SARS-CoV-2 vertical transmission in a twin-pregnant woman: a case report

Maternal Fever and Reduced Fetal Movement as Predictive Risk Factors for Adverse Neonatal Outcome in Cases of Congenital SARS-CoV-2 Infection: A Meta-Analysis of Individual Participant Data from Case Reports and Case Series

OBJECTIVES

To determine risk factors for primary and secondary adverse neonatal outcomes in newborns with congenital SARS-CoV-2 infection.

DATA SOURCES

PubMed/MEDLINE and Google Scholar from January 2020 to January 2022.

STUDY ELIGIBILITY CRITERIA

newborns delivered after 24 weeks of gestation with confirmed/possible congenital SARS-CoV-2 infection, according to standard classification criteria.

METHODS

Execution of the IPD analyses followed the PRISMA-IPD statement. Univariate non-parametric tests compared numerical data distributions. Fisher's exact or Chi-square test determined categorical variables' statistical significance. Multivariate logistic regression revealed risk factors for adverse neonatal outcome.

RESULTS

Maternal fever was associated with symptomatic congenital infection (OR: 4.55, 95% CI: 1.33-15.57). Two-thirds of women that reported decreased fetal movements were diagnosed with IUFD (p-value = 0.001). Reduced fetal movement increased the risk of intrauterine fetal death by 7.84 times (p-value = 0.016, 95% CI: 2.23-27.5). The risk of stillbirth decreased with gestational age at the time of maternal infection (p-value < 0.05, OR: 0.87, 95% CI: 0.79-0.97).

CONCLUSIONS

Maternal fever and perception of reduced fetal movement may be predictive risk factors for adverse pregnancy outcome in cases with congenital SARS-CoV-2 infection.

SARS-CoV-2 Infection in Pregnancy: Clues and Proof of Adverse Outcomes

BACKGROUND

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) represents one of the most threatening viral infections in the last decade. Amongst susceptible individuals, infected pregnant women might be predisposed to severe complications. Despite the extensive interest in SARS-CoV-2 research, the clinical course of maternal infection, the vertical transmission and the neonatal outcomes have not been completely understood yet. The aim of our study was to investigate the association between SARS-CoV-2 infection, obstetric outcomes and vertical transmission.

METHODS

A prospective observational study was performed, enrolling unvaccinated pregnant patients positive for SARS-CoV-2 (cases) and matched with uninfected pregnant women (controls). Maternal and neonatal nasopharyngeal swabs, maternal and cord blood, amniotic fluid and placenta tissue samples were collected; blood samples were tested for anti-S and anti-N antibodies, and histologic examination of placental tissues was performed.

RESULTS

The cases showed a significant association with the development of some obstetric complications, such as intrauterine growth restriction and pregnancy-associated hypothyroidism and diabetes, as compared to controls; their newborns were more likely to have a low birth weight and an arterial umbilical pH less than 7. The viral genome was detected in maternal and cord blood and placental samples in six cases.

CONCLUSIONS

Pregnant women positive for SARS-CoV-2 infection are more likely to develop severe obstetric outcomes; their newborns could have a low birth weight and arterial pH. Vertical transmission seems a rare event, and further investigation is strongly needed.

Outcome of Newborns with Confirmed or Possible SARS-CoV-2 Vertical Infection-A Scoping Review

Severe acute respiratory syndrome virus 2 (SARS-CoV-2), the virus that causes 2019 coronavirus disease (COVID-19), has been isolated from various tissues and body fluids, including the placenta, amniotic fluid, and umbilical cord of newborns. In the last few years, much scientific effort has been directed toward studying SARS-CoV-2, focusing on the different features of the virus, such as its structure and mechanisms of action. Moreover, much focus has been on developing accurate diagnostic tools and various drugs or vaccines to treat COVID-19. However, the available evidence is still scarce and consistent criteria should be used for diagnosing vertical transmission. Applying the PRISMA ScR guidelines, we conducted a scoping review with the primary objective of identifying the types, and examining the range, of available evidence of vertical transmission of SARS-CoV-2 from mother to newborn. We also aimed to clarify the key concepts and criteria for diagnosis of SARS-CoV-2 vertical infection in neonates and summarize the existing evidence and advance the awareness of SARS-CoV-2 vertical infection in pregnancy. Most studies we identified were case reports or case series (about 30% of poor quality and inconsistent reporting of the findings). Summarizing the existing classification criteria, we propose an algorithm for consistent diagnosis. Registration: INPLASY2022120093.

Mixed Intervillositis in SARS-CoV-2 Infection Associated with Fetal Death: A Case Report

Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been shown in epidemiological studies to be associated with an increased risk of stillbirth. Several histopathologic features of placental SARS-CoV-2 infection have been proposed as potential causes of fetal death. We present a case of an otherwise healthy G3P1 women with mild symptoms of SARS-CoV-2 infection at 23 6/7 weeks of gestation. At 25 2/7 weeks, she presented with signs and symptoms of preterm labor and decreased fetal movements. Fetal death was diagnosed at admission. Placental pathology showed pronounced placental mixed intervillositis. Inflammatory infiltrate caused extreme narrowing of intervillous space leading to placental malfunction and fetal death. Placental tissue SARS-CoV-2 infection was confirmed by positive immunohistochemistry staining of syncytiotrophoblasts with spike protein antibody. The case presented suggests that SARS-CoV-2 associated inflammatory placental changes pose an elevated risk for the fetus.