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Biechele G, Koliogiannis V, Rennollet P, Prester T, Schulz E, Kolben T, Jegen M, Hübener C, Hasbargen U, Flemmer A, Dietrich O, Burkard T, Schinner R, Dinkel J, Muenchhoff M, Hintz S, Delius M, Mahner S, Ricke J, Hilgendorff A, Stoecklein S. Preserved prenatal lung growth assessed by fetal MRI in the omicron-dominated phase of the SARS-CoV-2 pandemic. Eur Radiol 2024:10.1007/s00330-024-11031-9. [PMID: 39210162 DOI: 10.1007/s00330-024-11031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/28/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES With SARS-CoV-2 evolving, disease severity and presentation have changed due to changes in mechanisms of entry and effector site as well as due to effects of vaccination- and/or infection-acquired immunity. We re-assessed fetal lung pathology in pregnancies with uncomplicated SARS-CoV-2 infections during the late, omicron-dominated pandemic phase to inform disease understanding and pregnancy consultation. METHODS In this case-control study, fetal lung volumes were assessed by fetal MRI in 24 pregnancies affected by mild maternal SARS-CoV-2 infection during the omicron-dominated pandemic phase with prevailing immunity through vaccination and/or prior SARS-CoV-2 infection. RESULTS Fetal lung volumes (normalized to estimated fetal weight) in 24 pregnancies (GA 33.3 ± 3.8, 12 female fetuses) following mild, uncomplicated SARS-CoV-2 infection did not differ significantly from both, published reference values (96.3% ± 22.5% of 50th percentile reference values, p = 0.43), or fetal lung volumes of a site-specific, non-COVID control group (n = 15, 94.2% ± 18.5%, p = 0.76). Placental assessment revealed no group differences in thrombotic changes or placental heterogeneity (p > 0.05, respectively), and fetal lung volume did not correlate with placental heterogeneity when adjusting for gestational age at scan (p > 0.05). CONCLUSION Assessment of fetal lung volume by MRI revealed unaffected lung growth in pregnancies affected by uncomplicated SARS-CoV-2 infection in the omicron-dominated pandemic phase in the presence of prevailing hybrid immunity. This finding contrasts sharply with the observed reduction in fetal lung volume following maternal alpha-variant infection in the pre-vaccination era and might reflect tropism- as well as immunity-related effects. KEY POINTS Question: Is fetal lung development affected by mild maternal SARS-CoV-2 infection during the omicron-dominated phase of the pandemic? FINDINGS Fetal lung volume in 24 affected pregnancies did not differ significantly from published reference values or fetal lung volumes in 15 site-specific, non-COVID-affected control pregnancies. CLINICAL RELEVANCE Preserved fetal lung volume following mild maternal SARS-CoV-2 infection during the omicron-dominated phase contrasts with previous findings of reduced volume in unvaccinated pregnancies during the alpha-dominated pandemic phase. These observations might reflect tropism- as well as immunity-related effects.
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Affiliation(s)
- Gloria Biechele
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Vanessa Koliogiannis
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Philippe Rennollet
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Tobias Prester
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Enrico Schulz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Thomas Kolben
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Magdalena Jegen
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christoph Hübener
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Uwe Hasbargen
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Andreas Flemmer
- Division of Neonatology, University Children's Hospital, Dr. von Hauner Children's Hospital and Perinatal Center, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Olaf Dietrich
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Tanja Burkard
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Maximilian Muenchhoff
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU Munich, Pettenkoferstraße 9a, 80336, Munich, Germany
| | - Susan Hintz
- Department of Pediatrics - Neonatology, Stanford University, 750 Welch Road, Suite 315, Palo Alto, CA, 94034, USA
| | - Maria Delius
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Anne Hilgendorff
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center (CPC), Helmholtz Munich, Member of the German Lung Research Center (DZL), Max-Lebsche-Platz 31, 81377, Munich, Germany
- Center for Comprehensive Developmental Care (CDeCLMU), Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Member of the German Lung Research Center (DZL), Lindwurmstraße 4, 80337, Munich, Germany
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Max-Lebsche-Platz 31, 81377, Munich, Germany.
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Celik IH, Ozkaya Parlakay A, Canpolat FE. Management of neonates with maternal prenatal coronavirus infection and influencing factors. Pediatr Res 2024; 95:436-444. [PMID: 37857851 DOI: 10.1038/s41390-023-02855-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/09/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
The coronavirus disease 2019 (COVID-19) in pregnancy causes adverse outcomes for both the mother and the fetus. Neonates are at risk of vertical transmission and in-utero infection. Additionally, intensive care unit (ICU) admission and impairment in the organ systems of the mother are associated with neonatal outcomes, including impaired intrauterine growth, prematurity, and neonatal ICU admission. The management of neonates born from infected mothers has changed over the progress of the pandemic. At the beginning of the pandemic, cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoiding of skin-to-skin contact, breast milk, and breastfeeding were the main practices to reduce vertical and horizontal transmission risk in the era of insufficient knowledge. The effects of antenatal steroids and delayed cord clamping on COVID-19 were also not known. As the pandemic progressed, data showed that prenatal, delivery room, and postnatal care of neonates can be performed as pre-pandemic practices. Variants and vaccines that affect clinical course and outcomes have emerged during the pandemic. The severity of the disease and the timing of infection in pregnancy also influence maternal and neonatal outcomes. The knowledge and lessons from COVID-19 will be helpful for the next pandemic if it happens. IMPACT: Prenatal infection with COVID-19 is associated with adverse maternal and neonatal outcomes. Our review includes the management of neonates with prenatal COVID-19 infection exposure, maternal-fetal, delivery room, and postnatal care of neonates, clinical features, treatment of neonates, and influencing factors such as variants, vaccination, severity of maternal disease, and timing of infection during pregnancy. There is a growing body of data and evidence about the COVID-19 pandemic. The knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
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Affiliation(s)
- Istemi Han Celik
- University of Health Sciences Turkey; Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye.
| | - Aslinur Ozkaya Parlakay
- Ankara Yildirim Beyazit University; Ankara Bilkent City Hospital, Department of Pediatrics, Pediatric Infectious Diseases Unit, Ankara, Türkiye
| | - Fuat Emre Canpolat
- University of Health Sciences Turkey, Ankara Bilkent City Hospital, Department of Pediatrics, Division of Neonatology, Ankara, Türkiye
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3
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Celik IH, Tanacan A, Canpolat FE. Neonatal outcomes of maternal prenatal coronavirus infection. Pediatr Res 2024; 95:445-455. [PMID: 38057579 DOI: 10.1038/s41390-023-02950-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
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Affiliation(s)
- Istemi Han Celik
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Türkiye; Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, 06010, Ankara, Türkiye.
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Perinatology Clinic, University of Health Sciences Turkiye, Ankara Bilkent City Hospital, 06800, Ankara, Türkiye
| | - Fuat Emre Canpolat
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Türkiye, Ankara Bilkent City Hospital, 06800, Ankara, Türkiye
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Amaral E, Money D, Jamieson D, Pasupathy D, Aronoff D, Jacobsson B, Lizcano EIO. Vaccination during pregnancy: A golden opportunity to embrace. Int J Gynaecol Obstet 2023; 163:476-483. [PMID: 37417315 DOI: 10.1002/ijgo.14981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Immunization strategies are part of routine pregnancy care to prevent infectious diseases in the mother, the fetus, and the newborn. Maternal immunization recommendations followed the recognition of the consequences of infectious diseases in pregnancy, including vertical transmission and perinatal consequences. The recent COVID-19 pandemic highlighted the issue of vaccination among pregnant individuals. Recommendations vary globally; however, Tdap, influenza, and, recently, COVID-19 vaccines are routinely recommended during pregnancy. There are several new maternal immunization products in the pipeline, including those directed against malaria, cytomegalovirus, Group B Streptococcus, herpes simplex virus, and respiratory syncytial virus. Important challenges must be addressed in all countries to guarantee that pregnant individuals and their babies receive the best care possible, including uptake of recommended immunizations by their entire target population groups. These challenges include disseminating appropriate data for vaccine recommendations and many others, such as ensuring stakeholder endorsement, achieving in-country distribution and administration, adequate vaccine supply, and a well-organized healthcare system, ideally offering the immunization free of charge. More recently, the hesitancy of pregnant women to receive immunizations highlights the relevance of cultural aspects and other contextual factors affecting vaccine uptake among pregnant individuals.
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Affiliation(s)
- Eliana Amaral
- Department of Obstetrics & Gynecology, University of Campinas, São Paulo, Brazil
| | - Deborah Money
- Department of Obstetrics & Gynecology, University of Vancouver, Vancouver, British Columbia, Canada
| | - Denise Jamieson
- Department of Gynecology & Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dharmintra Pasupathy
- Department of Maternal & Fetal Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Aronoff
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bo Jacobsson
- Department of Obstetrics & Gynecology, University of Gothenburg, Gothenburg, Sweden
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Pietrasanta C, Ronchi A, Agosti M, Mangili G, Sinelli M, Ghirardello S, Barachetti R, Crimi R, Fasolato V, Martinelli S, Bellan C, Crippa B, Artieri G, Perniciaro S, Saruggia M, Ventura ML, Garofoli F, Pagliotta C, Uceda Renteria SC, Piralla A, Bergami F, Morandi G, Proto A, Pontiggia F, Risso FM, Bossi A, Ferrari S, Cavalleri V, Servi P, Castiglione A, Spada E, Ceriotti F, Baldanti F, Mosca F, Pugni L. Early Postnatal Infection of Neonates Born to Mothers Infected by SARS-CoV-2 Omicron Variant. Pediatrics 2023; 152:e2023062702. [PMID: 37830167 DOI: 10.1542/peds.2023-062702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES To evaluate the rate of postnatal infection during the first month of life in neonates born to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive mothers during the predominant circulation of the omicron (B.1.1.529) variant. METHODS This prospective, 10-center study enrolled mothers infected by SARS-CoV-2 at delivery and their infants, if both were eligible for rooming-in, between December 2021 and March 2022. Neonates were screened for SARS-CoV-2 RNA at 1 day of life (DOL), 2 to 3 DOL, before discharge, and twice after hospital discharge. Mother-infant dyads were managed under a standardized protocol to minimize the risk of viral transmission. Sequencing data in the study area were obtained from the Italian Coronavirus Disease 2019 Genomic platform. Neonates were included in the final analysis if they were born when the omicron variant represented >90% of isolates. RESULTS Eighty-two percent (302/366) of mothers had an asymptomatic SARS-CoV-2 infection. Among 368 neonates, 1 was considered infected in utero (0.3%), whereas the postnatal infection rate during virtually exclusive circulation of the omicron variant was 12.1%. Among neonates infected after birth, 48.6% became positive during the follow-up period. Most positive cases at follow-up were detected concurrently with the peak of coronavirus disease 2019 cases in Italy. Ninety-seven percent of the infected neonates were asymptomatic. CONCLUSIONS The risk of early postnatal infection by the SARS-CoV-2 omicron variant is higher than that reported for previously circulating variants. However, protected rooming-in practice should still be encouraged given the paucity of symptoms in infected neonates.
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Affiliation(s)
- Carlo Pietrasanta
- Neonatology and NICU
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Massimo Agosti
- Neonatology and NICU, Del Ponte Hospital, Varese, Italy
- Department of Pediatrics, University of Insubria, Varese, Italy
| | | | - Mariateresa Sinelli
- Neonatology and NICU, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB), Italy
| | | | | | - Riccardo Crimi
- Neonatology and NICU
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valeria Fasolato
- Neonatology and NICU, ASST Mantova, Ospedale Carlo Poma, Mantova, Italy
| | | | - Cristina Bellan
- Neonatology and NICU, ASST Bergamo Est, Ospedale Bolognini Seriate, Seriate, Italy
| | | | - Giacomo Artieri
- Neonatology and NICU
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Maria Luisa Ventura
- Neonatology and NICU, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB), Italy
| | | | | | | | - Antonio Piralla
- Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Bergami
- Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Grazia Morandi
- Neonatology and NICU, ASST Mantova, Ospedale Carlo Poma, Mantova, Italy
| | - Alice Proto
- Neonatology and NICU, Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Pontiggia
- Neonatology and NICU, ASST Bergamo Est, Ospedale Bolognini Seriate, Seriate, Italy
| | - Francesco Maria Risso
- Neonatology and NICU, ASST Spedali Civili di Brescia, Presidio Ospedale dei Bambini - Children Hospital, Brescia, Italy
| | - Angela Bossi
- Neonatology and NICU, Del Ponte Hospital, Varese, Italy
| | | | - Valeria Cavalleri
- Neonatology and NICU, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB), Italy
| | | | | | - Elena Spada
- Neonatology and NICU
- Laboratorio della Conoscenza Carlo Corchia- APS, Firenze, Italy
| | - Ferruccio Ceriotti
- Clinical Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fausto Baldanti
- Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Pediatric and Diagnostic Sciences, University of Pavia, Pavia, Italy
| | - Fabio Mosca
- Neonatology and NICU
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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De Luca D, Vauloup-Fellous C, Benachi A, Vivanti A. Transmission of SARS-CoV-2 from mother to fetus or neonate: What to know and what to do? Semin Fetal Neonatal Med 2023; 28:101429. [PMID: 36935314 PMCID: PMC10010052 DOI: 10.1016/j.siny.2023.101429] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
SARS-CoV-2 can be vertically transmitted from the mother to the fetus and the neonate. This transmission route is rare compared to the environmental or horizontal spread and therefore, the risk can be deemed inconsequential by some medical providers. However, severe, although just as rare, feto-neonatal consequences are possible: fetal demise, severe/critical neonatal COVID-19 and multi-inflammatory syndrome (MIS-N) have been described. Therefore, it is important for the clinicians to know the mechanism of vertical transmission, how to recognize this, and how to deal with neonatal COVID-19 and MIS-N. Our knowledge about this field has significantly increased in the last three years. This is a summary of the pathophysiology, diagnostics, and therapeutics of vertical SARS-CoV-2 transmission that clinicians apply in their clinical practice.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.
| | - Christelle Vauloup-Fellous
- Division of Virology, "Paul Brousse" Hospital, Paris Saclay University Hospitals, APHP, Villejuif, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Alexandre Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
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