We've received many messages asking us to break down a recent study about neurodevelopmental outcomes in infants who's mothers had COVID during pregnancy. So for #medicalmonday, here we go... Edlow et al. recently published a study in JAMA called “Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy”. What did they find? They find that those who tested positive for COVID-19 during pregnancy and then went on to give birth between March 2020 and September 2020 were MORE LIKELY to have their child receive a diagnosis of a neurodevelopmental disorder (NDD), such as speech language and motor function delays. How much more likely? After accounting for several factors, such as health insurance and premature birth, they found the strength of the effect of COVID-19 infection to be 1.86 [95% CI, 1.03-3.36]; P = .04. What does it mean? If a confidence interval (CI) crosses the number 1.00, then the association between the two variables in question (COVID-19 infection and NDDs) is likely due to chance (i.e., randomly getting these results). Their confidence interval is very close to 1.00.... Let’s dive into the study and see whether this should be concerning. Our critique: While we agree that studying the maternal-fetal impact of COVID-19 infection is extremely important, the data is very preliminary with several limitations. Here are the 4 main reasons: (1) All births (and COVID-19 cases) occurred between March and September 2020 → this means that no one in the study was vaccinated and it is impossible to draw conclusions on what the impact is for those vaccinated. (2) The length of follow-up time was very short They followed children up 12 months after birth -- this is not enough time to adequately observe children for dx of NDD (3) Their control groups likely differs from the group with COVID-19 because, especially early on in the pandemic, vulnerable populations were more likely to contract COVID-19. (4) They do not account for other factors that are known to be associated with NDD, such as vaccination status, education status of parents and family history of NDD (1/2)