Stress levels among expectant mothers have soared. Pregnant women with Covid are five times as likely as uninfected pregnant people to require intensive care and 22 times as likely to die. Infected moms are four times as likely to have a stillborn child.
Yet some of the pandemic’s greatest threats to infants’ health may not be apparent for years or even decades.
Full coverage of the Covid-19 pandemic
That’s because babies of Covid-infected moms are 60 percent more likely to be born very prematurely, which increases the danger of infant mortality and long-term disabilities such as cerebral palsy, asthma and hearing loss, as well as a child’s risk of adult disease, including depression, anxiety, heart disease and kidney disease.
“Some of these conditions do not show up until middle childhood or early adult life, but they have their origins in fetal life,” said Dr. Evdokia Anagnostou, a neurologist and pediatrics professor at the University of Toronto.
For fetuses exposed to Covid, the greatest danger is usually not the coronavirus itself, but the mother’s immune system.
Both severe Covid infections and the strain of the pandemic can expose fetuses to harmful inflammation, which can occur when a mother’s immune system is fighting a virus or when stress hormones send nonstop alarm signals.
Prenatal inflammation “changes the way the brain develops and, depending on the timing of the infection, it can change the way the heart or kidneys develop,” Anagnostou said.
At least 150,000 pregnant people have been diagnosed with Covid; more than 25,000 of them have been hospitalized, and 249 have died, according to the Centers for Disease Control and Prevention.
Although most babies will be fine, even a small increase in the percentage of children with special medical or educational needs could have a large effect on the population, given the huge number of Covid infections, Anagnostou said.
“If someone has a baby who is doing well, that is what they should focus on,” Anagnostou said. “But from a public health point of view, we need to follow women who experienced severe Covid and their babies to understand the impact.”
Learning from history
Previous crises have shown that the challenges fetuses face in the womb — such as maternal infections, hunger, stress and hormone-disrupting chemicals — can leave a lasting imprint on their health, as well as that of their children and grandchildren, said Dr. Frederick Kaskel, director of pediatric nephrology at the Children’s Hospital at Montefiore.