Editorial: Fetal Exposure to Maternal Infection by SARS-CoV-2 and Effects on Child Neurodevelopment.

The systematic review and meta-analysis by Rizzo et al.1 should be of interest to child psychiatrists and pediatricians based on its historical and contemporary relevance (Table 12-9). Historically, it addresses the 2019 COVID-19 pandemic-so far the most devastating health-related event of the 21st century-which may haunt us for decades because of post-acute sequelae of SARS-CoV-2 (PASC) or Long-COVID, which is now affecting millions of individuals. Contemporarily, it addresses an unresolved issue regarding neurodevelopment in children with a history of fetal exposure to SARS-CoV-2 during pregnancy (presumably uninfected, because vertical transmission is rare), as well as a contentious public debate regarding outcomes of children with fetal and childhood exposure to COVID-19 vaccinations. For this review, the authors applied both a narrow approach (by restricting the review to studies of neurodevelopment in children) and a broad approach (by including studies with "neurodevelopmental outcomes of the child at any age" and "any available measure of child development"). They did the following: (1) identified studies that met the exposure criteria (ie, maternal infection or vaccination) for the review ("70 studies" with 88 neurodevelopmental outcomes); (2) described basic characteristics and findings of all studies in an informative table ("which summarizes methodologies, key findings, and covariates adjustments"); (3) presented structured narrative syntheses for the studies classified into 7 outcome subdomains (with "… consistency [defined] as >70% of studies within a domain reporting effects in the same direction"): and (4) conducted meta-analyses for multiple studies with dichotomous outcomes (based on "…the number of individuals screening positive versus negative for specific auditory or developmental concerns"). As outlined in Table 1, the narrative syntheses suggested reassurances that fetal exposure did not disrupt neurodevelopment (because adverse effects of were not consistent across studies for any outcome domain), but the authors did not accept the null hypothesis (even though it was consistent with their own research). Instead, they conducted meta-analyses that suggested that there may be cause for concern (given that adverse effects were statistically significant for an initial neonatal auditory test and for some ratings of neurodevelopment).