Findings of Reduced Head Circumference with COVID-19 Infection in the Third Trimester: A Retrospective Cohort Study

<b>Background</b>: COVID-19 is linked to multiple adverse pregnancy outcomes but with inconsistent evidence associating the disease with fetal growth restriction (FGR) and small for gestational age (SGA). There are limited data on the impact of COVID-19 on neonatal growth measurements, s...

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Main Authors: Kristen Lee Moriarty, Kelsey Manfredi, Pascale Carrel, Emma Kryzanski, David A. Schwartz, Lucas Godoy, Chia-Ling Kuo, Andrea Shields
Format: Article
Language:English
Published: MDPI AG 2025-03-01
Series:Biomedicines
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Online Access:https://www.mdpi.com/2227-9059/13/4/832
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author Kristen Lee Moriarty
Kelsey Manfredi
Pascale Carrel
Emma Kryzanski
David A. Schwartz
Lucas Godoy
Chia-Ling Kuo
Andrea Shields
author_facet Kristen Lee Moriarty
Kelsey Manfredi
Pascale Carrel
Emma Kryzanski
David A. Schwartz
Lucas Godoy
Chia-Ling Kuo
Andrea Shields
author_sort Kristen Lee Moriarty
collection DOAJ
description <b>Background</b>: COVID-19 is linked to multiple adverse pregnancy outcomes but with inconsistent evidence associating the disease with fetal growth restriction (FGR) and small for gestational age (SGA). There are limited data on the impact of COVID-19 on neonatal growth measurements, specifically microcephaly without SGA or low birth weight. We hypothesize that COVID-19 is associated with smaller neonatal head measurements without increasing the risk of small for gestational age. This relationship may be related to the timing of COVID-19 exposure in pregnancy. <b>Methods</b>: An Institutional Review Board (IRB) approved retrospective cohort study enrolled 140 COVID-19-infected and 136 COVID-19-uninfected patients. Inclusion criteria: (a) singleton birth between 28 April 2020 and 31 December 2022; and (b) maternal COVID-19 infection diagnosed via polymerase chain reaction (PCR). Exclusion criteria: Less than 12 years of maternal age, major fetal anomalies, and fetal loss < 15 weeks. The outcomes were a comparison of newborn growth measurements (length, weight, and head circumference (HC) at birth), Ponderal Index (PI), and development of SGA between SARS-CoV-2-infected and uninfected patients. Maternal and neonatal characteristics were descriptively summarized, and multivariate analyses and linear regression models were performed. Baseline maternal demographics did not differ amongst cohorts. <b>Results</b>: Compared to the uninfected cohort, COVID-19 diagnosed in the third trimester was associated with a lower neonatal HC compared to newborns of uninfected patients (β = −0.38 [0.38 SD lower], 95% CI −0.65 to −0.10, <i>p</i> = 0.024). There was no significant difference among cohorts in birth length, weight, or diagnosis of small for gestational age. <b>Conclusions</b>: We found that COVID-19 infection in the third trimester was associated with a lower neonatal head circumference without associated SGA. The cause underlying this association is unknown. Further research to determine the risk of neurotropic fetal infection by SARS-CoV-2, like ZIKA’s effect on the fetal immune system leading to microcephaly, is urgently needed.
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spelling doaj-art-e3a5bdc7d4cb4b619f6836a7c0691b932025-08-20T03:14:20ZengMDPI AGBiomedicines2227-90592025-03-0113483210.3390/biomedicines13040832Findings of Reduced Head Circumference with COVID-19 Infection in the Third Trimester: A Retrospective Cohort StudyKristen Lee Moriarty0Kelsey Manfredi1Pascale Carrel2Emma Kryzanski3David A. Schwartz4Lucas Godoy5Chia-Ling Kuo6Andrea Shields7Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, UConn Health, Farmington, CT 06030, USADepartment of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, UConn Health, Farmington, CT 06030, USASchool of Medicine, The University of Connecticut, Storrs, CT 06030, USASchool of Medicine, The University of Connecticut, Storrs, CT 06030, USAPerinatal Pathology Consulting, Atlanta, GA 30342, USAThe Cato T. Laurencin Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT 06030, USAThe Cato T. Laurencin Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT 06030, USADepartment of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, UConn Health, Farmington, CT 06030, USA<b>Background</b>: COVID-19 is linked to multiple adverse pregnancy outcomes but with inconsistent evidence associating the disease with fetal growth restriction (FGR) and small for gestational age (SGA). There are limited data on the impact of COVID-19 on neonatal growth measurements, specifically microcephaly without SGA or low birth weight. We hypothesize that COVID-19 is associated with smaller neonatal head measurements without increasing the risk of small for gestational age. This relationship may be related to the timing of COVID-19 exposure in pregnancy. <b>Methods</b>: An Institutional Review Board (IRB) approved retrospective cohort study enrolled 140 COVID-19-infected and 136 COVID-19-uninfected patients. Inclusion criteria: (a) singleton birth between 28 April 2020 and 31 December 2022; and (b) maternal COVID-19 infection diagnosed via polymerase chain reaction (PCR). Exclusion criteria: Less than 12 years of maternal age, major fetal anomalies, and fetal loss < 15 weeks. The outcomes were a comparison of newborn growth measurements (length, weight, and head circumference (HC) at birth), Ponderal Index (PI), and development of SGA between SARS-CoV-2-infected and uninfected patients. Maternal and neonatal characteristics were descriptively summarized, and multivariate analyses and linear regression models were performed. Baseline maternal demographics did not differ amongst cohorts. <b>Results</b>: Compared to the uninfected cohort, COVID-19 diagnosed in the third trimester was associated with a lower neonatal HC compared to newborns of uninfected patients (β = −0.38 [0.38 SD lower], 95% CI −0.65 to −0.10, <i>p</i> = 0.024). There was no significant difference among cohorts in birth length, weight, or diagnosis of small for gestational age. <b>Conclusions</b>: We found that COVID-19 infection in the third trimester was associated with a lower neonatal head circumference without associated SGA. The cause underlying this association is unknown. Further research to determine the risk of neurotropic fetal infection by SARS-CoV-2, like ZIKA’s effect on the fetal immune system leading to microcephaly, is urgently needed.https://www.mdpi.com/2227-9059/13/4/832fetal growth restrictionCOVID-19head circumferencefetal growthsmall for gestational ageSARS-CoV-2
spellingShingle Kristen Lee Moriarty
Kelsey Manfredi
Pascale Carrel
Emma Kryzanski
David A. Schwartz
Lucas Godoy
Chia-Ling Kuo
Andrea Shields
Findings of Reduced Head Circumference with COVID-19 Infection in the Third Trimester: A Retrospective Cohort Study
Biomedicines
fetal growth restriction
COVID-19
head circumference
fetal growth
small for gestational age
SARS-CoV-2
title Findings of Reduced Head Circumference with COVID-19 Infection in the Third Trimester: A Retrospective Cohort Study
title_full Findings of Reduced Head Circumference with COVID-19 Infection in the Third Trimester: A Retrospective Cohort Study
title_fullStr Findings of Reduced Head Circumference with COVID-19 Infection in the Third Trimester: A Retrospective Cohort Study
title_full_unstemmed Findings of Reduced Head Circumference with COVID-19 Infection in the Third Trimester: A Retrospective Cohort Study
title_short Findings of Reduced Head Circumference with COVID-19 Infection in the Third Trimester: A Retrospective Cohort Study
title_sort findings of reduced head circumference with covid 19 infection in the third trimester a retrospective cohort study
topic fetal growth restriction
COVID-19
head circumference
fetal growth
small for gestational age
SARS-CoV-2
url https://www.mdpi.com/2227-9059/13/4/832
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