{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T08:11:09Z","timestamp":1774253469537,"version":"3.50.1"},"posted":{"date-parts":[[2026,3,19]]},"group-title":"Pediatrics","reference-count":97,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,3,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Parent\/caregiver-infant early relational health (ERH) is known to play a critical role in the promotion of socio-emotional functioning and wellbeing across the life course. The negative impact of the COVID-19 pandemic on maternal mental health and secondarily on ERH and child socio-emotional functioning is clear. However, the direct impact of maternal viral exposure during pregnancy on ERH has not been investigated.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The goal of this study was to determine the impact of prenatal SARS-CoV-2 exposure on ERH and infant socio-emotional functioning in the first 6 months of life.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Mothers with and without SARS-CoV-2 exposure during pregnancy who gave birth from 02\/2020 to 09\/2021 were enrolled from 05\/2020 to 09\/2021 in one of two parallel prospective studies (the COVID-19 Mother Baby Outcomes [COMBO] Initiative or the Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI] COMBO sub-study). Mothers reported on their health and the socioemotional functioning of their infant via online surveys (REDCap) at enrollment, 1, 2, 4, and 6 months. At 4 to 6 months, dyads were invited to participate in a video-based, remote assessment of ERH.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>884 mother-infant dyads from three U.S. States (Alabama, New York, and Utah).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Exposure<\/jats:title>\n                  <jats:p>Prenatal SARS-CoV-2.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures<\/jats:title>\n                  <jats:p>\n                    Maternal-reported ERH (parental stress, parenting confidence and bonding) and observer-based ERH (video-coded quality of maternal caregiving behaviors and mother-infant emotional connection). Infant socio-emotional development assessed using the 6-month Ages and Stages Questionnaire: Socio-Emotional 2\n                    <jats:sup>nd<\/jats:sup>\n                    Edition (ASQ:SE-2).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>316 (36%) mothers had a positive prenatal SARS-CoV-2 exposure. Prenatal SARS-CoV-2 exposure was associated with an adjusted estimate of \u223c5% reduction (incidence rate ratio=0.95, 95% confidence interval [0.90, 1.00], p=0.03) in observed maternal caregiving quality, after accounting for postnatal maternal mental health and sociodemographic factors. We found no evidence of effect on other ERH constructs or infant socio-emotional functioning.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions and Relevance<\/jats:title>\n                  <jats:p>In this large prospective cohort study, prenatal SARS-CoV-2 was associated with a small decrement in caregiving quality, but not other ERH constructs or infant socioemotional functioning. These findings should be interpreted as hypothesis generating and will require replication in independent studies.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Key Points<\/jats:title>\n                  <jats:list list-type=\"bullet\">\n                    <jats:list-item>\n                      <jats:p>\n                        <jats:bold>Question<\/jats:bold>\n                        : Is SARS-CoV-2 exposure during pregnancy associated with maternal-reported and observer-based measures of early relational health (ERH) and infant socio-emotional functioning at 4-6 months postpartum?\n                      <\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>\n                        <jats:bold>Findings<\/jats:bold>\n                        : Prenatal SARS-CoV-2 exposure was associated with a \u223c5% reduction in observed quality of maternal caregiving after accounting for postnatal mental health symptomatology and sociodemographic factors.\n                      <\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>\n                        <jats:bold>Meaning<\/jats:bold>\n                        : A small reduction in maternal caregiving quality, but not other ERH constructs (parental stress, parenting confidence, bonding and emotional connection) or infant socio-emotional functioning, was associated with prenatal SARS-CoV-2 exposure. Results should be interpreted as hypothesis generating and will require replication in independent studies.\n                      <\/jats:p>\n                    <\/jats:list-item>\n                  <\/jats:list>\n                <\/jats:sec>","DOI":"10.64898\/2026.03.12.26346895","type":"posted-content","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T17:40:18Z","timestamp":1773942018000},"source":"Crossref","is-referenced-by-count":0,"title":["Prenatal exposure to SARS-CoV-2, early relational health, and child socio-emotional functioning in the first 6 months"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5702-3084","authenticated-orcid":false,"given":"Andr\u00e9ane","family":"Lavall\u00e9e","sequence":"first","affiliation":[{"name":"Center for Early Relational Health, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4215-5126","authenticated-orcid":false,"given":"Jennifer M.","family":"Warmingham","sequence":"additional","affiliation":[{"name":"Mt. 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