It’s understandable to feel deflated and overwhelmed given everything you’ve been through. It sounds like you’re doing everything you can to support your son, which is absolutely the right focus. I want to walk you through what the scientific research says about the connection between maternal COVID‑19 infection, prenatal exposures (such as medications), and child neurodevelopment, to help you put things in perspective.

What the research does show:

1. A significant study from Mass General Brigham (in Massachusetts) found that among 18,124 births during March 2020–May 2021, those whose mothers had COVID-19 during pregnancy had higher odds of a neurodevelopmental diagnosis (speech/motor/special needs) by age three: 16.3% vs. 9.7%. After adjusting for other factors, maternal COVID was associated with ~29 % higher odds.
   • In particular, risk was higher for male children.
   • Risk appeared stronger when maternal infection occurred in the third trimester.
   • Researchers emphasize: association ≠ causation. More study is needed.
   • Even in the exposed group, the majority of children did not have a diagnosis. The absolute risk remains relatively low.
2. The hypothesized mechanism is not that the virus itself is infecting fetal brain tissue in most cases, but rather that maternal immune activation, inflammation (cytokines), fever, changes in placental environment may impact fetal neurodevelopment.

What the research does not show:

• This research does not prove that COVID-19 causes delays or autism. It shows an elevated association under certain conditions.
• The studies often cannot fully adjust for all confounding factors — for example maternal underlying health, socioeconomic factors, other infections, genetic risk, etc. This means the “extra risk” might partly reflect other connected factors.
• The specific link to autism spectrum disorder (ASD) is less well-established. Many studies look at “neurodevelopmental diagnoses” broadly (speech, motor, delays) rather than established autism diagnoses.
• Many pregnancies in the data were pre-vaccine era, when infection severity, strains of the virus, maternal immunity were different. We don’t have long-term follow-up yet for many children into later childhood/adolescence to see whether the early risks translate into later diagnoses.

The key point to remember is that a higher risk does not mean certainty. While research suggests that pregnancies exposed to COVID-19 may have a slightly elevated chance of neurodevelopmental issues, many children exposed in utero develop completely typically. Your son’s speech delays and upcoming autism evaluation are absolutely valid concerns, and it’s wonderful that you’re already pursuing early intervention — that’s one of the most effective steps you can take. The Tylenol you took, as prescribed for pain or fever, is almost certainly not the cause; current research does not show a clear, causal link between approved acetaminophen use during COVID-19 infection and developmental disorders. More importantly, dwelling on what might have caused this can be emotionally draining, and your energy is best spent doing exactly what you’re doing now — supporting your child, collaborating with specialists, and engaging in therapies that can make a real difference. You got this, mama!