Authors' objective was to examine the impact of infection with SARS-CoV-2 during pregnancy on child neurodevelopment in the first years of life. A longitudinal prospective cohort study was conducted among a diverse population of 69,987 children born January 2020–September 2021 in Northern California to members of an integrated healthcare system. Maternal SARS-CoV-2 infection during pregnancy was confirmed by polymerase chain reaction (PCR) test. All neurodevelopmental disorders (NDD) diagnosed in children by December 2023 were identified, including autism spectrum disorder (ASD), speech/language delay, and motor delay. A total of 2,777 (3.97%) pregnant individuals had PCR-confirmed SARS-CoV-2 infection during pregnancy. 

Findings: Among 69,987 children aged 27–48 months, 12,006 (17.15%) were diagnosed with NDD; 2724 (3.89%) with ASD, 10,047 (14.36%) with speech/language delay, and 2716 (3.88%) with motor delay. Maternal infection with SARS-CoV-2 during pregnancy was not associated with an increased risk of speech/language delay or motor delay but was associated with an elevated risk of ASD among females but not males. Prenatal exposure to SARS-CoV-2 infection may increase risk for autism spectrum disorders among females. Future studies are needed to confirm and extend these findings.