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COVID-19 During Pregnancy: Q&A With Roy Perlis, MD, MSc

In This Article

  • A preliminary study led by Massachusetts General Hospital's Roy Perlis, MD, MSc, investigated the potential long-term effects of COVID-19 exposure during pregnancy
  • Among children whose mothers had a positive COVID-19 test during pregnancy, there was a small increase in the likelihood of a neurodevelopmental diagnosis in the first year of life
  • Those diagnoses generally reflected developmental delays, either in motor skills or speech
  • Dr. Perlis explains the study and its implications, as well as the need for larger, longer studies to continue monitoring the risks of COVID-19 exposure

A preliminary study co-led by Roy Perlis, MD, MSc, associate chief for research in the Department of Psychiatry at Massachusetts General Hospital and director of the Center for Quantitative Health in the Division of Clinical Research and Andrea Edlow, MD, MSc, an investigator in the Vincent Center for Reproductive Biology at Massachusetts General Hospital, suggests that COVID-19 infection during pregnancy may lead to developmental delays in the child's early life. Dr. Perlis explains the study and its implications in this Q&A.

Q. Tell me about your research interests as it relates to COVID-19.

I think like many Massachusetts General Hospital researchers, at the beginning of the pandemic, I tried to figure out how I could make myself useful while I sat in my attic and waited for my lab to reopen. Since part of my group works on electronic health records, it was natural for us to start looking at how we might use health records to try to understand various aspects of COVID-19. Initially we focused on building models to understand risk after initial COVID-19 infection; more recently we've been examining potential longer-term risks of infection.

Q. Your latest study raises concern that COVID-19 during pregnancy might increase the risk of developmental delays in a child's early life. What specifically did you find? What are the long-term risks for a child's development?

I would emphasize that this is a preliminary study, intended to show a method we might use to understand the longer-term effects of COVID-19 exposure. We need longer and larger studies, and studies that evaluate these children systematically and in person, to really understand whether there might be a risk.

What we found was that, among children whose mothers had a positive COVID-19 test during pregnancy, there was a small increase in the likelihood of getting a neurodevelopmental diagnosis in the first year of life. Those diagnoses really reflected delays, either in developing motor skills or speech—they are very nonspecific, and they may well resolve with time. But our results suggest the importance of continuing to follow these children.

Q. Does the severity of the COVID-19 case change the risk level?

We don't know. Very few of the COVID-19-positive mothers in our study were hospitalized, so we can't tell if greater severity is associated with greater risk. Hopefully, as we increase the size of our cohort, we'll be able to answer those questions.

Q. If a pregnant person is vaccinated and still contracts COVID-19, does that lessen the risk to the fetus?

There are so many good reasons to be vaccinated, including for pregnant women. We know that vaccination is safe and effective during pregnancy—in fact, some of that important work was done by the paper's lead author Andrea Edlow, MD, MSc, and other Mass General colleagues.

Our study can't yet address the role of vaccination because it reports on women who delivered their babies before vaccination was available. We're hoping to address this key question in our next paper.

Q. What does this study indicate as mitigation measures for pregnant people and their care teams?

We know so much now about how to prevent COVID-19, or at least minimize the risk of becoming infected with it. I think our study is simply a reminder that we shouldn't let our guards down—for example, that wearing masks and getting vaccinated and boosted remain critical public health strategies.

Q. Why are some experts questioning the findings?

Sometimes in science, it's hard to tolerate papers that report findings different from ours, particularly when we have firmly-held beliefs, even if those papers use different methods and much larger samples. I think for people who took the time to read the paper, most of the critiques are actually things we considered and addressed. For example, some experts worried that children of moms with COVID-19 might just get closer follow-up—but if that were true, we'd expect a bunch of other diagnoses to be more common, which was not the case. Some don't like the fact that the diagnoses we identified were vague—which is why we manually reviewed the charts to confirm that the clinician had documented a delay of some sort.

In one small survey published earlier, the authors argued that it was the stress of being pregnant during COVID-19 that could account for increased delays. But since we compared mothers with and without a positive test, all of whom were pregnant during the pandemic, we were able to exclude that explanation.

We were very clear that this is a preliminary study. Our hope is that presenting this work will encourage others to do similar studies, and even prove us wrong. The questions from colleagues show that the scientific process is working.

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Learn more about the Center for Quantitative Health


Researchers at Mass General are studying the effects of SARS-CoV-2 infection and mRNA vaccines in pregnant and lactating individuals, as well as neonates.


By reprogramming neonatal cord blood mononuclear cells, researchers at Massachusetts General Hospital have created patient-specific models of fetal microglia-mediated synaptic pruning. These will permit non-invasive investigation of how maternal exposures, including SARS-CoV-2 infection, affect the fetal brain.