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Santos A, Sauer M, Neil AJ, Solomon IH, Hornick JL, Roberts DJ, Quade BJ, Parra-Herran C. Absence of SARS-CoV-2 Spike glycoprotein expression in placentas from individuals after mRNA SARS-CoV-2 vaccination. Mod Pathol 2022; 35:1175-1180. [PMID: 35361888 PMCID: PMC8967927 DOI: 10.1038/s41379-022-01061-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 01/09/2023]
Abstract
Current public health initiatives to contain the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) global pandemic focus on expanding vaccination efforts to include vulnerable populations such as pregnant people. Vaccines using messenger ribonucleic acid (mRNA) technology rely on translation by immune cells, primarily at the injection site. Hesitancy remains among the general population regarding the safety of mRNA vaccines during gestation, and it remains unknown whether the SARS-CoV-2 Spike protein (the product of mRNA vaccines available) accumulates in the placenta after vaccination. Objective: To determine whether Spike protein translation and accumulation occurs in placental tissue in the context of recent mRNA SARC-CoV-2 vaccination during pregnancy. We identified 48 patients receiving one or two doses of mRNA SARS-CoV-2 vaccine during gestation and used immunohistochemistry against SARS-CoV-2 Spike protein in formalin-fixed, paraffin-embedded placental tissue. One placenta, positive for SARS-CoV-2 RNA by in situ hybridization (ISH) was used as positive control. Seven term placentas collected prior to the emergence of SARS-CoV-2 served as negative controls. Eighty one percent of patients in the study group underwent third-trimester delivery; remaining had a first-trimester spontaneous abortion or elective second-trimester termination. Patients received two (52%) or one (48%) vaccine doses during pregnancy, with a median interval between latest dose and delivery of 13 days (range 2-79 days). Most (63%) cases had their latest dose within 15 days prior to delivery. All the placentas in the study and negative control groups were negative for SARS-CoV-2 immunohistochemistry. Six study cases with short vaccine-delivery intervals (2-7 days) were subjected to SARS-CoV-2 ISH and were negative. Our findings suggest that mRNA vaccines do not reach significant concentrations in the placenta given the absence of definitive SARS-CoV-2 Spike protein accumulation in placental tissue. This observation provides evidence supporting the safety of mRNA vaccines to the placental-fetal unit.
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Affiliation(s)
- Andres Santos
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Madeline Sauer
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
- Faculty of Medicine, University of Missouri, Columbia, USA
| | - Alexander J Neil
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Isaac H Solomon
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Bradley J Quade
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
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Intrauterine fetal demise as a result of maternal COVID-19 infection in the third trimester of pregnancy: A case report. Int J Surg Case Rep 2022; 98:107492. [PMID: 35979448 PMCID: PMC9372023 DOI: 10.1016/j.ijscr.2022.107492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Presentation of case Discussion Conclusion Sequela of COVID-19 during pregnancy Impact of the COVID vaccine during pregnancy Risk factors of COVID-19 infection during pregnancy, including thrombocytopenia and elevated liver enzymes Critical outcomes despite unremarkable health history, prior pregnancies, and mild presenting symptoms.
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Boncompagni A, De Agostini M, Lugli L, Ternelli G, Colonna V, Biagioni E, Bonasoni MP, Salviato T, Gabrielli L, Falconi M, Facchinetti F, Berardi A. Unexpected Vertical Transmission of SARS-CoV-2: Discordant Clinical Course and Transmission from Mother to Newborn. Microorganisms 2022; 10:1718. [PMID: 36144320 PMCID: PMC9501093 DOI: 10.3390/microorganisms10091718] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/06/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
Mother-to-newborn COVID-19 transmission is mainly postnatal, but single-case reports and small case series have also described SARS-CoV-2 transplacental transmission. Unfortunately, studies regarding vertical transmission of SARS-CoV-2 lack systematic approaches to diagnosis and classification. So far, scientific evidence seems to suggest that the severity of maternal infection increases the risk of vertical transmission. We report two neonates born from COVID-19-positive mothers, of which one of the newborns had a vertical infection. The placental involvement, and consequent intrauterine transmission of SARS-CoV-2, were inversely related to the severity of the maternal disease. The description of cases divergent from current evidence on this topic could provide new insights to better understand SARS-CoV-2 vertical transmission.
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Affiliation(s)
- Alessandra Boncompagni
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Mattia De Agostini
- Pediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, Post-Graduate School of Pediatrics, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Giliana Ternelli
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Valeria Colonna
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Emanuela Biagioni
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy
| | | | - Tiziana Salviato
- Pathology Institute, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Liliana Gabrielli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
| | - Mirella Falconi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
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54
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Pathologic Assessment of the Placenta: Evidence Compared With Tradition. Obstet Gynecol 2022; 140:341-342. [DOI: 10.1097/aog.0000000000004883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
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Redline RW, Ravishankar S, Bagby C, Saab S, Zarei S. Diffuse and Localized SARS-CoV-2 Placentitis: Prevalence and Pathogenesis of an Uncommon Complication of COVID-19 Infection During Pregnancy. Am J Surg Pathol 2022; 46:1036-1047. [PMID: 35319524 PMCID: PMC9281407 DOI: 10.1097/pas.0000000000001889] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coronavirus disease 2019 (COVID-19) infection in pregnancy has been associated with preterm delivery and preeclampsia. A less frequent and underrecognized complication is extensive placental infection which is associated with high rates of perinatal morbidity and mortality. The frequency, early pathogenesis, and range of lesions associated with this infection are poorly understood. We conducted a population-based study of placental pathology from all mothers with COVID-19 (n=271) over an 18-month period delivering within our health system. The overall prevalence of diffuse severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) placentitis, as defined by typical histology and immunohistochemical (IHC) staining for SARS-CoV-2 spike protein, was 14.8/1000, but increased to 59/1000 in preterm births. We also identified 3 cases with isolated small foci of localized SARS-CoV-2 placentitis, characterized by focal perivillous fibrin and intervillositis, which illustrate the early pathogenesis and suggest that infection may be contained in some cases. Two other placental lesions were more common in mothers with COVID-19, high-grade maternal vascular malperfusion in preterm deliveries and high-grade chronic villitis at term (5/5 cases tested of the latter were negative by IHC for SARS-CoV-2). Additional investigation of diffuse and localized SARS-CoV-2 placentitis by IHC showed loss of BCL-2, C4d staining in surrounding villi, and an early neutrophil-predominant intervillous infiltrate that later became dominated by monocyte-macrophages. We propose a model of focal infection of syncytiotrophoblast by virally infected maternal leukocytes leading to loss of BCL-2 and apoptosis. Infection is then either contained by surrounding fibrinoid (localized) or initiates waves of aponecrosis and immune activation that spread throughout the villous parenchyma (diffuse).
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Affiliation(s)
- Raymond W. Redline
- Department of Pathology, University Hospitals Cleveland Medical Center
- Departments of Pathology
- Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sanjita Ravishankar
- Department of Pathology, University Hospitals Cleveland Medical Center
- Departments of Pathology
| | - Christina Bagby
- Department of Pathology, University Hospitals Cleveland Medical Center
- Departments of Pathology
| | - Shahrazad Saab
- Department of Pathology, University Hospitals Cleveland Medical Center
- Departments of Pathology
| | - Shabnam Zarei
- Department of Pathology, University Hospitals Cleveland Medical Center
- Departments of Pathology
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Gesaka SR, Obimbo MM, Wanyoro A. Coronavirus disease 2019 and the placenta: A literature review. Placenta 2022; 126:209-223. [PMID: 35872511 PMCID: PMC9293390 DOI: 10.1016/j.placenta.2022.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/13/2022] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of multiple organs and organ systems. Due to the novelty of the disease, there is a need to review emerging literature to understand the profile of SARS-CoV-2 in the placenta. This review sought to evaluate the literature on the mediators, mechanism of entry, pathogenesis, detection, and pathology of SARS-CoV-2 in the placenta. Systematic literature searches found 96 eligible studies. Our review revealed that SARS-CoV-2 canonical mediators, angiotensin-converting enzyme-2 (ACE2), and transmembrane serine protease-2 (TMPRSS2) are variably expressed in various placenta compartments, including the villous cytotrophoblasts, syncytiotrophoblasts (STBs), and extravillous trophoblasts (EVTs) throughout pregnancy. Placental SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs), including basigin (BSG/CD147), dipeptidyl peptidase-4 (DPP4/CD26), cathepsin B/L (CTL B/L), furin, interferon-induced transmembrane protein (IFITM1-3), and lymphocyte antigen 6E (LY6E) may increase or reduce the permissiveness of the placenta to SARS-CoV-2. EVTs express genes that code for proteins that may drive viral pathogenesis in the placenta. Viral RNA, proteins, and particles were detected primarily in the STBs by in situ hybridization, immunohistochemistry, electron microscopy, and polymerase chain reaction. Placental pathology in SARS-CoV-2-infected placentas included maternal and fetal vascular malperfusion and a generally nonspecific inflammatory-immune response. The localization of SARS-CoV-2 receptors, proteases, and genes involved in coding proteins that drive viral pathogenesis in the placenta predisposes the placenta to SARS-CoV-2 infection variably in all pregnancy trimesters, with antecedent placental pathology. There is a need for further studies to explicate the mechanism of entry and pathogenesis of SARS-CoV-2 in the placenta.
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Affiliation(s)
- Samwel R Gesaka
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya.
| | - Moses M Obimbo
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya; Department of Human Anatomy, University of Nairobi, Nairobi, Kenya; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
| | - Anthony Wanyoro
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya; Department of Obstetrics and Gynecology, Kenyatta University, Nairobi, Kenya.
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Salvatore MA, Corsi Decenti E, Bonasoni MP, Botta G, Castiglione F, D’Armiento M, Fulcheri E, Nebuloni M, Donati S. Placental Characteristics of a Large Italian Cohort of SARS-CoV-2-Positive Pregnant Women. Microorganisms 2022; 10:1435. [PMID: 35889153 PMCID: PMC9317507 DOI: 10.3390/microorganisms10071435] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 12/13/2022] Open
Abstract
The variety of placental morphological findings with SARS-CoV-2 maternal infections has raised the issue of poor agreement in histopathological evaluation. The aims of this study were: to describe the histopathological placental features of a large sample of SARS-CoV-2-positive women who gave birth in Italy during the COVID-19 pandemic, to analyse the factors underlying these lesions, and to analyse the impact of placental impairment on perinatal outcomes. From 25 February 2020 to 30 June 2021, experienced perinatal pathologists examined 975 placentas of SARS-CoV-2-positive mothers enrolled in a national prospective study, adopting the Amsterdam Consensus Statement protocol. The main results included the absence of specific pathological findings for SARS-CoV-2 infections, even though a high proportion of placentas showed signs of inflammation, possibly related to a cytokine storm induced by the virus, without significant perinatal consequences. Further research is needed to better define the clinical implications of placental morphology in SARS-CoV-2 infections, but the results of this large cohort suggest that placentas do not seem to be a preferential target for the new Coronavirus infection.
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Affiliation(s)
- Michele Antonio Salvatore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità—Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (S.D.)
| | - Edoardo Corsi Decenti
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità—Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (S.D.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy
| | - Maria Paola Bonasoni
- Pathology Unit, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Giovanni Botta
- Department of Foetal and Maternal Pathology, Sant’Anna Hospital, 10126 Turin, Italy;
| | - Francesca Castiglione
- Histopathology and Molecular Diagnostics, Careggi University Hospital, 50134 Florence, Italy;
| | - Maria D’Armiento
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Ezio Fulcheri
- Fetal-Perinatal Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Giannina Gaslini, 16147 Genoa, Italy;
- Division of Anatomic Pathology, Department of Surgical and Diagnostic Sciences (DISC), University of Genova, 16132 Genova, Italy
| | - Manuela Nebuloni
- Pathology Unit, ASST Fatebenefratelli Sacco, Department of Biological and Clinical Sciences, University of Milan, 20157 Milan, Italy;
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità—Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (S.D.)
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Takada K, Shimodai-Yamada S, Suzuki M, Trinh QD, Takano C, Kawakami K, Asai-Sato M, Komatsu A, Okahashi A, Nagano N, Misawa T, Yamaguchi K, Suzuki T, Kawana K, Morioka I, Yamada H, Hayakawa S, Hao H, Komine-Aizawa S. Restriction of SARS-CoV-2 replication in the human placenta. Placenta 2022; 127:73-76. [PMID: 35973367 PMCID: PMC9293377 DOI: 10.1016/j.placenta.2022.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/13/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
Although SARS-CoV-2 can infect human placental tissue, vertical transmission is rare. Therefore, the placenta may function as a barrier to inhibit viral transmission to the foetus, though the mechanisms remain unclear. In this study, we confirmed the presence of the SARS-CoV-2 genome in human placental tissue by in situ hybridization with antisense probes targeting the spike protein; tissue staining was much lower when using sense probes for the spike protein. To the best of our knowledge, this is the first evidence directly indicating inefficient viral replication in the SARS-CoV-2-infected placenta. Additional studies are required to reveal the detailed mechanisms.
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Affiliation(s)
- Kazuhide Takada
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Japan
| | - Sayaka Shimodai-Yamada
- Division of Human Pathology, Department of Pathology and Microbiology Nihon University School of Medicine, Japan
| | - Mayumi Suzuki
- Division of Human Pathology, Department of Pathology and Microbiology Nihon University School of Medicine, Japan
| | - Quang Duy Trinh
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Japan
| | - Chika Takano
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Japan
| | - Kaori Kawakami
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Japan
| | - Atsushi Komatsu
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Japan
| | - Aya Okahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Japan
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Japan
| | - Toshiya Misawa
- Department of Obstetrics and Gynecology, Nagoya Ekisaikai Hospital, Japan
| | - Kyohei Yamaguchi
- Department of Obstetrics and Gynecology, National Hospital Organization, Mie Chuo Medical Center, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Japan
| | - Hideto Yamada
- Center for Recurrent Pregnancy Loss, Teine Keijinkai Hospital Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Satoshi Hayakawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Japan
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology Nihon University School of Medicine, Japan.
| | - Shihoko Komine-Aizawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Japan.
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Placental pathology from COVID-19-recovered (nonacute) patients. Hum Pathol 2022; 125:18-22. [PMID: 35405186 PMCID: PMC8993452 DOI: 10.1016/j.humpath.2022.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 01/31/2023]
Abstract
Placental pathology can identify characteristic features of specific infectious pathogens. The histopathology of acute SARS-CoV-2 placental infection and exposure without infection has been well described. However, whether the characteristic placental pathology persists after the acute phase of the infection is less clear. We retrospectively identified 67 COVID-19-recovered pregnant patients who had placental pathology available. After reviewing the gross and histopathology, we categorized the findings and studied the placentas for evidence of chronic infection by immunohistochemistry for the spike protein of the virus. We found these placentas showed significantly increased prevalence of maternal and a trend towards significance of fetal vascular malperfusion when compared to a control group of placentas examined for the sole indication of maternal group B streptococcal colonization. None of the COVID-19-recovered placentas showed expression of the viral spike protein; therefore, we found no evidence of persistent infection of the placenta in women with a history of COVID-19 during their pregnancy. We conclude that recovery from a SARS-CoV-2 infection during pregnancy puts the pregnancy at risk for specific pathology.
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60
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Timi P, Kellerhals SE, Joseph NT, Dude CM, Verkerke HP, Irby LS, Smith AK, Stowell SR, Jamieson DJ, Badell ML. Placental Injury and Antibody Transfer Following COVID-19 Disease in Pregnancy. J Infect Dis 2022; 227:850-854. [PMID: 35767286 PMCID: PMC9384443 DOI: 10.1093/infdis/jiac270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
We examined the relationship between placental histopathology and transplacental antibody transfer in pregnant patients following SARS-CoV-2 infection. Differences in plasma concentrations of anti-Receptor Biding Domain (RBD) Immunoglobulin (Ig) G antibodies in maternal and cord blood were analyzed according to presence of placental injury. Median [IQR] anti-RBD IgG concentrations in cord blood with placental injury (n = 7) did not differ significantly from those without injury (n= 16) [(2.7 [1.8,3.6] vs 2.7[2.4, 2.9], p= 0.59). However, they were associated with lower transfer ratios (median [IQR] 0.77[0.61, 0.97] vs. 0.97[0.80, 1.01], p = 0.05) suggesting that SARS-CoV-2 placental injury mediates reduced maternal-fetal antibody transfer.
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Affiliation(s)
| | | | - Naima T Joseph
- Correspondence: Naima T. Joseph, MD, MPH, Beth Israel Deaconess Medical Center, Harvard Medical Center, Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, 330 Brookline Ave, Kirstein 3rd floor, Boston, MA 02215 ()
| | - Carolynn M Dude
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hans P Verkerke
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Les’Shon S Irby
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sean R Stowell
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Martina L Badell
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Horn LC, Krücken I, Hiller GGR, Niedermair M, Perac K, Pietsch C, Höhn AK. Placental pathology in sudden intrauterine death (SIUD) in SARS-CoV-2-positive oligosymptomatic women. Arch Gynecol Obstet 2022; 307:1811-1822. [PMID: 35716208 PMCID: PMC9206072 DOI: 10.1007/s00404-022-06614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/05/2022] [Indexed: 11/21/2022]
Abstract
Background Pregnant women are also susceptible to SARS-CoV-2. Although an infection of the placenta may be rare, pregnancy may occasionally be affected by intrauterine failure. The knowledge of placental morphology on sudden intrauterine demise is still limited. Methods Fetal and placental tissue of two cases of sudden intrauterine death in the second trimester were analysed morphologically and by immunohistochemistry. One case was evaluated by RT-PCR. Results Both mothers were tested positive for the Alpha variant of SARS-CoV-2 but were oligosymptomatic for COVID-19. Unexpected sudden intrauterine death (SIUD) occurred at 15 + 2 and 27 + 3 weeks of gestation. One fetus demonstrated an intrauterine growth restriction. No malformations nor inflammatory changes were observed in either fetus on autopsy. In contrast to the placentas, the fetal tissue was negative for SARS-CoV-2 on immunohistochemical and RT-PCR analyses. Macroscopically, the placentas showed an increased consistency with a white, reticular cutting surface covering about 95% of the whole placenta. Only very focal histiocytic chronic intervillositis was noted histologically. Massive perivillous fibrin deposits with extensive necroses of the villous trophoblast were present in more than 90% of the placental tissue. Immunohistochemical staining was strong and diffusely positive for SARS-CoV-2 in the villous trophoblast and rarely within the villous stromal cells. Placental SARS-CoV-2 infection was confirmed by RT-PCR. Conclusion Sudden intrauterine death may occur in mothers who are oligosymptomatic for COVID-19. Acute placental failure is responsible for SIUD, demonstrated by massive perivillous fibrin deposits and extensive necroses of the villous trophoblast with SARS-CoV-2-positivity based on immunohistochemical staining and RT-PCR. Detailed histopathological examination of placental and fetal tissue is mandatory to verify SARS-CoV-2 and to evaluate the pathogenesis and functionality of this disease.
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Affiliation(s)
- Lars-Christian Horn
- Division of Breast Gynecologic and Perinatal Pathology, Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany.
| | - Irene Krücken
- Division of Breast Gynecologic and Perinatal Pathology, Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany
| | - Grit Gesine Ruth Hiller
- Division of Breast Gynecologic and Perinatal Pathology, Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany
| | - Maria Niedermair
- Institute of Clinical and Molecular Pathology, City Hospital Wels-Grieskirchen, Grieskirchen, Austria
| | - Kristina Perac
- Institute of Clinical and Molecular Pathology, City Hospital Wels-Grieskirchen, Grieskirchen, Austria
| | - Corinna Pietsch
- Institute of Medical Microbiology and Virology, University Hospital of Leipzig, Leipzig, Germany
| | - Anne Kathrin Höhn
- Division of Breast Gynecologic and Perinatal Pathology, Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany
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Terry J, Bedaiwy MA. Placental interferon signaling is involved in chronic intervillositis of unknown etiology. Placenta 2022; 124:5-11. [DOI: 10.1016/j.placenta.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
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Response to "Diffuse trophoblast damage is the hallmark of SARS-CoV-2-associated fetal demise.". Mod Pathol 2022; 35:850-851. [PMID: 34845304 PMCID: PMC8629101 DOI: 10.1038/s41379-021-00975-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/18/2023]
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64
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Abstract
The Amsterdam Placental Workshop Group Consensus Statement on Sampling and Definitions of Placental Lesions has become widely accepted and is increasingly used as the universal language to describe the most common pathologic lesions found in the placenta. This review summarizes the most salient aspects of this seminal publication and the subsequent emerging literature based on Amsterdam definitions and criteria, with emphasis on publications relating to diagnosis, grading, and staging of placental pathologic conditions. We also provide an overview of the recent expert recommendations on the pathologic grading of placenta accreta spectrum, with insights on their clinical context. Finally, we discuss the emerging entity of SARS-CoV2 placentitis.
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65
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Ward J, Cornaby C, Kato T, Gilmore R, Bunch D, Miller M, Boucher R, Schmitz J, Askin F, Scanga L. The clinical impact of maternal COVID-19 on mothers, their infants, and placentas with an analysis of vertical transfer of maternal SARS-CoV-2-specific IgG antibodies. Placenta 2022; 123:12-23. [PMID: 35512490 PMCID: PMC9057562 DOI: 10.1016/j.placenta.2022.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/17/2022] [Accepted: 04/28/2022] [Indexed: 12/12/2022]
Abstract
Introduction The effect of SARS-CoV-2 severity or the trimester of infection in pregnant mothers, placentas, and infants is not fully understood. Methods A retrospective, observational cohort study in Chapel Hill, NC of 115 mothers with SARS-CoV-2 and singleton pregnancies from December 1, 2019 to May 31, 2021 via chart review to document the infants’ weight, length, head circumference, survival, congenital abnormalities, hearing loss, maternal complications, and placental pathology classified by the Amsterdam criteria. Results Of the 115 mothers, 85.2% were asymptomatic (n = 37) or had mild (n = 61) symptoms, 13.0% had moderate (n = 9) or severe (n = 6) COVID-19, and 1.74% (n = 2) did not have symptoms recorded. Moderate and severe maternal infections were associated with increased C-section, premature delivery, infant NICU admission, and were more likely to occur in Type 1 (p = 0.0055) and Type 2 (p = 0.0285) diabetic mothers. Only one infant (0.870%) became infected with SARS-CoV-2, which was not via the placenta. Most placentas (n = 63, 54.8%) did not show specific histologic findings; however, a subset showed mild maternal vascular malperfusion (n = 26, 22.6%) and/or mild microscopic ascending intrauterine infection (n = 28, 24.3%). The infants had no identifiable congenital abnormalities, and all infants and mothers survived. Discussion Most mothers and their infants had a routine clinical course; however, moderate and severe COVID-19 maternal infections were associated with pregnancy complications and premature delivery. Mothers with pre-existing, non-gestational diabetes were at greatest risk of developing moderate or severe COVID-19. The placental injury patterns of maternal vascular malperfusion and/or microscopic ascending intrauterine infection were not associated with maternal COVID-19 severity.
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66
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Abstract
SARS-CoV-2 infection poses increased risks of poor outcomes during pregnancy, including preterm birth and stillbirth. There is also developing concern over the effects of SARS-CoV-2 infection on the placenta, and these effects seem to vary between different viral variants. Despite these risks, many pregnant individuals have been reluctant to be vaccinated against the virus owing to safety concerns. We now have extensive data confirming the safety and effectiveness of COVID-19 vaccination during pregnancy, although it will also be necessary to determine the effectiveness of these vaccines specifically against newly emerging viral variants, including Omicron. In this Progress article, I cover recent developments in our understanding of the risks of SARS-CoV-2 infection in pregnancy, and how vaccination can reduce these.
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Affiliation(s)
- Victoria Male
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
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67
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Almohammadi NH. A review of the main placenta histopathological findings reported in coronavirus disease 2019. J Taibah Univ Med Sci 2022; 17:165-173. [PMID: 35250425 PMCID: PMC8879984 DOI: 10.1016/j.jtumed.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 12/30/2022] Open
Abstract
Several studies have reported that pregnant women are more susceptible to contracting the SARS-CoV-2 disease. However, SARS-CoV-2 infection studies have limited evidence regarding its impact on pregnancy, particularly its pathological effects on the maternal-fetal interface. This review emphasized the placental structures and immunomodulatory defense mechanism against the viral infection COVID and highlighted the spectrum of reported histopathological changes from SARS-CoV-2-infected mothers' placenta to contribute to the knowledge of the nature of this placental pathology. Further studies where collaborations that seek to maximize sample numbers analyzed can be performed to improve the generalizability and reliability of the findings. This can lead to improved knowledge on the relationship between placental dysfunction and pathology from maternal SARS-CoV-2 infection. Consequently, this can help improve maternity care delivery during the pandemic.
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Affiliation(s)
- Nawal H. Almohammadi
- Department of Pathology, Faculty of Medicine, Taibah University, Madinah, KSA
- Department of Histopathology, Prince Sultan Armed Forces Hospital, Madinah, KSA
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68
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Shook LL, Brigida S, Regan J, Flynn JP, Mohammadi A, Etemad B, Siegel MR, Clapp MA, Li JZ, Roberts DJ, Edlow AG. SARS-CoV-2 Placentitis Associated With B.1.617.2 (Delta) Variant and Fetal Distress or Demise. J Infect Dis 2022; 225:754-758. [PMID: 35024844 PMCID: PMC8807229 DOI: 10.1093/infdis/jiac008] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
There is limited information on the specific impact of maternal infection with the SARS-CoV-2 B.1.617.2 (delta) variant on pregnancy outcomes. We present 2 cases of intrauterine fetal demise and 1 case of severe fetal distress in the setting of maternal infection with delta-variant SARS-CoV-2. In all cases, fetal demise or distress occurred within 14 days of COVID-19 diagnosis. Evaluation revealed maternal viremia, high nasopharyngeal viral load, evidence of placental infection with delta-variant SARS-CoV-2, and hallmark features of SARS-CoV-2 placentitis. We suggest that delta-variant SARS-CoV-2 infection during pregnancy warrants vigilance for placental dysfunction and fetal compromise regardless of disease severity.
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Affiliation(s)
- Lydia L Shook
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara Brigida
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Regan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James P Flynn
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abbas Mohammadi
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Behzad Etemad
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly R Siegel
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Clapp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Z Li
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea G Edlow
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
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69
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Khalil A, Blakeway H, Samara A, O'Brien P. COVID-19 and stillbirth: direct vs indirect effect of the pandemic. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:288-295. [PMID: 34951732 DOI: 10.1002/uog.24846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - H Blakeway
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Samara
- Division of Clinical Paediatrics, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
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70
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Huynh A, Sehn JK, Goldfarb IT, Watkins J, Torous V, Heerema-McKenney A, Roberts DJ. SARS-CoV-2 Placentitis and Intraparenchymal Thrombohematomas Among COVID-19 Infections in Pregnancy. JAMA Netw Open 2022; 5:e225345. [PMID: 35311965 PMCID: PMC8938715 DOI: 10.1001/jamanetworkopen.2022.5345] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This cases series examines SARS-CoV-2 placentitis and intraparenchymal thrombohematomas among COVID-19 infections during pregnancy.
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Affiliation(s)
- Anh Huynh
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Jennifer K. Sehn
- Department of Pathology, St Louis University School of Medicine, St Louis, Missouri
| | - Ilona Telefus Goldfarb
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston
| | - Jaclyn Watkins
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Vanda Torous
- Department of Pathology, Massachusetts General Hospital, Boston
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71
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Eich ML, Menter T, Mokwa NF, Grüttner B, Müller AM. Intrauteriner Fruchttod bei massiver SARS-CoV-2-assoziierter („severe acute respiratory syndrome coronavirus 2“) plazentarer maternaler Malperfusion im Rahmen einer SARS-CoV-2-Plazentitis. DER PATHOLOGE 2022; 43:135-139. [PMID: 34913103 PMCID: PMC8673691 DOI: 10.1007/s00292-021-01035-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/31/2022]
Abstract
Wir berichten über die Befunde einer Plazenta der 31. Schwangerschaftswoche bei intrauterinem Fruchttod (IUFT) mit ungewöhnlich ausgeprägter maternaler Malperfusion und chronisch-histiozytärer Intervillositis im Sinn einer SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Plazentitis. Mikrobiologisch sowie mittels Realtime-PCR wurde SARS-CoV-2- und B‑beta-Coronavirus-spezifische RNA am Plazenta‑, Nabelschnur- und Eihautgewebe nachgewiesen. Die bei SARS-CoV-2-Infektion inzwischen wiederholt beschriebene maternale Malperfusion ist in der vorliegenden Ausprägung Ausprägung im Rahmen einer schweren SARS-CoV-2-Plazentitis ungewöhnlich. Es betont die Notwendigkeit einer maternalen Thromboembolieprophylaxe.
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Affiliation(s)
- Marie-Lisa Eich
- Institut für Pathologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Thomas Menter
- Pathologie, Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Universität Basel, Basel, Schweiz
| | - Nils Fabian Mokwa
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Köln, Köln, Deutschland
| | - Berthold Grüttner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Köln, Köln, Deutschland
| | - Annette M Müller
- Praxis für Pathologie/Zentrum für Kinderpathologie an der Uniklinik Köln, Köln, Deutschland
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72
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Reagan-Steiner S, Bhatnagar J, Martines RB, Milligan NS, Gisondo C, Williams FB, Lee E, Estetter L, Bullock H, Goldsmith CS, Fair P, Hand J, Richardson G, Woodworth KR, Oduyebo T, Galang RR, Phillips R, Belyaeva E, Yin XM, Meaney-Delman D, Uyeki TM, Roberts DJ, Zaki SR. Detection of SARS-CoV-2 in Neonatal Autopsy Tissues and Placenta. Emerg Infect Dis 2022; 28:510-517. [PMID: 35138244 PMCID: PMC8888232 DOI: 10.3201/eid2803.211735] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Severe coronavirus disease in neonates is rare. We analyzed clinical, laboratory, and autopsy findings from a neonate in the United States who was delivered at 25 weeks of gestation and died 4 days after birth; the mother had asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and preeclampsia. We observed severe diffuse alveolar damage and localized SARS-CoV-2 by immunohistochemistry, in situ hybridization, and electron microscopy of the lungs of the neonate. We localized SARS-CoV-2 RNA in neonatal heart and liver vascular endothelium by using in situ hybridization and detected SARS-CoV-2 RNA in neonatal and placental tissues by using reverse transcription PCR. Subgenomic reverse transcription PCR suggested viral replication in lung/airway, heart, and liver. These findings indicate that in utero SARS-CoV-2 transmission contributed to this neonatal death.
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Affiliation(s)
| | | | - Roosecelis B. Martines
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Nicholas S. Milligan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Carly Gisondo
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Frank B. Williams
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Elizabeth Lee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Lindsey Estetter
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Hannah Bullock
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Cynthia S. Goldsmith
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Pamela Fair
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Julie Hand
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Gillian Richardson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Kate R. Woodworth
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Titilope Oduyebo
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Romeo R. Galang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Rebecca Phillips
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Elizaveta Belyaeva
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Xiao-Ming Yin
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Dana Meaney-Delman
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Timothy M. Uyeki
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Drucilla J. Roberts
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Sherif R. Zaki
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
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Stillbirth after COVID-19 in Unvaccinated Mothers Can Result from SARS-CoV-2 Placentitis, Placental Insufficiency, and Hypoxic Ischemic Fetal Demise, Not Direct Fetal Infection: Potential Role of Maternal Vaccination in Pregnancy. Viruses 2022; 14:v14030458. [PMID: 35336864 PMCID: PMC8950737 DOI: 10.3390/v14030458] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
Stillbirth is a recently recognized complication of COVID-19 in pregnant women. Other congenitally transmitted infections from viruses, bacteria and parasites can cause stillbirth by infecting fetal organs following transplacental transmission of the agent from the maternal bloodstream. However, recent research on pregnant women with COVID-19 having stillbirths indicates that there is another mechanism of stillbirth that can occur in placentas infected with SARS-CoV-2. In these cases, viral infection of the placenta results in SARS-CoV-2 placentitis, a combination of concurrent destructive findings that include increased fibrin deposition which typically reaches the level of massive perivillous fibrin deposition, chronic histiocytic intervillositis and trophoblast necrosis. These three pathological lesions, in some cases together with placental hemorrhage, thrombohematomas and villitis, result in severe and diffuse placental parenchymal destruction. This pathology can involve greater than one-half of the placental volume, averaging 77% in the largest study of 68 cases, effectively rendering the placenta incapable of performing its function of oxygenating the fetus. This destructive placental process can lead to stillbirth and neonatal death via malperfusion and placental insufficiency which is independent of fetal infection. Fetal autopsies show no evidence that direct infection of fetal organs is contributory. Because all mothers examined have been unvaccinated, maternal vaccination may prevent viremia and consequent placental infection.
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74
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Ramey-Collier K, Craig AM, Hall A, Weaver KE, Wheeler SM, Gilner JB, Swamy GK, Hughes BL, Dotters-Katz SK. Symptomatic versus asymptomatic COVID-19: does it impact placental vasculopathy? J Matern Fetal Neonatal Med 2022; 35:9460-9462. [PMID: 35172668 DOI: 10.1080/14767058.2022.2041597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study sought to assess the impact of COVID-19 on placental vasculature in the context of maternal symptomatology - comparing asymptomatic to symptomatic pregnant patients - and disease severity - comparing pregnant patients with mild, moderate, severe, and critical COVID-19 infection. PCR-confirmed COVID-19 positive pregnant patients in a single health system who delivered between 3/2020-5/2021 included. All patients had positive COVID test and delivered during the study period. Primary outcome was incidence of any vascular malperfusion on placental pathology. Secondary outcomes were FVM and MVM on placental pathology. Placental pathology compared between symptomatic (sCOVID) and asymptomatic (aCOVID) patients. Secondary analysis of symptomatic patients, comparing placental pathology between mild disease(mCOVID) and worse disease(moderate, severe, or critical-defined by 2020 NIH guidelines) (dCOVID), also performed. Of 112 patients, 53 (47%) had symptoms. Twenty-seven (24.1%) patients had evidence of vascular malperfusion; 26 (23.2%) had MVM. When comparing aCOVID and sCOVID patients, no difference in rate of vascular malperfusion identified, nor any differences in rates of FVM or MVM. Among sCOVID patients (n = 53), 39 (74%) had mCOVID and 14 (26%) had dCOVID (moderate n = 4, severe n = 9, critical n = 1). Patients with dCOVID had earlier median delivery GA (37.4wks vs 39.2wks, p = .03). No difference in latency from diagnosis to delivery seen between mCOVID and dCOVID groups (4.4 vs 3.0wks, p = .96). Twelve (30.8%) patients had vascular malperfusion on pathology, all had mCOVID (p = .02). Eleven (28.2%) mCOVID patients had MVM; no dCOVID patients had evidence of vascular malperfusion (p = .03). No difference in FVM was found between cohorts. Symptomatic COVID-19 infection did not impact placental vasculature differently than asymptomatic infection, even when stratifying by trimester of infection. Among pregnant patients with symptomatic COVID-19, mild disease was associated with placental vascular changes on the maternal side while severe disease was not. Further studies are needed to understand the implications of these findings.
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Affiliation(s)
| | - Amanda M Craig
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Allison Hall
- Formerly of Department of Pathology, Duke University, Durham, NC, USA
| | - Kristin E Weaver
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Sarahn M Wheeler
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Jennifer B Gilner
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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75
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Shimao Y, Yamauchi A, Ohtsuka T, Terao K, Kodama Y, Yamada N, Asada Y, Sato Y. C4d deposition and CD39 downregulation in the placental infection by SARS-CoV-2. Pathol Int 2022; 72:267-269. [PMID: 35165981 PMCID: PMC9115534 DOI: 10.1111/pin.13214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Yoshiya Shimao
- Departments of Diagnostic Pathology, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Aya Yamauchi
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Teruo Ohtsuka
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Kiminari Terao
- Department of Obstetrics and Gynecology, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Yuki Kodama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Miyazaki University Hospital, University of Miyazaki, Miyazaki, Japan
| | - Naoshi Yamada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Miyazaki University Hospital, University of Miyazaki, Miyazaki, Japan
| | - Yujiro Asada
- Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital, University of Miyazaki, Miyazaki, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital, University of Miyazaki, Miyazaki, Japan
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76
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Schwartz DA, Avvad-Portari E, Babál P, Baldewijns M, Blomberg M, Bouachba A, Camacho J, Collardeau-Frachon S, Colson A, Dehaene I, Ferreres JC, Fitzgerald B, Garrido-Pontnou M, Gerges H, Hargitai B, Helguera-Repetto AC, Holmström S, Irles CL, Leijonhfvud Å, Libbrecht S, Marton T, McEntagart N, Molina JT, Morotti R, Nadal A, Navarro A, Nelander M, Oviedo A, Oyamada Otani AR, Papadogiannakis N, Petersen AC, Roberts DJ, Saad AG, Sand A, Schoenmakers S, Sehn JK, Simpson PR, Thomas K, Valdespino-Vázquez MY, van der Meeren LE, Van Dorpe J, Verdijk RM, Watkins JC, Zaigham M. Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries. Arch Pathol Lab Med 2022; 146:660-676. [PMID: 35142798 DOI: 10.5858/arpa.2022-0029-sa] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Perinatal death is an increasingly important problem as the COVID-19 pandemic continues, but the mechanism of death has been unclear. OBJECTIVE.— To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for SARS-CoV-2. DESIGN.— Case-based retrospective clinico-pathological analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. RESULTS.— All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25/68) and chronic villitis (32%; 22/68). The majority (19, 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. CONCLUSIONS.— The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
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Affiliation(s)
| | - Elyzabeth Avvad-Portari
- Department of Pathology, Fernandes Figueira Institute, FIOCRUZ - Rio de Janeiro, Brazil (Avvad-Portari)
| | - Pavel Babál
- Department of Pathology, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Babál)
| | - Marcella Baldewijns
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns)
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden (Blomberg)
| | - Amine Bouachba
- Institut de Pathologie Multisite des Hospices Civils de Lyon, Lyon, France; SOFFOET-Société Française de Foetopathologie, Paris, France (Bouachba)
| | - Jessica Camacho
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Camacho)
| | - Sophie Collardeau-Frachon
- Department of Pathology, Hopital Femme-Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 and SOFFOET-Société Française de Foetopathologie, Paris France (Collardeau-Frachon)
| | - Arthur Colson
- Department of Obstetrics, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium (Colson)
| | - Isabelle Dehaene
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Dehaene)
| | - Joan Carles Ferreres
- Pathology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Barcelona, Spain (Ferreres)
| | - Brendan Fitzgerald
- Department of Pathology, Cork University Hospital, Wilton, Cork, Republic of Ireland (Fitzgerald)
| | - Marta Garrido-Pontnou
- Pathology Department, Hospital Universitari Vall d'Hebron, Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain (Garrido-Pontnou)
| | - Hazem Gerges
- Department of Obstetrics and Gynaecology, Doncaster and Bassetlaw NHS Teaching Hospitals, Women's Hospital, Doncaster, United Kingdom (Gerges)
| | - Beata Hargitai
- Division of Perinatal Pathology, Department of Cellular Pathology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Hargitai)
| | - A Cecilia Helguera-Repetto
- Immunobiochemistry Department, National Institute of Perinatology, Mexico City, Mexico (Helguera-Repetto)
| | - Sandra Holmström
- Department of Obstetrics and Gynaecology, Halland Hospital, Varberg, Sweden (Holmström)
| | - Claudine Liliane Irles
- Department of Physiology and Cellular Development, National Institute of Perinatology "Isidro Espinosa de los Reyes", Mexico City, Mexico (Irles)
| | - Åsa Leijonhfvud
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science Helsingborg, Lund University, Lund, Sweden (Leijonhfvud)
| | - Sasha Libbrecht
- Department of Pathological Anatomy, Antwerp University Hospital, Edegem, Belgium (Libbrecht)
| | - Tamás Marton
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham, United Kingdom (Marton)
| | - Noel McEntagart
- Histopathology, Rotunda Hospital, Dublin, Republic of Ireland (McEntagart)
| | - James T Molina
- Pathology and Laboratory Medicine, CHRISTUS Hospital St. Elizabeth, 2830 Calder St, Beaumont, Texas (Molina)
| | - Raffaella Morotti
- Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, Connecticut (Morotti)
| | - Alfons Nadal
- Pathology Department, Hospital Clínic, Barcelona, Spain (Nadal).,Department of Basic Clinical Practice, School of Medicine, Universitat de Barcelona, and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (Nadal)
| | - Alexandra Navarro
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Navarro)
| | - Maria Nelander
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Nelander)
| | - Angelica Oviedo
- Department of Pathology and Laboratory Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico (Oviedo)
| | | | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Department of Pathology, Karolinska University Hospital, Stockholm, Sweden (Papadogiannakis)
| | - Astrid C Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark (Petersen)
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Roberts)
| | - Ali G Saad
- Pediatric Pathology and Neuropathology, Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, Florida (Saad)
| | - Anna Sand
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Obstetrics and Gynaecology, Karolinska University Hospital, Solna, Stockholm, Sweden (Sand)
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Schoenmakers)
| | - Jennifer K Sehn
- Department of Pathology, St. Louis University School of Medicine, St. Louis, Missouri (Sehn)
| | - Preston R Simpson
- Department of Pathology, CHRISTUS Hospital St. Elizabeth, 2830 Calder St., Beaumont, Texas (Simpson)
| | - Kristen Thomas
- Department of Pathology, NYU Langone Health - Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, New York (Thomas)
| | | | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (van der Meeren).,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands (van der Meeren)
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium (Van Dorpe)
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Verdijk)
| | - Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Watkins)
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Institution of Clinical Sciences Lund, Lund University, Sweden (Zaigham).,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden (Zaigham)
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77
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González-Mesa E, García-Fuentes E, Carvia-Pontiasec R, Lavado-Fernández AI, Cuenca-Marín C, Suárez-Arana M, Blasco-Alonso M, Benítez-Lara B, Mozas-Benítez L, González-Cazorla A, Egeberg-Neverdal H, Jiménez-López JS. Transmitted Fetal Immune Response in Cases of SARS-CoV-2 Infections during Pregnancy. Diagnostics (Basel) 2022; 12:diagnostics12020245. [PMID: 35204335 PMCID: PMC8870756 DOI: 10.3390/diagnostics12020245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Little is known about the effects of SARS-CoV-2 on the placenta, and whether the maternal inflammatory response is transmitted vertically. This research aims to provide information about the effects of SARS-CoV-2 infection on maternal and fetal immunity. (2) Methods: We have studied placental changes and humoral and cellular immunity in maternal and umbilical cord blood (UCB) samples from a group of pregnant women delivering after the diagnosis of SARS-CoV-2 infection during pregnancy. IgG and IgM SARS-CoV-2 antibodies, Interleukin 1b (IL1b), Interleukin 6 (IL6), and gamma-Interferon (IFN-γ), have been studied in the UCB samples. Lymphocyte subsets were studied according to CD3, CD8, CD4, CD34, and invariant natural Killer T cells (iNKT) markers. We used in situ hybridization techniques for the detection of viral RNA in placentas. (3) Results: During the study period, 79 pregnant women and their corresponding newborns were recruited. The main gestational age at the time of delivery was 39.1 weeks (SD 1.3). We did not find traces of the SARS-CoV-2 virus RNA in any of the analyzed placental samples. Detectable concentrations of IgG anti-SARS-CoV-2 antibodies, IL1b, IL6, and IFN-γ, in UCB were found in all cases, but IgM antibodies anti-ARS-CoV-2 were systematically undetectable. We found significant correlations between fetal CD3+ mononuclear cells and UCB IgG concentrations. We also found significant correlations between UCB IgG concentrations and fetal CD3+/CD4+, as well as CD3+/CD8+ T cells subsets. We also discovered that fetal CD3+/CD8+ cell counts were significantly higher in those cases with placental infarctions. (4) Conclusion: we have not verified the placental transfer of SARS-CoV-2. However, we have discovered that a significant immune response is being transmitted to the fetus in cases of SARS-CoV-2 maternal infection.
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Affiliation(s)
- Ernesto González-Mesa
- Biochemistry and Inmunology Department, Malaga Biomedical Research Institute-IBIMA, University of Málaga, Surgical Specialities, 29010 Málaga, Spain; (B.B.-L.); (L.M.-B.); (A.G.-C.); (H.E.-N.); (J.S.J.-L.)
- Obstetrics and Gynecology Department, Málaga Regional Maternity Hospital (SSPA), 29010 Málaga, Spain; (C.C.-M.); (M.S.-A.); (M.B.-A.)
- Correspondence:
| | - Eduardo García-Fuentes
- Digestive System Clinical Management Unit, Malaga Biomedical Research Institute-IBIMA, Virgen de la Victoria University Hospital, 29010 Málaga, Spain;
| | - Rafael Carvia-Pontiasec
- Provincial Unit of Pathological Anatomy of Malaga, Regional University Hospital of Malaga, SSPA, 29010 Málaga, Spain; (R.C.-P.); (A.I.L.-F.)
| | - Ana I. Lavado-Fernández
- Provincial Unit of Pathological Anatomy of Malaga, Regional University Hospital of Malaga, SSPA, 29010 Málaga, Spain; (R.C.-P.); (A.I.L.-F.)
| | - Celia Cuenca-Marín
- Obstetrics and Gynecology Department, Málaga Regional Maternity Hospital (SSPA), 29010 Málaga, Spain; (C.C.-M.); (M.S.-A.); (M.B.-A.)
| | - María Suárez-Arana
- Obstetrics and Gynecology Department, Málaga Regional Maternity Hospital (SSPA), 29010 Málaga, Spain; (C.C.-M.); (M.S.-A.); (M.B.-A.)
| | - Marta Blasco-Alonso
- Obstetrics and Gynecology Department, Málaga Regional Maternity Hospital (SSPA), 29010 Málaga, Spain; (C.C.-M.); (M.S.-A.); (M.B.-A.)
| | - Blanca Benítez-Lara
- Biochemistry and Inmunology Department, Malaga Biomedical Research Institute-IBIMA, University of Málaga, Surgical Specialities, 29010 Málaga, Spain; (B.B.-L.); (L.M.-B.); (A.G.-C.); (H.E.-N.); (J.S.J.-L.)
| | - Laura Mozas-Benítez
- Biochemistry and Inmunology Department, Malaga Biomedical Research Institute-IBIMA, University of Málaga, Surgical Specialities, 29010 Málaga, Spain; (B.B.-L.); (L.M.-B.); (A.G.-C.); (H.E.-N.); (J.S.J.-L.)
| | - Ana González-Cazorla
- Biochemistry and Inmunology Department, Malaga Biomedical Research Institute-IBIMA, University of Málaga, Surgical Specialities, 29010 Málaga, Spain; (B.B.-L.); (L.M.-B.); (A.G.-C.); (H.E.-N.); (J.S.J.-L.)
| | - Herink Egeberg-Neverdal
- Biochemistry and Inmunology Department, Malaga Biomedical Research Institute-IBIMA, University of Málaga, Surgical Specialities, 29010 Málaga, Spain; (B.B.-L.); (L.M.-B.); (A.G.-C.); (H.E.-N.); (J.S.J.-L.)
| | - Jesús S. Jiménez-López
- Biochemistry and Inmunology Department, Malaga Biomedical Research Institute-IBIMA, University of Málaga, Surgical Specialities, 29010 Málaga, Spain; (B.B.-L.); (L.M.-B.); (A.G.-C.); (H.E.-N.); (J.S.J.-L.)
- Obstetrics and Gynecology Department, Málaga Regional Maternity Hospital (SSPA), 29010 Málaga, Spain; (C.C.-M.); (M.S.-A.); (M.B.-A.)
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78
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Beesley MA, Davidson JR, Panariello F, Shibuya S, Scaglioni D, Jones BC, Maksym K, Ogunbiyi O, Sebire NJ, Cacchiarelli D, David AL, De Coppi P, Gerli MFM. COVID-19 and vertical transmission: assessing the expression of ACE2/TMPRSS2 in the human fetus and placenta to assess the risk of SARS-CoV-2 infection. BJOG 2022; 129:256-266. [PMID: 34735736 PMCID: PMC8652560 DOI: 10.1111/1471-0528.16974] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pregnant women have been identified as a potentially at-risk group concerning COVID-19 infection, but little is known regarding the susceptibility of the fetus to infection. Co-expression of ACE2 and TMPRSS2 has been identified as a prerequisite for infection, and expression across different tissues is known to vary between children and adults. However, the expression of these proteins in the fetus is unknown. METHODS We performed a retrospective analysis of a single cell data repository. The data were then validated at both gene and protein level by performing RT-qPCR and two-colour immunohistochemistry on a library of second-trimester human fetal tissues. FINDINGS TMPRSS2 is present at both gene and protein level in the predominantly epithelial fetal tissues analysed. ACE2 is present at significant levels only in the fetal intestine and kidney, and is not expressed in the fetal lung. The placenta also does not co-express the two proteins across the second trimester or at term. INTERPRETATION This dataset indicates that the lungs are unlikely to be a viable route of SARS-CoV2 fetal infection. The fetal kidney, despite presenting both the proteins required for the infection, is anatomically protected from the exposure to the virus. However, the gastrointestinal tract is likely to be susceptible to infection due to its high co-expression of both proteins, as well as its exposure to potentially infected amniotic fluid. TWEETABLE ABSTRACT This work provides detailed mechanistic insight into the relative protection & vulnerabilities of the fetus & placenta to SARS-CoV-2 infection by scRNAseq & protein expression analysis for ACE2 & TMPRSS2. The findings help to explain the low rate of vertical transmission.
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Affiliation(s)
- MA Beesley
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
| | - JR Davidson
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
- EGA Institute for Women’s HealthUniversity College LondonUK
| | - F Panariello
- Telethon Institute of Genetics and Medicine (TIGEM)Armenise/Harvard Laboratory of Integrative GenomicsPozzuoliItaly
| | - S Shibuya
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
| | - D Scaglioni
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
| | - BC Jones
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
| | - K Maksym
- EGA Institute for Women’s HealthUniversity College LondonUK
| | - O Ogunbiyi
- NIHR Great Ormond Street Biomedical Research CentreLondonUK
| | - NJ Sebire
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
- Department of Translational MedicineUniversity of Naples ‘Federico II’NaplesItaly
| | - D Cacchiarelli
- Telethon Institute of Genetics and Medicine (TIGEM)Armenise/Harvard Laboratory of Integrative GenomicsPozzuoliItaly
- Department of Translational MedicineUniversity of Naples ‘Federico II’NaplesItaly
| | - AL David
- EGA Institute for Women’s HealthUniversity College LondonUK
- Fetal Medicine UnitUniversity College London NHS Foundation TrustLondonUK
| | - P De Coppi
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
- NIHR Great Ormond Street Biomedical Research CentreLondonUK
- Great Ormond Street Hospital for ChildrenLondonUK
| | - MFM Gerli
- Great Ormond Street Institute of Child HealthUniversity College LondonUK
- UCL Division of Surgery and Interventional ScienceRoyal Free HospitalLondonUK
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79
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Rakheja D, Treat K, Timmons CF, Carrillo D, Miller SE, Stroberg E, Barton LM, Duval EJ, Mukhopadhyay S. SARS-CoV-2 Immunohistochemistry In Placenta. Int J Surg Pathol 2021; 30:393-396. [PMID: 34939436 PMCID: PMC9111943 DOI: 10.1177/10668969211067754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Compared to the parental SARS-CoV-2 virus, infections by the now dominant Delta
variant of SARS-CoV-2 appear to be more common and more severe in pregnant
women. The need for a robust, cheap, and quick method for diagnosing placental
infection by SARS-CoV-2 has thus become more acute. Here, we describe a highly
sensitive and specific immunohistochemical assay for SARS-CoV-2 nucleocapsid
protein for routine use in placental pathology practice.
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Affiliation(s)
- Dinesh Rakheja
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Dallas, TX, USA
| | | | - Charles F. Timmons
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health, Dallas, TX, USA
| | | | | | - Edana Stroberg
- Office of the Chief Medical Examiner, Oklahoma City, OK, USA
| | - Lisa M. Barton
- Office of the Chief Medical Examiner, Oklahoma City, OK, USA
| | - Eric J. Duval
- Office of the Chief Medical Examiner, Oklahoma City, OK, USA
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80
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Intrauterine Fetal Demise After Uncomplicated COVID-19: What Can We Learn from the Case? Viruses 2021; 13:v13122545. [PMID: 34960815 PMCID: PMC8708385 DOI: 10.3390/v13122545] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background: SARS-CoV-2 infection in pregnant women can lead to placental damage and transplacental infection transfer, and intrauterine fetal demise is an unpredictable event. Case study: A 32-year-old patient in her 38th week of pregnancy reported loss of fetal movements. She overcame mild COVID-19 with positive PCR test 22 days before. A histology of the placenta showed deposition of intervillous fibrinoid, lympho-histiocytic infiltration, scant neutrophils, clumping of villi, and extant infarctions. Immunohistochemistry identified focal SARS-CoV-2 nucleocapsid and spike protein in the syncytiotrophoblast and isolated in situ hybridization of the virus’ RNA. Low ACE2 and TMPRSS2 contrasted with strong basigin/CD147 and PDL-1 positivity in the trophoblast. An autopsy of the fetus showed no morphological abnormalities except for lung interstitial infiltrate, with prevalent CD8-positive T-lymphocytes and B-lymphocytes. Immunohistochemistry and in situ hybridization proved the presence of countless dispersed SARS-CoV-2-infected epithelial and endothelial cells in the lung tissue. The potential virus-receptor protein ACE2, TMPRSS2, and CD147 expression was too low to be detected. Conclusion: Over three weeks’ persistence of trophoblast viral infection lead to extensive intervillous fibrinoid depositions and placental infarctions. High CD147 expression might serve as the dominant receptor for the virus, and PDL-1 could limit maternal immunity in placental tissue virus clearance. The presented case indicates that the SARS-CoV-2 infection-induced changes in the placenta lead to ischemia and consecutive demise of the fetus. The infection of the fetus was without significant impact on its death. This rare complication of pregnancy can appear independently to the severity of COVID-19’s clinical course in the pregnant mother.
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81
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Bewley DJ, Lee J, Popescu O, Oviedo A. SARS-CoV-2 Placental Infection in an Unvaccinated Mother Resulting in Fetal Demise. Cureus 2021; 13:e20833. [PMID: 35141086 PMCID: PMC8800441 DOI: 10.7759/cureus.20833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 12/31/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy may have devastating complications including fetal demise. Here, we describe a case of SARS-CoV-2 infection in a second-trimester pregnancy. The placenta demonstrated the presence of SARS-CoV-2 viral RNA along with intervillositis and perivillous fibrin deposition. SARS-CoV-2 directly infects the trophoblastic cells of the placenta through the angiotensin-converting enzyme 2 receptor. This case report details the clinical history of a SARS-CoV-2-infected pregnancy with fetal demise. In addition, we show the images of the placental pathology and SARS-CoV-2 RNA in situ studies.
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Affiliation(s)
- Dominic J Bewley
- Pathology, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Jessica Lee
- Pathology, Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Oana Popescu
- Pathology and Laboratory Medicine, Vernon Jubilee Hospital, Vernon, CAN
| | - Angelica Oviedo
- Pathology and Laboratory Medicine, Burrell College of Osteopathic Medicine, Las Cruces, USA
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82
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Dumont S, Balduyck J, Reynders M, Vanwalleghem L, Lebbe B. Acute SARS-CoV-2 alpha variant infection leading to placental insufficiency and fetal distress. J Med Virol 2021; 94:1196-1200. [PMID: 34617608 PMCID: PMC8662159 DOI: 10.1002/jmv.27379] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023]
Abstract
The effect of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) Alpha variant (also known as B.1.1.7 lineage, 20I/501Y.V1, the UK variant or VOC 202012/01) infection on pregnancy is currently unknown. We present a case of a 37‐year‐old woman admitted to our tertiary hospital at a gestational age of 29 weeks and 1 day because of oligohydramnios with reduced fetal movements for 10 days. About 20 days before admission, she tested positive for SARS‐CoV‐2 Alpha variant. The following day, due to abnormal cardiotocography, increased brain sparing, and absent end‐diastolic flow in the umbilical artery, an urgent cesarean section was performed. The neonate had an uneventful admission to the neonatal intensive care unit. All neonatal samples proved negative for SARS‐CoV‐2. Pathological examination of the placenta revealed intervillous fibrin deposition, ischemic necrosis of villi and histiocytic intervillositis, corresponding with the SARS‐CoV‐2 placentitis triad. The placental tissue demonstrated a high viral load, possibly explaining the acute onset of placental insufficiently and subsequent fetal distress. This case demonstrates the importance of seeking medical care when experiencing reduced fetal movement in SARS‐CoV‐2 infected patients since acute infection can induce significant placental and subsequent fetal pathology.
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Affiliation(s)
- Sander Dumont
- Department of Gynecology, Obstetrics, and Fertility, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium.,Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Balduyck
- Department of Gynecology, Obstetrics, and Fertility, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium.,Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Reynders
- Department of Microbiology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Lieve Vanwalleghem
- Department of Pathology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Barbara Lebbe
- Department of Gynecology, Obstetrics, and Fertility, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
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83
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COVID-19 Infection in Pregnancy: PCR Cycle Thresholds, Placental Pathology, and Perinatal Outcomes. Viruses 2021; 13:v13091884. [PMID: 34578466 PMCID: PMC8473449 DOI: 10.3390/v13091884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
(1) This study aimed to evaluate characteristics, perinatal outcomes, and placental pathology of pregnant women with or without SARS-CoV-2 infection in the context of maternal PCR cycle threshold (CT) values. (2) This was a retrospective case-control study in a third-level health center in Mexico City with universal screening by RT-qPCR. The association of COVID-19 manifestations, preeclampsia, and preterm birth with maternal variables and CT values were assessed by logistic regression models and decision trees. (3) Accordingly, 828 and 298 women had a negative and positive test, respectively. Of those positive, only 2.6% of them presented mild to moderate symptoms. Clinical characteristics between both groups of women were similar. No associations between CT values were found for maternal features, such as pre-gestational BMI, age, and symptomatology. A significantly higher percentage of placental fibrinoid was seen with women with low CTs (<25; p < 0.01). Regarding perinatal outcomes, preeclampsia was found to be significantly associated with symptomatology but not with risk factors or CT values (p < 0.01, aOR = 14.72). Moreover, 88.9% of women diagnosed with COVID-19 at <35 gestational weeks and symptomatic developed preeclampsia. (4) The data support strong guidance for pregnancies with SARS-CoV-2 infection, in particular preeclampsia and placental pathology, which need further investigation.
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84
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Disse SC, Manuylova T, Adam K, Lechler A, Zant R, Klingel K, Aepinus C, Finkenzeller T, Wellmann S, Schneble F. COVID-19 in 28-Week Triplets Caused by Intrauterine Transmission of SARS-CoV-2-Case Report. Front Pediatr 2021; 9:812057. [PMID: 35004553 PMCID: PMC8740284 DOI: 10.3389/fped.2021.812057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, in-utero transmission of SARS-CoV-2 remains a rarity and only very few cases have been proven across the world. Here we depict the clinical, laboratory and radiologic findings of preterm triplets born at 28 6/7 weeks to a mother who contracted COVID-19 just 1 week before delivery. The triplets showed SARS-CoV-2 positivity right after birth, developed significant leukopenia and early-onset pulmonary interstitial emphysema. The most severely affected triplet I required 10 days of high-frequency oscillatory ventilation due to failure of conventional invasive ventilation, and circulatory support for 4 days. Despite a severe clinical course in two triplets (triplet I and II), clinical management without experimental, targeted antiviral drugs was successful. At discharge home, the triplets showed no signs of neurologic or pulmonary sequelae. Placental immunohistology with SARS-CoV-2 N-protein localized strongly to syncytiotrophoblast cells and, to a lesser extent, to fetal Hofbauer cells, proving intrauterine virus transmission. We discuss the role of maternal viremia as a potential risk factor for vertical transmission. To the best of our knowledge, our report presents the earliest unequivocally confirmed prenatal virus transmission in long-term surviving children, i.e., at the beginning of the third trimester.
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Affiliation(s)
- Sigrid C Disse
- Children's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Tatiana Manuylova
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Klaus Adam
- Children's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Annette Lechler
- Women's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Robert Zant
- Children's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Karin Klingel
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Christian Aepinus
- Institute of Laboratory Medicine and Microbiology, Synlab Medizinisches Versorgungszentrum (MVZ) Weiden, Weiden, Germany
| | - Thomas Finkenzeller
- Institute of Radiology, Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Sven Wellmann
- Department of Neonatology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Fritz Schneble
- Children's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
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