Key Findings

Find a parent-focused resource outlining some of our biggest findings in the first 5 years of COMBO. 

So far, COMBO’s results are reassuring: 

• There does not seem to be any significant developmental effect on babies whose moms had Covid during pregnancy. These babies:
  • Are developing just as well as other babies in learning & understanding, language, and movement (aspects of brain development) through the first year of life
  • Are not at greater risk for hearing loss (as babies or as toddlers) 
  • Have similar temperaments (at 6 months old) as babies who were not exposed during pregnancy, including being able to regulate their own emotions and behavior at an age-appropriate level 
• Mothers have an extremely low risk (~2%) of transmitting COVID to their babies during pregnancy, after birth, or while breastfeeding.
  • This finding was a groundbreaking step in confirming the safety of mothers and infants “rooming-in” together postpartum and breastfeeding, both of which are known to be highly beneficial for mother and child. 
  • Whereas the start of the pandemic saw newborns separated from their mothers for fear of transmitting the virus, there has been a turnaround in hospital policy at the national and global level. 
  • Because of this policy reform, Dr. Dumitriu was asked to collaborate on a Dear Colleagues Letter to Senate leaders
    • The letter laid out scientific reasons for funding to be directed to unfunded research areas, including child development and mental health
    • This letter ultimately helped infuse $1.5 billion into the research initiative that became the RECOVER Initiative

Key findings for children born 2020-2022 

While prenatal exposure to the Covid-19 virus does not seem to be impacting children’s development, COMBO is seeing some differences in neurodevelopmental outcomes for babies born from 2020-2022, whether or not their mothers had Covid in pregnancy, making stress from social disruption a key area of focus: 

• Compared to babies born before the pandemic, babies born during the pandemic are slower to develop certain developmental skills (at 6 months old), such as fine & gross motor skills and social skills
  • (This may be because the first trimester of pregnancy is a critical time point when stress can actually get embedded into fetal development.) 
  • These seminal findings contributed to a global action plan to optimize brain health across the life course and establish brain health as a pressing global priority. 
  • The JAMA Pediatrics publication of these findings is in the top 5% of all research outputs scored by Altmetric and has been cited in over 316 news stories from 223 outlets around the world, including PLOS Medicine, the International Journal of Infectious Diseases, the Washington Post, Scientific American, Science, Nature, NBC News, CNN, Today, Nouvelles du Monde, Espanol News, and the Times of India. 

As quoted in the New York Times, Dr. Dumitriu asserts, “It is absolutely possible for these children to catch up, if we catch things early. There is nothing deterministic about a brain at six months.” To identify early opportunities for intervention, continuing to follow these children is essential

• Children born during the pandemic are not more likely to screen positive for autism at 18 months — whether or not their moms had Covid during pregnancy — compared to children born in the two years before the pandemic.

Dr. Dumitriu says, “It’s important to note that we're not looking at autism diagnosis here. We're looking at autism risk, based on parent report. It’s too early to have definitive diagnostic numbers. But this screen is predictive, and it’s not showing that prenatal exposure to Covid or the pandemic increases the likelihood for autism.” 

Key findings for mothers who gave birth in 2020 

• While prenatal COVID exposure does not impact a baby’s temperament, a mom’s stress levels can:
  •  Mothers experienced pandemic-related stress, whether or not they had COVID during pregnancy 
  • As moms’ perceived stress levels increased during the first 4 months postpartum, their babies had a harder time with emotions & behavior, and tuning into their moms (at 6 months old) 
• Pregnant and postpartum moms experienced disruptions in their medical care in the first year of the pandemic (such as canceled prenatal visits) that impacted their mental health: Depression and anxiety symptoms were exacerbated in mothers who reported more changes in their perinatal care, and especially in moms who were separated from their baby after birth.
• When infants didn’t sleep well, it lowered their mothers’ quality of sleep.
• Both pregnant and postpartum mothers slept better & had better energy levels when they used active coping methods (such as social support and self-care) versus passive coping methods (such as screen time and social media use).

Upcoming protocols for this cohort 

• While COMBO continues to enroll pregnant mothers, the original COMBO cohort children are turning 4 & 5 this year. The data so far show that this generation may be slower to reach some developmental milestones, with ongoing potential for future neurodevelopmental findings. 
• For example, while these children are not screening positive for a higher risk of autism, Dr. Dumitriu says that “doesn't mean we might not see jumps in other areas. The risk of various neurodevelopmental conditions changes based on different insults, so there's still a risk that we might see increases in ADHD, depression, anxiety, and (later on) schizophrenia. Continued long-term monitoring is important for primary prevention and early intervention.” 
• Given this, and with school readiness on the horizon for this cohort, COMBO’s study protocols are transitioning more fully into an ERH focus, with key developmental assessments, including: 
  • Social & emotional skills 
  • Fine & gross motor skills 
  • Cognition and language 
  • Memory 
  • Behavioral regulation 
  • Emotional & biobehavioral synchrony