Impact of Comorbid COVID-19 and Substance Use During Pregnancy on Fetal and Infant Development Workshop




Da-Yu Wu

Additional Information

Pregnant woman

NIDA Brain Development Research Consortium

The short- and potentially long-term impact of the COVID-19 pandemic cannot be overstated. Numerous underlying medical conditions are associated with worse outcomes for those infected with SARS-CoV-2, including pregnancy and recent pregnancy (defined as at least 42 days following the end of pregnancy). In the short-term, SARS-CoV-2 infection in pregnant individuals increases the risk for severe illness for the mother leading to hospitalization, caesarean birth, and death as well as risks for the fetus including stillbirth, pre-term birth, and poor fetal outcomes. The long-term impact of COVID-19 illness during and following recent pregnancy is still being determined; however, recent studies point to potential effects on neurodevelopment. And while efficacious vaccines have been developed that at the very least lessen severity for most individuals, vaccine hesitancy among pregnant individuals has been particularly high.

Not only is maternal COVID-19 illness of concern, but rather simply becoming pregnant and delivering during the pandemic is having a profound impact on families and their children. Social distancing, fears of children or personally becoming infected, economic burden, daycare and school closures are all examples of pandemic stressors that many have experienced and continue to endure. Moreover, for pregnant individuals restrictions have meant changes to typical prenatal care as well as less real or perceived support during prenatal visits, delivery, and post-delivery that have made pregnancy during the pandemic much different and arguably more stressful for most individuals compared to the pre-pandemic period. Data on maternal health during pregnancy and the neurodevelopment of infants born during the pandemic is emerging though importantly how reproducible, persistent, and clinically meaningful neurodevelopmental effects will be remains to be determined.

Finally, the COVID-19 pandemic is occurring at a time when our nation is still grappling with the overlapping opioid epidemic and other substance use disorders (SUD). Given the unique pandemic-related stressors, there are concerns that substance use in pregnant individuals may increase. Substance use during pregnancy is associated with poor outcomes for infants including miscarriage, pre-term birth, and low birthweight and can result in neonatal opioid withdrawal syndrome (NOWS), neonatal abstinence syndrome (NAS), and fetal alcohol spectrum disorders (FASD) for individuals that use opioids, other substances, or consume alcohol, respectively. While data are still accumulating regarding substance use in pregnant individuals during the pandemic, there is some evidence that substance use has increased among this population. Thus, the concern that the pandemic may be exacerbating substance use in pregnant individuals is a major public health concern that could have a lasting impact on children born during the pandemic and exposed in utero to substances.

The pandemic has had a significant impact on pregnant individuals that merits continued attention to assess the short- and long-term effects. COVID infections, decreased social support, increased pandemic-related stress, worsened maternal mental health, and a potential increase in substance use are all consequences of the pandemic that may have lasting impacts on the COVID generation. This workshop will include four sessions that cover: the impact of COVID infection (with attention to the variant) on the developing fetus, the impact of pandemic stress on maternal health, the impact of comorbid COVID-19 infection and/or pandemic stress and substance use on fetal outcomes and neurodevelopment, and innovations in remote data collection and telehealth born out of the pandemic. The workshop will establish the state of the science in efforts to understand gaps and opportunities for ongoing research.

Questions to be addressed

  1. How does COVID-19 infection affect placental function?
  2. What are the consequences of COVID-19 infection on fetal development?
  3. Does ‘long-COVID’ have any implications for reproductive health and/or fetal outcomes during pregnancy?
  4. How has the pandemic uniquely impacted maternal health?
  5. What are protective factors that buffer the impact of pandemic-related stress?
  6. What are lessons learned for future pandemic and/or natural disasters to alleviate the impact on maternal health?
  7. How has the pandemic impacted the neurodevelopment of children born during the pandemic?
  8. How has the pandemic affected substance use?
  9. Does substance use during pregnancy exacerbate the impact of pandemic-related stress and/or COVID infection on maternal health and/or fetal outcomes?
  10. How does comorbid COVID infection and substance use during pregnancy impact neurodevelopment?
  11. What technological innovations have emerged as a result of conducting research during the pandemic?
  12. What has conducting research during the pandemic taught us about team science: lessons from the COVGEN Research Alliance?


  • 10:00 am Welcome and Introduction
    Michelle Freund, Ph.D., National Institute on Drug Abuse
  • 10:00 am Opening Remarks
    Janine Clayton, M.D., FARVO, Office of Research on Women’s Health, Office of the Director, National Institutes of Health
    Nora D. Volkow, M.D., Director, National Institute on Drug Abuse
  • 10:15 am Keynote Address
    Mark Scher, M.D., Department of Pediatric Neurology, Case Western University
    Gene-Environment Interactions Influence Brain Development: Endogenous-Exogenous Factors across Developmental Time
  • 11:00 am Session One: Impact of COVID Infection on the Developing Fetus 
    Andrea Edlow, M.D., MSc, Division of Maternal-Fetal Medicine, Massachusetts General Hospital
    Torri Metz, M.D., M.S., Department of Obstetrics and Gynecology, University of Utah
    Anna Penn, M.D., Ph.D., Department of Pediatrics, Columbia University
    20 min panel discussion
  • 12:20 pm BREAK
  • 12:40 pm Session Two: Impact of Pandemic Stress on Maternal Health and Neurodevelopment of Children Born During the Pandemic
    Courtney Townsel, M.D., MSc, Maternal Fetal Medicine, University of Michigan
    Dani Dumitriu, M.D., Department of Pediatrics, Columbia University
    Jamie Lo, M.D., Department of Obstetrics and Gynecology, OHSU School of Medicine
    20 min panel discussion
  • 2:00 pm BREAK
  • 2:15 pm Session Three: Impact of Comorbid COVID-19 Infection and/or Pandemic Stress and Substance Use on Fetal Outcomes and Neurodevelopment
    Elisha Wachman, M.D., Department of Pediatrics, Boston University
    Intersection of COVID-19 And Opioid Use in Pregnancy: Effects on Fetal and Infant Development
    Elizabeth Krans, M.D., MSc, Department of Obstetrics and Gynecology and Reproductive Sciences, Magee Women’s Health Research Institute & Foundation
    20 min panel discussion
  • 3:15 pm Session Four: Innovations in Remote Data Collection and Telehealth Born Out of the Pandemic
    Hannah Gustafsson, Ph.D., Department of Psychiatry, Oregon Health Sciences University
    Innovative Methods for Remote Assessment of Neurobehavioral Development
    Leeann Whiteside-Mansell, Ed.D., Department of Family and Preventive Medicine University of Arkansas for Medical Sciences
    15 min panel discussion
  • 4:00 pm Flash Talks
    Denise Werchan, Ph.D., New York University
    Sharon Ruyak, Ph.D., R.N., University of New Mexico
    Multiple-Modality Approach in Evaluating the Effects of the COVID-19 Pandemic on Pregnant and Postpartum Women in a Well-characterized Cohort
    Kathryn Manning, Ph.D., University of Calgary
    Constance Guille, M.D., Medical University of South Carolina
  • 4:30 pm Final Panel Discussion
    Moriah Thomason, Ph.D., New York University
    Julie Croff, Ph.D., M.P.H., Oklahoma State University
  • Laura Stroud, Ph.D., Brown University
    Mishka Terplan, M.D., M.P.H., Friends Research Institute
  • 5:00 pm Adjourn


  • Michelle Freund, NIDA
  • Da-Yu Wu, NIDA


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