The COVID-19 Health Impact on Long-term Child Development in Scotland (CHILDS) study

COVID-19 (COV) has exposed pregnant women to potential infection with a novel coronavirus and the associated public health measures have radically altered the nature of healthcare and support for pregnant women and their children. We aim to understand how being born in the pandemic (including potential infection with the virus itself) affects child development to age 5. We place particular emphasis on understanding the role of social inequality, which has already been shown to be a significant factor in studies of health and wellbeing during the pandemic.

COV is highly contagious and pregnant women are at particular risk of viral infection because pregnancy is an 'immuno-suppressive condition', making the body less able to fight infection. Early evidence suggests that COV infection during pregnancy leads to increased risk for miscarriage and premature birth. Studies have established that maternal infection during pregnancy can also affect long term child development, though investigation of these effects for COV have not been possible until now.

A broad body of evidence suggests that infection during pregnancy, maternal mental health, support during pregnancy and birth all have important roles in how children develop. Support for pregnant women and new mothers has been substantially disrupted by the Public Health and Social Measures (PHSM) necessary to contain the pandemic. Women have received less antenatal care, fewer midwife appointments, less face-to-face support and less informal and professional support from charities, friends and family. Most healthcare providers have placed restrictions on home births and non-emergency caesarean sections. Initial studies suggest that Social Inequality is an important factor in determining the effect of these changes on developmental outcomes and a range of more immediate health outcomes. In some cases, increased isolation appears to have reduced non-COV infections and provided a better environment for breastfeeding. Other research points to a poorer maternal environment, with increased mental health challenges and domestic violence during the pandemic. Our work will explore the important role of Social Inequality in explaining these different outcomes.

This study will examine the effects of COV and the related PHSM (including changes to healthcare provision) on pregnant women and their children across the whole of Scotland. We will use routinely collected data from healthcare, education and social care records. This will allow the team to build a detailed understanding of pregnancy, maternal and child health and development for approximately 99,000 children born during the pandemic, up to the age of 5; to be compared with the same information for approximately 200,000 children born before the pandemic.

In Scotland each citizen has a Community Health Index (CHI) number, which allows data for mothers and children to be linked whilst remaining entirely anonymous. The CHI system is managed by the NHS and uses well established protocols to ensure only relevant data are provided to the research team.

There are three main focus areas for this study:
1) Understanding how COV infection during pregnancy affects child health and development up to the age of 5.
2) Understanding the impact of Public Health and Social Measures (PSHM) taken during the pandemic on early child development.
3) Examining the role of social inequality on mother and child development outcomes in light of the pandemic.

The study will efficiently build on extensive work already being conducted and will maximise the use of existing infrastructure and health care reviews. The study will provide a unique reference point for healthcare providers and policy-makers in Scotland and globally about the needs of those born in the pandemic, allowing improved targeting of resources and a better understanding of how policy can improve outcomes at these crucial early stages of life.