The project aimed to explore whether maternal infection by the SARS-CoV-2 virus during pregnancy harmed the developing fetal brain or increased sensitivity to later developmental and environmental insults. The novel coronavirus (COVID-19) outbreak had fundamentally altered the child health landscape, ushering in sweeping changes in the social and economic fabric within which children grew. The rapidity of these environmental changes, coupled with the novelty of the SARS-CoV-2 virus and the widespread nature of infections, had presented multiple pressing questions.

Among the unknowns that directly affected newborn and child health were:

• How did COVID-19 infection during pregnancy affect the developing fetus or subsequent infant neurodevelopment?
• How did the unprecedented scale and scope of concurrent environmental changes impact child health and neurodevelopment?

Unfortunately, over the course of the outbreak, the impact on children had been slow to be recognized, with studies of COVID-19 infection or effects in infants and young children being sparse or nonexistent. Moreover, while the health and economic impacts of the COVID-19 outbreak had been felt by everyone, the most severe effects had been felt by racial and ethnic minorities and lower-income families. Thus, the most sensitive families and children, already at risk for worsened neurodevelopmental outcomes, had been disproportionately and more intensely affected. Studies of newborns and infants had therefore been seen as critical to designing effective guidelines of care for expectant mothers, optimizing early care and support for mothers and their newborns, and prioritizing pre- and postnatal interventions.

This supplement project aimed to contribute important and timely evidence by characterizing neurodevelopmental profiles in infants born to mothers with and without antenatal COVID-19 infection and examining the concurrent impact of social, economic, and substance use factors.