IJPDS International Journal of Population Data Science IJPDS 2399-4908 Swansea University 10.23889/ijpds.v10i4.3030 10:3:22 Early childhood developmental concerns following SARS-CoV-2 infection and COVID-19 vaccination during pregnancy: a Scottish population-level retrospective cohort study Hardie Iain 1 Marryat Louise 2 Murray Aja 1 King Josiah 1 Okelo Kenneth 1 Boardman James P. 3 4 Lombardo Michale V 5 Stock Sarah J. 6 Wood Rachael 7 Auyeung Bonnie 1 Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, United Kingdom School of Health Sciences, University of Dundee, Dundee, United Kingdom Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, United Kingdom Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems, Istituto Italiano di Tecnologia, Rovereto, Italy Usher Institute, University of Edinburgh, Edinburgh, United Kingdom Public Health Scotland, Edinburgh, United Kingdom 01 06 2025 2025 8 4 3030 This work is licenced under a Creative Commons Attribution 4.0 International License. This article is available from the IJPDS website at: https://ijpds.org/article/view/3030 Objectives

Understanding the effects of SARS-CoV-2 infection and COVID-19 vaccination during pregnancy can help inform clinical guidance and tackle vaccine hesitancy. We examined relationships between SARS-CoV-2 infection during pregnancy, COVID-19 vaccination during pregnancy, and early child developmental concerns in children age 13–15 months in Scotland.

 Methods

A total of 24 919 child–mother pairs (12 752 [51·2%] male children; 12 167 [48·8%] female children) were included. 1631 (6·5%) children were prenatally exposed to SARS-CoV-2 and 4943 (19·8%) to COVID-19 vaccination. We found no associations between SARS-CoV-2 infection during pregnancy and developmental concerns. After confounder and covariate adjustment, COVID-19 vaccination during pregnancy was associated with reduced odds of developmental concerns regarding problem solving (odds ratio 0·78 [95% CI 0·64–0·95]), personal–social (0·76 [0·61–0·95]), and emotional–behavioural (0·67 [0·48–0·92]) development, but had no associations with other developmental concerns.

 Results

1.3% of children had a caution or conviction before the age of 15/16.

Higher z-scores on the EYFSP (indicating better functional development) were associated with decreased odds of a caution or conviction by the age of 15/16 (adjusted OR for 1SD increase in z-score = 0.70, 95% CI = 0.69–0.72).

Being eligible for Free School Meals (living in absolute poverty) at age 4/5 was associated with increased odds of having a caution or conviction by age 15/16 (adjusted OR = 4.62, 95% CI = 4.46–4.92).

There was a statistical interaction between these two risk factors (adjusted OR = 1.33, 95% CI = 1.27–1.39). Children living in poverty had consistently higher risk at every z-score on the EYFSP, and living in poverty worsened the absolute risk conferred by lower z-scores on the EYFSP.

 Conclusion

SARS-CoV-2 infections during pregnancy do not appear to be linked to early childhood developmental concerns, and COVID-19 vaccinations during pregnancy are safe from the perspective of early childhood developmental concerns. As some developmental concerns do not become apparent until children are older than 13–15 months, future research should continue to monitor outcomes as children grow and develop.