Our Research

We are currently conducting studies investigating the impacts of prenatal Zika virus, SARS-CoV-2, and Lyme disease exposures on child neurodevelopment and families.

Zika Virus (ZIKV)

During the 2015-2016 Zika virus (ZIKV) epidemic in the Americas, a large number of children were born following antenatal exposure to ZIKV. About 5-12% of children born following prenatal ZIKV exposure have Congenital Zika Syndrome (CZS) evident at birth. CZS is the severe neurological phenotype of congenital ZIKV infection which is characterized by microcephaly, birth defects, developmental delays and vision and hearing abnormalities.

However, approximately 90% of children born following in utero ZIKV exposure appear healthy at birth (meaning they do not have birth defects or microcephaly) but they can be at risk for the emergence of neurodevelopmental delays or abnormalities in infancy and childhood. This has been a major focus of our lab.

Long-term Neurodevelopment of ZIKV-Exposed Children Without Congenital Zika Syndrome (NCT04398901)

For the past 10 years, our team has conducted a longitudinal study of two cohorts of children exposed to Zika virus (ZIKV) in utero in 2015-2016 who did not have any clinical symptoms of CZS at birth. One cohort of 70 children lives in the Department of Atlantico, Colombia (endemic ZIKV exposure) and our other cohort of 14 children is based in Washington, DC (travel or emigration-related exposure). We have followed the children’s neurodevelopment serially and compared it to that of non-exposed control children using both behavioral assessments and neuroimaging. The study evaluated the outcomes of these cohorts through age 7 years using a ZIKV Outcome Toolbox to assess multiple domains of neurodevelopment and cognitive functioning and with advanced brain MRI.

This study is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD102445; the DC Intellectual and Developmental Disabilities Research Center (NICHD P50HD105328-01) and Thrasher Research Fund.

More information about this study can be found on ClinicalTrials.gov.

Placental Histopathology and Neurodevelopmental Outcomes of Children with Antenatal ZIKV Exposure

We received a pilot award from the Children's National Center for Prenatal, Neonatal and Maternal Health Research to study the placental histopathology of placental samples (n=41) collected from our Colombian cohort of maternal-fetal dyads with antenatal Zika virus (ZIKV) infection. We plan to correlate the placental pathology findings with the neurodevelopmental and neuroimaging outcomes of the children. This will be among the largest reports of placental pathology following antenatal ZIKV infection. Analysis is currently in progress.

Environmental Influences on Colombian Children's Cognitive and Social-Emotional Development

We received a pilot award from the Children’s National Global Health Initiative to study child neurodevelopment at age 5 in three different locations in Colombia, including: Bogota, the large capital city with 8 million inhabitants; Barranquilla, a regional capital city with a population of 1.2 million and towns in the municipality of Sabanalarga, each with populations of less than 10,000. We assessed multi-domain neurodevelopment, in addition to collecting extensive information about the community and home environment including parental education, home and community resources, maternal and child nutrition, child school setting, family structure and socioeconomic status. Our goal was to evaluate the effect of these variables on the cognitive and social-emotional development of children between urban and rural locations.

Highlighted Publications and News Articles

• Neurodevelopmental Abnormalities in Children With In Utero Zika Virus Exposure Without Congenital Zika Syndrome
• Accounting for social and environmental drivers of neurodevelopment: lessons from a pilot study in a pediatric Colombian cohort
• School-age child neurodevelopment following antenatal Zika virus exposure
• School entry neurodevelopmental outcomes of Zika-exposed Colombian children
• Measuring preschoolers’ cognitive development in Latin America

Visit the publications page for additional articles.

SARS-CoV-2

Exposure to viral infection during pregnancy or in early life can put infants at risk of abnormal neurodevelopment. Since the beginning of the SARS-CoV-2 pandemic, Dr. Mulkey has been following the outcomes of prenatally exposed infants and supporting their healthy development.

Maternal SARS-CoV2 Infection, Placenta Biology, and Neurodevelopmental Outcomes in the Offspring

Children’s National, in collaboration with Inova Fairfax Women’s Hospital and Lieber Institute for Brain Development, is conducting a research study to assess the relationship between maternal SARS-CoV-2 infection during pregnancy and offspring neurodevelopmental outcomes. Neurodevelopmental outcomes are being assessed longitudinally with a series of standardized developmental tools from infancy to age 3 years. We are also using placental and blood specimens to identify genetic risk factors for developmental delays, as well as any pathological changes. Altogether, our study aims to develop a comprehensive understanding of the long-term effects of infectious exposure during pregnancy on child development. The study is funded by The Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD107140 and supplement 3R01HD107140-02S1 (PI:Ursini).

Highlighted Publications and News Articles

• Will SARS-CoV-2 during pregnancy impact child's neurodevelopment?
• Using telehealth to study babies born to mothers infected with SARS-CoV-2
• Pediatric research with impact: connecting families to developmental resources
• Neurodevelopment in infants with antenatal or early neonatal exposure to SARS-CoV-2

Visit the publications page for additional articles.

Lyme Disease

There are many questions about Lyme disease during pregnancy that have not yet been answered. Dr. Mulkey's research evaluates pregnancy and child outcomes after antenatal exposure to Lyme disease and seeks to understand the experience of parenting while living with Lyme disease to help families affected by Lyme and other tick-borne diseases.

Pregnancy and Neurodevelopmental Outcomes After In Utero Lyme Disease Exposure (NCT06026969)

This pilot study is the first study to systematically follow Lyme disease-exposed infants through pregnancy and childhood and track their development. We aim to see if babies exposed to Lyme disease have any differences in their brains or development as they grow up. We will also explore pregnancy outcomes associated with Lyme disease during pregnancy and see if there are differences in outcomes based on the timing of diagnosis, Lyme-related symptoms and treatment.

The main goal of the study is to assess the feasibility of recruiting pregnant women with Lyme disease and following their infants through age 18 months. This study will hopefully lay the groundwork for future research where we can learn even more about Lyme disease during pregnancy and the complexities of diagnosis, treatment and potential effects on the developing brain.

Parents' Experiences Navigating Pregnancy and Parenthood with Lyme Disease (NCT06397794)

There are many ways that Lyme disease can impact someone while they are pregnant or parenting. While no two people’s experiences are the same, we want to better understand what challenges people with Lyme disease face in their parenthood journeys- and how they overcome them. This mixed methods study is the first study to explore the experiences of pregnancy and parenting in the context of Lyme disease. The study includes those who had acute Lyme disease, post-treatment Lyme disease syndrome, and other chronic symptoms attributed to Lyme during pregnancy.

Highlighted Publications and News Articles

• New paper offers evidence of perinatal transmission of Lyme bacteria, calls for interim clinical guidance
• First-of-its-kind study on impacts of Lyme disease in pregnancy and infant development
• Examining Infant and Child Neurodevelopmental Outcomes After Lyme Disease During Pregnancy
• Promoting a Positive Relationship Between Physicians and Patients with Lyme Disease During Pregnancy and Parenthood

Visit the publications page for additional articles.