RESEARCH ARTICLE |
https://doi.org/10.5005/jp-journals-11003-0135 |
Prevalence of Autism in Toddlers Born to Coronavirus Disease 2019-positive Mothers
1,2,4Department of Paediatrics, Army College of Medical Sciences & Base Hospital, Delhi Cantt, Delhi, India
3Department of Psychiatry, Army College of Medical Sciences & Base Hospital, Delhi Cantt, Delhi, India
Corresponding Author: Deepika G Dumeer, Department of Paediatrics, Army College of Medical Sciences & Base Hospital, Delhi Cantt, Delhi, India, Phone: +91 8130861700, email: drgulatideepika@gmail.com
Received: 24 November 2023; Accepted: 15 December 2023; Published on: 30 December 2023
ABSTRACT
Autism is a neurobehavioral disorder seen in toddler characterized by speech delay, lack of social interaction, and repetitive stereotyped behaviors. There were reports of increase in risk of neurodevelopmental disorders in children born to coronavirus disease 2019 (COVID-19)-positive mothers. This study was being done to find out any relation between COVID-19 infection in mothers and autism in children. It was a retrospective cross-sectional study of 250 children of age 1–3 years born to COVID-19-positive mothers attending outpatient department (OPD) of a tertiary care hospital of West Delhi. This study showed a significant rise in risk of autism in children born to mothers in COVID-19-positive mothers.
How to cite this article: Dumeer DG, Agarwal R, Dutta BK, et al. Prevalence of Autism in Toddlers Born to Coronavirus Disease 2019-positive Mothers. J Med Acad 2023;6(2):58–60.
Source of support: Nil
Conflict of interest: None
Patient consent statement: The author(s) have obtained written informed consent from the patient’s parents/legal guardians for publication of the case report details and related images.
Keywords: Autistic spectrum disorder, Coronavirus disease 2019, Modified checklist for autism in toddlers score
INTRODUCTION
As per the WHO, autism is disorder of developing brain characterized by lack of social interaction, speech delay, and fixed repetitive stereotyped movements. About one in 100 children has autism.1 According to the Autism and Developmental Disabilities Monitoring (ADDM) networks in 2020, there has been an increase in the number of autism spectrum disorder (ASD) cases in the last few years. Presently, one in 36 children aged 8 years were identified with ASD in the year 2020.2 This surge was being attributed to improvements in evaluation and ASD detection. However, discontinuation of this practice during the coronavirus disease 2019 (COVID-19) pandemic led to fall in ASD cases at a higher age-group. Early diagnosis of autism can pave the way for early intervention. This will improve the child’s quality of life as they get older.3,4 Late diagnosis is associated with increased parental stress and delayed early intervention, which is critical to positive outcome over time.5-7 It has been proved that interventions done before 4 years of age are associated with significant gains in cognition, language, and adaptive behavior.8,9
For diagnosis of ASD, a screening method called modified checklist for autism in toddlers (M-CHAT) is used before age of 2 years,10 but sometimes, these early symptoms can be misinterpreted as shyness.11
Due to COVID-19, there was a major effect on social and communicative life of people. So, it affected both physical and mental health of the individuals.12 It was reported in a study in Spain that during lockdown, physical activity of pregnant women decreased significantly.13
MATERIALS AND METHODS
It was a retrospective cross-sectional study done from March to September 2023. A total of 250 consecutive children born in the years 2020–2022, whose mothers were COVID-19-positive in pregnancy, were enrolled for the study. Parents were given M-CHAT screening questionnaire. Score of more than two was taken as risk for autism.14 History of COVID-19 infection in pregnancy was being asked. Positive polymerase chain reaction (PCR) report was taken as positive.
Inclusion Criteria
All children of age 1–3 years born to COVID-19-positive mothers in the years 2020–2022 coming to the outpatient department (OPD) of the Tertiary Care Hospital of West Delhi were included in the present study.
Exclusion Criteria
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Parents who refused to enroll for study.
-
Children with other neurodisabilities like cerebral palsy.
-
Children with congenital syndromes like Down syndrome, Williams syndrome, etc.
Statistical Analysis
Taking the current prevalence of autism in the community as 2% and keeping 10% level of significance and absolute allowable error as 5%, the sample size came out to be 250.
The results have been taken using Statistical Package for the Social Sciences (SPSS) Software version 23.
RESULTS
In the present study, 16 children, that is, around 7%, had M-CHAT score of more than two (Table 1). This suggested that the prevalence of autism in COVID-19-positive mothers was approximately one in 16 children, which was higher than the result of the studies done in the pre-COVID era. Study done in Chandigarh in the year 2019 suggested that the prevalence of ASD was found to be 2.25 per 1,000 children.15
| M-CHAT score | |||||
|---|---|---|---|---|---|
| Frequency | Percent | Valid percent | Cumulative percent | ||
| Valid | 2 | 235 | 93.6 | 93.6 | 93.6 |
| 4 | 16 | 6.4 | 6.4 | 100.0 | |
| Total | 251 | 100.0 | 100.0 | ||
The incidence of autism in males in the present study was 69%, while that of females was 31% only. This could be attributed to upregulation of placental interferon signaling leading to reduced maternal antisevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in male offspring. So, the prevalence of neurodevelopmental and neuropsychiatric disorders like autism in the offspring differs as per the sex of the child (Table 2).16,19
| Relation with sex | |||||
|---|---|---|---|---|---|
| Frequency | Percent | Valid percent | Cumulative percent | ||
| Valid | F | 5 | 31.3 | 31.3 | 31.3 |
| M | 11 | 68.8 | 68.8 | 100.0 | |
| Total | 16 | 100.0 | 100.0 | ||
Out of the 250 children, only eight were born preterm and had stormy neonatal course. However, none of them had autism. All 16 autistic children were born at term, and postnatal period was uneventful. A cohort study done in more than six hospitals in the United States showed that COVID-19 infection in mother was associated with risk for neurodevelopmental disorders in the first 12 months after birth (Table 3).20
| Relation with gestation | |||||
|---|---|---|---|---|---|
| Frequency | Percent | Valid percent | Cumulative percent | ||
| Valid | Preterm (<37 weeks) | 0 | 0 | 0 | 0 |
| Term (>37 weeks) | 16 | 100 | 100 | 100.0 | |
| Total | 16 | 100.0 | 100.0 | ||
DISCUSSION
In this study, the prevalence of autism came out to be 7% in children of COVID-19-positive mothers. It was more than that of the prevalence in general population.2
Perlis found that babies born to COVID-19-positive mothers had increased risk of developmental disorder in infancy. The rationale for this was that development of fetal brain might be affected by mother’s immune response to inflammation that gets transferred to the baby via the placenta. However, as COVID-19 infection may also lead to preterm delivery, babies may have problems related to prematurity.21
It was also noted that COVID-19 infection in pregnancy had higher risk of neurodevelopment disorder in babies’ brain if the infection occurred in the third trimester. However, we could not find any such association in our study.
Perlis found in their study that even after accounting for preterm delivery, there is still the risk of neurodevelopmental disorders more in babies of affected mothers.21
In a study done by Edlow et al., they found that male offsprings of mothers affected with COVID-19 during pregnancy have 94% more chances of having any neurodevelopmental diagnosis at age of 12 months.8
In a Swedish study, they found a 30% increase in risk for ASD among offspring of women infected with an intrapartum infection.22
Another study in Sweden found that the risk of ASD in offspring was 79% higher in mothers having any infection during pregnancy.21
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has persistent effect in brain development.23,29
Studies showing maternal and placental immune response for SARS-CoV-2 suggest that anti-SARS-CoV-2 antibodies in mothers were less in case of male babies compared to female babies.16
A large number of studies show that incidence of autism increases as gestational age decreases.30 So, the odds of autism were 3.3 times more in preterm children than in the general population.31
CONCLUSION
Children born to mothers who had COVID-19 during pregnancy had a higher risk of autism-like features. So, early screening and regular follow-ups are required for their better neurodevelopmental outcome.
Limitations
As we were able to show only the association between maternal COVID-19 infection and autism in children, so further studies are needed to show a causal connection between the two.
Since we have studied only the toddler population, they have to be followed up further for their neurodevelopmental assessment.
As we have taken the M-CHAT score as our screening questionnaire, all at-risk babies need further diagnostic tests and follow-ups to assess the neurodevelopmental risk.
ORCID
Deepika G Dumeer https://orcid.org/0009-0003-7288-9929
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