COVID-19 During Pregnancy Raises Neurodevelopmental Risks in Children

Maternal COVID-19 infection is associated with increased risk of neurodevelopmental diagnoses among children by age 3, according to findings published in Obstetrics & Gynecology. The findings come amid other data showing the dangers of maternal infection on in-utero development.¹

What are the dangers of maternal infections?

Conversations about the downstream effects of maternal fever or infection are growing as federal health leaders focus on increased cases of neurodevelopmental disorders in children.

The topic traces back to claims of autism risk related to vaccination, followed by misinformation surrounding acetaminophen (Tylenol; Kenvue) use in pregnancy. A plethora of research shows no such relationship between autism and maternal Tylenol use.²

“In more than 2 decades of research on the use of acetaminophen in pregnancy, not a single reputable study had successfully concluded that the use of acetaminophen in any trimester of pregnancy causes neurodevelopmental disorders in children,” Steven J. Fleischman, MD, MBA, FACOG president of ACOG, said in an official statement.²

Instead, study findings indicate that the confounding factors underlying Tylenol use during pregnancy—most notably fever and infection—are responsible for infant developmental complications.³

Health care professionals emphasize that untreated fevers during pregnancy can cause more harm than taking acetaminophen, as elevated maternal body temperatures have been associated with an increased risk of congenital anomalies, including neural tube and heart defects, particularly when fever occurs in the first trimester.^3,4

Evidence also suggests that infections themselves can disrupt fetal brain development through inflammatory responses known as maternal immune activation. Viral and bacterial infections can trigger cytokine activity and inflammation that interfere with normal neuronal growth and connectivity. For this reason, obstetric and infectious disease experts stress the importance of promptly treating both fever and its underlying cause during pregnancy to protect fetal health.³

As evidence continues to mount linking maternal infections to developmental outcomes, researchers are turning their attention to newer infectious exposures. Among them, COVID-19 has drawn significant interest for its potential to affect in utero brain development through the same inflammatory pathways seen in other viral infections.

“We are building on quite a solid foundation of literature looking at the association between maternal infection and neurodevelopmental outcomes," Lydia Shook, MD, of Massachusetts General Hospital in Boston, told MedPage Today. "We think of [COVID-19] as one of many potential exposures in pregnancy that could impact offspring neurodevelopment, probably through a common pathway of maternal immune activation."⁵

What Does the COVID-19 Study Show Us?

The researchers’ findings showed that maternal SARS-CoV-2 infection in pregnancy is associated with increased risk of adverse neurodevelopmental diagnoses by age 3 years, with effects most pronounced after third-trimester exposure and in male offspring.¹

The study focused on maternal SARS-CoV-2 infection, defined by a positive PCR test during pregnancy, and its potential impact on neurodevelopment in children up to 36 months of age. Neurodevelopmental outcomes were identified using standard diagnostic codes from the International Statistical Classification of Diseases, Tenth Revision (ICD-10). Researchers used logistic regression models to account for key factors, including maternal age, race and ethnicity, insurance type, hospital type, and preterm birth.¹

Among the 861 pregnancies with confirmed SARS-CoV-2 exposure (4.8% of the total cohort), 140 children (16.3%) received a neurodevelopmental diagnosis by age 3. In comparison, 1680 of 17,263 children (9.7%) born to uninfected mothers were diagnosed with a neurodevelopmental condition.¹

Sensitivity analyses suggested that the risk was highest for infections occurring in the third trimester (adjusted odds ratio 1.36, 95% CI, 1.07–1.72, P = .01) and among male offspring (adjusted odds ratio 1.43, 95% CI, 1.05–1.91, P = .02), highlighting potential windows of vulnerability in late pregnancy and differences by sex.¹

These findings build on the broader understanding of how maternal infections and immune activation may influence early brain development.

How Can Pharmacists Support Safe Fever, Infection Management During Pregnancy?

Pharmacists play a critical role in guiding pregnant patients through safe medication use and infection management. With growing evidence linking untreated fevers and maternal infections to adverse neurodevelopmental outcomes, pharmacists can help clarify misconceptions surrounding commonly used medications such as acetaminophen.

Counseling patients that appropriate use of acetaminophen is generally safe—and that the risks of leaving a fever untreated often outweigh potential concerns—reinforces both maternal and fetal safety. Pharmacists can also educate patients on dosing, timing, and monitoring for persistent or high fevers, empowering them to act quickly if symptoms escalate.

Beyond medication guidance, pharmacists are uniquely positioned to advise on preventive strategies, including vaccination, infection awareness, and early recognition of concerning symptoms. For emerging pathogens such as COVID-19, pharmacists can provide up-to-date information on risk mitigation, support timely testing, and collaborate with obstetric care teams to ensure appropriate follow-up for infected patients.

By combining medication expertise with patient education, pharmacists help reduce the downstream effects of maternal fever and infection, ultimately supporting healthier developmental outcomes for children.

REFERENCES

1. Shook L, Castro N, Ibanez-Pintor L, et al. Neurodevelopmental outcomes of 3-year-old children exposed to maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in utero. Obstetrics & Gynecology. October 30, 2025. Doi: 10.1097/AOG.0000000000006112

2. Halpern L. FDA alleges association between prenatal acetaminophen use and autism in children. Pharmacy Times. September 23, 2025. Accessed November 4, 2025. https://www.pharmacytimes.com/view/fda-alleges-association-between-prenatal-acetaminophen-use-and-autism-in-children

3. Yates EF, Mulkey SB. Viral infections in pregnancy and impact on offspring neurodevelopment: mechanisms and lessons learned. Pediatr Res. March 20, 2024. Doi: 10.1038/s41390-024-03145-z

4. What happens if pregnant women stop taking Tylenol? Nature. September 26, 2025. Accessed November 4, 2025. https://www.nature.com/articles/d41586-025-03138-w

5. Rudd T. COVID in pregnancy linked to kids' risk of neurodevelopmental disorders. MedPage Today. October 31, 2025. Accessed November 4, 2025. https://www.medpagetoday.com/infectiousdisease/covid19/118268