neurodevelopmental disorders (NDD), warranting investigation of prenatal pandemic-related traumatic stress (PTS) as a risk factor for NDD.Methods
We surveyed Kaiser Permanente Northern California (KPNC) members who were ≥ 12 weeks pregnant between June 2020 and September 2022. PTS was measured using the 10-item PTS Scale and modeled as a continuous total symptom score (range: 0-10) and binary exposure (high, ≥ 9; low, < 9). We prospectively followed children through July 2025 and linked to sociodemographic and medical characteristics, including NDD diagnoses, in KPNC electronic records. We fit Cox regression models adjusted for maternal age, race and ethnicity, insurance type, SARS-CoV-2 infection, pre-pregnancy BMI, pre-pregnancy depression, child birthyear and sex to estimate hazard ratios (HR) for any NDD and separately for autism spectrum disorder (ASD) associated with PTS and evaluated effect modification by child sex.Results
Of 13,859 mothers, 21.1% identified as Asian, 3.0% as Black, 19.6% as Hispanic, 4.6% as Multiracial, < 1.0% as Native American or Pacific Islander, 49.0% as White, and 1.7% were of Unknown race. The mean (SD) PTS score was 3.9 (2.6) and 722 (5.2%) mothers had high PTS (≥ 9); 2,750 (19.8%) children were diagnosed with any NDD and 651 (4.7%) with ASD. Higher PTS symptom score was associated with significantly greater risk of any NDD (HR = 1.02, 95% CI = 1.01-1.04) and ASD (HR = 1.04 [1.01-1.07]) per 1-point increase in continuous score. High compared to low PTS was associated with greater risk of NDD diagnoses (HR = 1.18 [1.01-1.37]) and ASD (HR = 1.20 [0.89-1.62]), although not statistically significant for ASD. Associations did not differ by sex for NDD (HRFemales= 1.20 [0.92-1.56], HRMales= 1.17 [0.96-1.41]; interaction P = 0.78) or ASD (HRFemales= 1.31 [0.73-2.34], HRMales= 1.17 [0.82-1.65]; interaction P = 0.60).Conclusions
Among this cohort of mothers who were pregnant during the COVID-19 pandemic, higher PTS was associated with greater risk of child NDD diagnoses. Further research is needed to investigate the potential biologic mechanisms underlying this association.
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BibTeX
@article{grosvenor2026prenatal,
title = {{Prenatal COVID-19 pandemic-related traumatic stress and risk of child neurodevelopmental disorders: a cohort study.}},
author = {Luke P Grosvenor and Meredith Anderson and Yinge Qian and Stacey E Alexeeff and Jennifer L Ames and Paul Ashwood and Kathryn K Ridout and Robert Yolken and Judith Van de Water and Lisa A Croen},
journal = {BMC medicine},
year = {2026},
month = jul,
doi = {10.1186/s12916-026-05090-6},
url = {https://europepmc.org/article/MED/42928291},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Prenatal COVID-19 pandemic-related traumatic stress and risk of child neurodevelopmental disorders: a cohort study.
AU - Luke P Grosvenor
AU - Meredith Anderson
AU - Yinge Qian
AU - Stacey E Alexeeff
AU - Jennifer L Ames
AU - Paul Ashwood
AU - Kathryn K Ridout
AU - Robert Yolken
AU - Judith Van de Water
AU - Lisa A Croen
PY - 2026
DA - 2026/07/29
JO - BMC medicine
DO - 10.1186/s12916-026-05090-6
UR - https://europepmc.org/article/MED/42928291
AB - Background The COVID-19 pandemic was a prolonged period of traumatic stress with potentially lasting health impacts, especially for vulnerable groups including pregnant individuals. Prenatal stress has been associated with greater risk of neurodevelopmental disorders (NDD), warranting investigation of prenatal pandemic-related traumatic stress (PTS) as a risk factor for NDD.Methods We surveyed Kaiser Permanente Northern California (KPNC) members who were ≥ 12 weeks pregnant between June 2020 and September 2022. PTS was measured using the 10-item PTS Scale and modeled as a continuous total symptom score (range: 0-10) and binary exposure (high, ≥ 9; low, < 9). We prospectively followed children through July 2025 and linked to sociodemographic and medical characteristics, including NDD diagnoses, in KPNC electronic records. We fit Cox regression models adjusted for maternal age, race and ethnicity, insurance type, SARS-CoV-2 infection, pre-pregnancy BMI, pre-pregnancy depression, child birthyear and sex to estimate hazard ratios (HR) for any NDD and separately for autism spectrum disorder (ASD) associated with PTS and evaluated effect modification by child sex.Results Of 13,859 mothers, 21.1% identified as Asian, 3.0% as Black, 19.6% as Hispanic, 4.6% as Multiracial, < 1.0% as Native American or Pacific Islander, 49.0% as White, and 1.7% were of Unknown race. The mean (SD) PTS score was 3.9 (2.6) and 722 (5.2%) mothers had high PTS (≥ 9); 2,750 (19.8%) children were diagnosed with any NDD and 651 (4.7%) with ASD. Higher PTS symptom score was associated with significantly greater risk of any NDD (HR = 1.02, 95% CI = 1.01-1.04) and ASD (HR = 1.04 [1.01-1.07]) per 1-point increase in continuous score. High compared to low PTS was associated with greater risk of NDD diagnoses (HR = 1.18 [1.01-1.37]) and ASD (HR = 1.20 [0.89-1.62]), although not statistically significant for ASD. Associations did not differ by sex for NDD (HRFemales= 1.20 [0.92-1.56], HRMales= 1.17 [0.96-1.41]; interaction P = 0.78) or ASD (HRFemales= 1.31 [0.73-2.34], HRMales= 1.17 [0.82-1.65]; interaction P = 0.60).Conclusions Among this cohort of mothers who were pregnant during the COVID-19 pandemic, higher PTS was associated with greater risk of child NDD diagnoses. Further research is needed to investigate the potential biologic mechanisms underlying this association.
SN - 1741-7015
ER -