Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Apr 23, 2025
Date Accepted: Nov 10, 2025
Date Submitted to PubMed: Nov 11, 2025
Neurodevelopment and Risk Factors in infants before, during and after COVID-19 Pandemic: A Cross-Sectional Study in Eastern China
ABSTRACT
Background:
Emerging studies suggests that exposure to the COVID-19 pandemic may heighten risks of neurodevelopmental disorders in infants, however, population-based studies investigating these associations in Chinese contexts remain scarce, particularly including the post-pandemic phase.
Objective:
To characterize dynamic changes in neurodevelopment among infants in eastern China during distinct phases of the COVID-19 pandemic, and identify critical risk factors associated with infant neurodevelopmental delays.
Methods:
This cross-sectional study analyzed 17,621 Peabody Developmental Motor Scales-II (PDMS-II) assessments and 7,877 Bayley Scales of Infant Development-Chinese Cities Revised (BSID-CR) from infants who visited a tertiary maternal and children hospital for routine neurodevelopment assessment from January 2019 to July 2023. Multivariate logistic regression models were used to evaluate associations between COVID-19 pandemic phases, seasonal variations, and perinatal variables (e.g., delivery mode, birth weight, gender) with neurodevelopmental outcomes.
Results:
Infants assessed at Stage II of the COVID-19 pandemic had a higher risk of neurodevelopmental delay compared to infants assessed at Stage I (total motor quotient: Odds Ratio (OR) =2.84, 95% confidential interval (CI): 2.17-3.72; fine motor quotient: OR=2.71, 95% CI: 1.99-3.68) and Stage III (total motor quotient: OR=2.52, 95% CI: 1.79-3.55; gross motor quotient: OR=1.65, 95% CI: 1.21-2.25; fine motor quotient: OR=3.40, 95% CI: 2.36-4.92). Infants assessed at stage III had the highest risk of mental development delay (OR=2.54, 95% CI: 1.91-3.36). In addition, cesarean section, male gender and low birth weight were independent risk factors of neurodevelopmental delay (P values < .05).
Conclusions:
The COVID-19 pandemic exacerbated neurodevelopmental vulnerabilities in infants, persisting into the post-pandemic period. Public health strategies should prioritize developmental monitoring for high-risk subgroups (boys, cesarean-delivered, low birth weight infants) and mitigate long-term effects through early interventions.
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