1
|
Zia MTK, Kumar K, Gamma EL, Shakeel F, Hanna I, Lin X, Hanna N. Vertical transmission of SARS-CoV-2 delta-variant in a preterm infant. BMC Infect Dis 2024; 24:537. [PMID: 38807052 PMCID: PMC11134764 DOI: 10.1186/s12879-024-09420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND As SARS-CoV-2 continues to be relevant and cause illnesses, the effect of emerging virus variants on perinatal health remains to be elucidated. It was demonstrated that vertical transmission of SARS-CoV-2 is a relatively rare event in the original SARS-CoV-2 strain. However, very few reports describe vertical transmission related to the delta-variant. CASE PRESENTATION We report a case of a preterm male neonate born to a mother with positive SARS-CoV-2 and mild respiratory complications. The neonate was born by cesarean section due to fetal distress. The rupture of the amniotic membrane was at delivery. The neonate had expected prematurity-related complications. His nasopharyngeal swabs for RT-PCR were positive from birth till three weeks of age. RT-ddPCR of the Placenta showed a high load of the SARS-CoV-2 virus with subgenomic viral RNA. RNAscope technique demonstrated both the positive strand of the S gene and the orf1ab negative strand. Detection of subgenomic RNA and the orf1ab negative strand indicats active viral replication in the placenta. CONCLUSIONS Our report demonstrates active viral replication of the SARS-CoV-2 delta-variant in the placenta associated with vertical transmission in a preterm infant.
Collapse
Affiliation(s)
- Muhammad T K Zia
- Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Department of Pediatrics, New York-Presbyterian/Hudson Valley Hospital, Cortlandt Manor, NY, USA
| | - Kishan Kumar
- Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Edmund La Gamma
- Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Department of Biochemistry & Molecular Biology, New York Medical College, Valhalla, USA
| | - Fauzia Shakeel
- Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Iman Hanna
- Department of Pathology, NYU Langone Hospital-Long Island, New York University Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Xinhua Lin
- Division of Neonatology, Department of Pediatrics, NYU Langone Hospital-Long Island, New York University Grossman Long Island School of Medicine, 259 First Street, Mineola, NY, 11501, USA
- Women and Children's Research Laboratory, NYU Langone Hospital-Long Island New York University Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Nazeeh Hanna
- Division of Neonatology, Department of Pediatrics, NYU Langone Hospital-Long Island, New York University Grossman Long Island School of Medicine, 259 First Street, Mineola, NY, 11501, USA.
- Women and Children's Research Laboratory, NYU Langone Hospital-Long Island New York University Grossman Long Island School of Medicine, Mineola, NY, USA.
| |
Collapse
|
2
|
Enninga EAL, Quach HQ, Jang JS, de Araujo Correia MCM, Fedyshyn Y, Fedyshyn B, Lemens M, Littlefield D, Behl S, Sintim-Aboagye E, Mejia Plazas MC, Cardenas MC, Chakraborty S, Yamaoka S, Ebihara H, Pandey A, Li H, Badley AD, Johnson EL, Sun J, Norgan AP, Theiler RN, Chakraborty R. Maternal SARS-CoV-2 infection in pregnancy disrupts gene expression in Hofbauer cells with limited impact on cytotrophoblasts. PLoS Pathog 2024; 20:e1011990. [PMID: 38324589 PMCID: PMC10878512 DOI: 10.1371/journal.ppat.1011990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/20/2024] [Accepted: 01/21/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Hofbauer cells (HBCs) and cytotrophoblasts (CTBs) are major cell populations in placenta. The indirect impact of maternal SARS-CoV-2 disease on these cells that are not directly infected has not been extensively studied. Herein, we profiled gene expression in HBCs and CTBs isolated from placentae of recovered pregnant subjects infected with SARS-CoV-2 during all trimesters of pregnancy, placentae from subjects with active infection, SARS-CoV-2 vaccinated subjects, and those who were unexposed to the virus. METHODS Placentae were collected within 4 h post-delivery and membrane-free tissues were enzymatically digested for the isolation of HBCs and CTBs. RNA extracted from HBCs and CTBs were sequenced using 150bp paired-end reads. Differentially expressed genes (DEGs) were identified by DESeq2 package in R and enriched in GO Biological Processes, KEGG Pathway, Reactome Gene Sets, Hallmark Gene Sets, and Canonical Pathways. Protein-protein interactions among the DEGs were modelled using STRING and BioGrid. RESULTS Pregnant subjects (n = 30) were recruited and categorized into six groups: infected with SARS-CoV-2 in i) the first (1T, n = 4), ii) second (2T, n = 5), iii) third (3T, n = 5) trimester, iv) tested positive at delivery (Delivery, n = 5), v) never infected (Control, n = 6), and vi) fully mRNA-vaccinated by delivery (Vaccinated, n = 5). Compared to the Control group, gene expression analysis showed that HBCs from infected subjects had significantly altered gene expression profiles, with the 2T group having the highest number of DEGs (1,696), followed by 3T and 1T groups (1,656 and 958 DEGs, respectively). These DEGs were enriched for pathways involved in immune regulation for host defense, including production of cytokines, chemokines, antimicrobial proteins, ribosomal assembly, neutrophil degranulation inflammation, morphogenesis, and cell migration/adhesion. Protein-protein interaction analysis mapped these DEGs with oxidative phosphorylation, translation, extracellular matrix organization, and type I interferon signaling. Only 95, 23, and 8 DEGs were identified in CTBs of 1T, 2T, and 3T groups, respectively. Similarly, 11 and 3 DEGs were identified in CTBs and HBCs of vaccinated subjects, respectively. Reassuringly, mRNA vaccination did not induce an inflammatory response in placental cells. CONCLUSIONS Our studies demonstrate a significant impact of indirect SARS-CoV-2 infection on gene expression of inner mesenchymal HBCs, with limited effect on lining CTB cells isolated from pregnant subjects infected and recovered from SARS-CoV-2. The pathways associated with these DEGs identify potential targets for therapeutic intervention.
Collapse
Affiliation(s)
- Elizabeth Ann L. Enninga
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Huy Quang Quach
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jin Sung Jang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | | | - Yaroslav Fedyshyn
- Children Research Center, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bohdana Fedyshyn
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Maureen Lemens
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dawn Littlefield
- Children Research Center, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Supriya Behl
- Children Research Center, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Elise Sintim-Aboagye
- Children Research Center, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Maria C. Mejia Plazas
- Children Research Center, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Maria C. Cardenas
- Children Research Center, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Shree Chakraborty
- Children Research Center, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Satoko Yamaoka
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Hideki Ebihara
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Akhilesh Pandey
- Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, United States of America
- Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Hu Li
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Andrew D. Badley
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Erica L. Johnson
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Jie Sun
- Thoracic Diseases Research Unit, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, United States of America
- Carter Immunology Center University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Andrew P. Norgan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Regan N. Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Rana Chakraborty
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, United States of America
- Children Research Center, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| |
Collapse
|
3
|
Robinson AA, Feder S, Krishna S, Brustman L. Likely Vertical Transmission of Neonatal SARS CoV-2 Infection. AJP Rep 2024; 14:e62-e65. [PMID: 38370331 PMCID: PMC10874692 DOI: 10.1055/s-0044-1779030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/22/2023] [Indexed: 02/20/2024] Open
Abstract
Maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can affect placental function, but the possibility of intrauterine transmission has been debated. Several authors have published inclusion criteria for vertical transmission, but few reports exist that are able to meet the suggested requirements. Despite the fact that the majority of fetuses born to infected mothers do well, others become critically ill. We present a case of likely intrauterine transmission of a neonate born to a mother who was recently symptomatic with a positive SARS CoV-2 polymerase chain reaction (PCR). The parturient complained of decreased fetal movement and presented at 31 2/7 weeks' gestation with a biophysical profile score of 2/10 and required an emergency cesarean delivery. The neonate went on to develop severe leukopenia with signs of sepsis with a positive SARS CoV-2 PCR on day 4 of life and an otherwise pan-negative workup. Meeting criteria for transplacental transmission requires timely collection of several diagnostic studies that are not standard of care. Further research is needed to support the notion that intrauterine/transplacental infection is possible. Collection swabs should be obtained soon after delivery to help diagnose neonatal infection because early diagnosis is crucial to help identify opportunities for intervention.
Collapse
Affiliation(s)
- Andre A. Robinson
- Department of Obstetrics and Gynecology, Mount Sinai West, New York, New York
| | - Samantha Feder
- Department of Obstetrics and Gynecology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Sushma Krishna
- Department of Neonatology, Mount Sinai West, New York, New York
| | - Lois Brustman
- Department of Maternal-Fetal Medicine, Mount Sinai West, New York, New York
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Ketabi K, Soleimanjahi H, Habibian A, Abroun S. Pregnancy and SARS-CoV-2 infection with a focus on its vertical transmission, breastfeeding, cord blood banking, and vaccination during COVID-19 infection. J Immunoassay Immunochem 2023; 44:361-380. [PMID: 37794764 DOI: 10.1080/15321819.2023.2259454] [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: 10/06/2023]
Abstract
The SARS-CoV-2 outbreak led to a health crisis worldwide. This infection can infect individuals, particularly pregnant women. In this review, we tried to find the possibility of vertical transmission of COVID-19 and investigate the effects of COVID-19 on pregnancy, breastfeeding, cord blood banking, and the effects of recommended vaccines on pregnant and lactating women. Keywords include COVID-19, congenital infection, SARS-CoV-2, pregnancy, and COVID-19 vaccines. Vertical transmission of SARS-CoV-2 was searched in scientific databases, such as PubMed, Google Scholar, and Scopus. The criteria for including studies in this article are the study of SARS-CoV-2 infection in pregnant women, fetuses, and neonates during pregnancy and while breastfeeding, and also the effect of COVID-19 vaccines on them. There are several conflicting results in the transmission of SARS-CoV-2 from the maternal-fetal interface. Since many neonates born from COVID-19-infected mothers had no signs of this infection, the possibility of SARS-CoV-2 congenital transmission cannot be confirmed. Also, SARS-CoV-2-infected women can breastfeed their babies if they have mild symptoms. Up till now, no adverse effect of COVID-19 vaccines has been identified on mothers, infants, and the fertility of men or women. Even so, more investigations are needed on the long-term effects of COVID-19 vaccines.
Collapse
Affiliation(s)
- Kiana Ketabi
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hoorieh Soleimanjahi
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ala Habibian
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Saied Abroun
- Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| |
Collapse
|
6
|
Nonn O, Bonstingl L, Sallinger K, Neuper L, Fuchs J, Gauster M, Huppertz B, Brislinger D, El-Heliebi A, Fluhr H, Kampelmühler E, Klaritsch P. Maternal COVID-19 causing intrauterine foetal demise with microthrombotic placental insufficiency: a case report. BMC Pregnancy Childbirth 2023; 23:653. [PMID: 37689629 PMCID: PMC10492311 DOI: 10.1186/s12884-023-05942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Pregnant women have an increased risk of getting infected with SARS-CoV-2 and are more prone to severe illness. Data on foetal demise in affected pregnancies and its underlying aetiology is scarce and pathomechanisms remain largely unclear. CASE Herein we present the case of a pregnant woman with COVID-19 and intrauterine foetal demise. She had no previous obstetric or gynaecological history, and presented with mild symptoms at 34 + 3 weeks and no signs of foetal distress. At 35 + 6 weeks intrauterine foetal death was diagnosed. In the placental histopathology evaluation, we found inter- and perivillous fibrin depositions including viral particles in areas of degraded placental anatomy without presence of viral entry receptors and SARS-CoV-2 infection of the placenta. CONCLUSION This case demonstrates that maternal SARS-CoV-2 infection in the third trimester may lead to an unfavourable outcome for the foetus due to placental fibrin deposition in maternal COVID-19 disease possibly via a thrombogenic microenvironment, even when the foetus itself is not infected.
Collapse
Affiliation(s)
- Olivia Nonn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
- Experimental and Clinical Research Centre, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria.
| | - Lilli Bonstingl
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Katja Sallinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Lena Neuper
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Julia Fuchs
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Division of Medical Physics and Biophysics, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Martin Gauster
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Berthold Huppertz
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Dagmar Brislinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Amin El-Heliebi
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- BioTechMed, Graz, Austria
| | - Herbert Fluhr
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Eva Kampelmühler
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
- Research Unit for Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| |
Collapse
|
7
|
Mei JY, Mok T, Cambou MC, Fuller T, Fajardo VM, Kerin T, Han CS, Nielsen-Saines K, Rao R. Can prenatal ultrasound predict adverse neonatal outcomes in SARS-CoV-2-affected pregnancies? Am J Obstet Gynecol MFM 2023; 5:101028. [PMID: 37295718 PMCID: PMC10247147 DOI: 10.1016/j.ajogmf.2023.101028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND On the basis of available data, at least 1 ultrasound assessment of pregnancies recovering from SARS-CoV-2 infection is recommended. However, reports on prenatal imaging findings and potential associations with neonatal outcomes following SARS-CoV-2 infection in pregnancy have been inconclusive. OBJECTIVE This study aimed to describe the sonographic characteristics of pregnancies after confirmed SARS-CoV-2 infection and assess the association of prenatal ultrasound findings with adverse neonatal outcomes. STUDY DESIGN This was an observational prospective cohort study of pregnancies diagnosed with SARS-CoV-2 by reverse transcription polymerase chain reaction between March 2020 and May 2021. Prenatal ultrasound evaluation was performed at least once after diagnosis of infection, with the following parameters measured: standard fetal biometric measurements, umbilical and middle cerebral artery Dopplers, placental thickness, amniotic fluid volume, and anatomic survey for infection-associated findings. The primary outcome was the composite adverse neonatal outcome, defined as ≥1 of the following: preterm birth, neonatal intensive care unit admission, small for gestational age, respiratory distress, intrauterine fetal demise, neonatal demise, or other neonatal complications. Secondary outcomes were sonographic findings stratified by trimester of infection and severity of SARS-CoV-2 infection. Prenatal ultrasound findings were compared with neonatal outcomes, severity of infection, and trimester of infection. RESULTS A total of 103 SARS-CoV-2-affected mother-infant pairs with prenatal ultrasound evaluation were identified; 3 cases were excluded because of known major fetal anomalies. Of the 100 included cases, neonatal outcomes were available in 92 pregnancies (97 infants); of these, 28 (29%) had the composite adverse neonatal outcome, and 23 (23%) had at least 1 abnormal prenatal ultrasound finding. The most common abnormalities seen on ultrasound were placentomegaly (11/23; 47.8%) and fetal growth restriction (8/23; 34.8%). The latter was associated with a higher rate of the composite adverse neonatal outcome (25% vs 1.5%; adjusted odds ratio, 22.67; 95% confidence interval, 2.63-194.91; P<.001), even when small for gestational age was removed from this composite outcome. The Cochran Mantel-Haenszel test controlling for possible fetal growth restriction confounders continued to show this association (relative risk, 3.7; 95% confidence interval, 2.6-5.9; P<.001). Median estimated fetal weight and birthweight were lower in patients with the composite adverse neonatal outcome (P<.001). Infection in the third trimester was associated with lower median percentile of estimated fetal weight (P=.019). An association between placentomegaly and third-trimester SARS-CoV-2 infection was noted (P=.045). CONCLUSION In our study of SARS-CoV-2-affected maternal-infant pairs, rates of fetal growth restriction were comparable to those found in the general population. However, composite adverse neonatal outcome rates were high. Pregnancies with fetal growth restriction after SARS-CoV-2 infection were associated with an increased risk for the adverse neonatal outcome and may require close surveillance.
Collapse
Affiliation(s)
- Jenny Y Mei
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA (Drs Mei, Mok, Han, and Rao)
| | - Thalia Mok
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA (Drs Mei, Mok, Han, and Rao)
| | - Mary Catherine Cambou
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Cambou)
| | - Trevon Fuller
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil (Dr Fuller)
| | - Viviana M Fajardo
- Division of Neonatology, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA (Dr Fajardo)
| | - Tara Kerin
- Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA (Drs Kerin and Nielsen-Saines)
| | - Christina S Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA (Drs Mei, Mok, Han, and Rao)
| | - Karin Nielsen-Saines
- Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA (Drs Kerin and Nielsen-Saines)
| | - Rashmi Rao
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA (Drs Mei, Mok, Han, and Rao).
| |
Collapse
|
8
|
Reznik SE, Vuguin PM, Cohen A, Khoury R, Loudig O, Balakrishnan R, Fineberg SA, Hughes F, Harigopal M, Charron MJ. SARS-CoV-2 Infection in Unvaccinated High-Risk Pregnant Women in the Bronx, NY, USA Is Associated with Decreased Apgar Scores and Placental Villous Infarcts. Biomolecules 2023; 13:1224. [PMID: 37627289 PMCID: PMC10452574 DOI: 10.3390/biom13081224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Babies born to severe acute respiratory syndrome corona virus-2 (SARS-CoV-2)-infected mothers are at greater risk for perinatal morbidity and more likely to receive a neurodevelopmental diagnosis in the first year of life. However, the effect of maternal infection on placental function and neonatal outcomes varies depending upon the patient population. We set out to test our hypothesis that maternal SARS-CoV-2 infection in our underserved, socioeconomically disadvantaged, mostly unvaccinated, predominantly African American and Latina population in the Bronx, NY would have effects evident at birth. Under IRB approval, 56 SARS-CoV-2-positive patients infected during the "first wave" of the pandemic with alpha and beta strains of the virus, 48 patients infected during the "second wave" of the pandemic with delta and omicron strains and 61 negative third-trimester high-risk patients were randomly selected from Montefiore Medical Center (MMC), Bronx, NY. In addition, two positive cases from Yale New Haven Hospital, CT were included as controls. All 104 placentas delivered by SARS-CoV-2-positive mothers were uninfected by the virus, based on immunohistochemistry, in situ hybridization, and qPCR analysis. However, placental villous infarcts were significantly increased in first-wave cases compared to second-wave cases or negative controls. Significantly lower Apgar scores at 1 min and 5 min were observed in neonates born to infected mothers with severe symptoms. These findings suggest that even without entering the placenta, SARS-CoV-2 can affect various systemic pathways, culminating in altered placental development and function, which may adversely affect the fetus, especially in a high-risk patient population such as ours. These results underline the importance of vaccination among pregnant women, particularly in low-resource areas.
Collapse
Affiliation(s)
- Sandra E. Reznik
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Pharmaceutical Sciences, St. John’s University, Queens, NY 11439, USA
| | - Patricia M. Vuguin
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA
| | - Alexa Cohen
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Rasha Khoury
- Obstetrics and Gynecology and Divisions of Complex Family Planning and Maternal Fetal Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Olivier Loudig
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
| | - Ridin Balakrishnan
- Department of Pathology, Louisiana School of Medicine, LSU Health, New Orleans, LA 70112, USA
| | - Susan A. Fineberg
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Francine Hughes
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Malini Harigopal
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Maureen J. Charron
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine and the Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| |
Collapse
|
9
|
Kosič N, Luzar B, Pečlin P, Druškovič M, Rus KR, Županc TA, Sršen TP. Fetal death from SARS-CoV-2 mediated acute placental failure. J Reprod Immunol 2023; 158:103958. [PMID: 37263029 PMCID: PMC10191722 DOI: 10.1016/j.jri.2023.103958] [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] [Received: 04/03/2023] [Revised: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION We demonstrate the nonlinear severity of symptoms of SARS-CoV-2 infection in the mother leading to fetal death after acute placental failure. METHODS Careful clinical evaluation, real-time RT-PCR molecular microbiologic testing, isolation of a viable virus, and autopsy with histologic results were used to investigate the possible vertical transmission of SARS-CoV-2 infection from mother to fetus. RESULTS Histologic changes in the placenta correlate with SARS-CoV-2 infection. Total nucleic acid isolated from vaginal swabs, fresh placental tissue, and deparaffinized tissue showed a high viral load of SARS-CoV-2. Complete genome sequencing confirmed the presence of the SARS-CoV-2 Delta variant. DISCUSSION Several methods have been used to confirm SARS-CoV-2-mediated acute placental failure, all of which were conclusive. It should be noted that careful periodic fetal well-being checks are required in women infected with SARS-CoV-2, regardless of the severity of symptoms. Most of the cases described with fetal death occurred in the third trimester.
Collapse
Affiliation(s)
- Nadja Kosič
- Department of Pathology, General Hospital Jesenice, Jesenice, Slovenia.
| | - Boštjan Luzar
- Institute of Pathology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Polona Pečlin
- Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mirjam Druškovič
- Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katarina Resman Rus
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tatjana Avšič Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Premru Sršen
- Division of Gynecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
10
|
González-Vanegas O, Martinez-Perez O. SARS-CoV-2 Infection and Preeclampsia-How an Infection Can Help Us to Know More about an Obstetric Condition. Viruses 2023; 15:1564. [PMID: 37515250 PMCID: PMC10385171 DOI: 10.3390/v15071564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/25/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Pregnant women with SARS-CoV-2 infection have a significantly higher risk of maternal death, ICU admission, preterm delivery, and stillbirth compared to those without infection. Additionally, the risk of preeclampsia (PE) increases in pregnant women infected with SARS-CoV-2, particularly in severe cases. The association between COVID-19 and PE is likely attributed to various mechanisms, including direct effects of the virus on trophoblast function and the arterial wall, exaggerated inflammatory response in pregnant women, local inflammation leading to placental ischemia, SARS-CoV-2-related myocardial injury, cytokine storm, and thrombotic microangiopathy. This paper aims to explore the similarities between PE and SARS-CoV-2 infection, considering COVID-19 as a valuable study model. By examining these parallels, we can enhance our knowledge and comprehension of PE. We wish to emphasize the potential for COVID-19-induced myocardial injury in pregnant women and its connection to the increased maternal mortality rate.
Collapse
Affiliation(s)
| | - Oscar Martinez-Perez
- Obstetric Departament, Hospital Universitario Puerta de Hierro 2, 28222 Majadahonda, Spain
| |
Collapse
|
11
|
Corbetta-Rastelli CM, Altendahl M, Gasper C, Goldstein JD, Afshar Y, Gaw SL. Analysis of placental pathology after COVID-19 by timing and severity of infection. Am J Obstet Gynecol MFM 2023; 5:100981. [PMID: 37094637 PMCID: PMC10122562 DOI: 10.1016/j.ajogmf.2023.100981] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/19/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND COVID-19 during pregnancy can have serious effects on pregnancy outcomes. The placenta acts as an infection barrier to the fetus and may mediate adverse outcomes. Increased frequency of maternal vascular malperfusion has been detected in the placentas of patients with COVID-19 compared with controls, but little is known about how the timing and severity of infection affect placental pathology. OBJECTIVE This study aimed to examine the effects of SARS-CoV-2 infection on placental pathology, specifically whether the timing and severity of COVID-19 affect pathologic findings and associations with perinatal outcomes. STUDY DESIGN This was a descriptive retrospective cohort study of pregnant people diagnosed with COVID-19 who delivered between April 2020 and September 2021 at 3 university hospitals. Demographic, placental, delivery, and neonatal outcomes were collected through medical record review. The timing of SARS-CoV-2 infection was noted, and the severity of COVID-19 was categorized on the basis of the National Institutes of Health guidelines. The placentas of all patients with positive nasopharyngeal reverse transcription-polymerase chain reaction COVID-19 testing were sent for gross and microscopic histopathologic examinations at the time of delivery. Nonblinded pathologists categorized histopathologic lesions according to the Amsterdam criteria. Univariate linear regression and chi-square analyses were used to assess how the timing and severity of SARS-CoV-2 infection affected placental pathologic findings. RESULTS This study included 131 pregnant patients and 138 placentas, with most patients delivered at the University of California, Los Angeles (n=65), followed by the University of California, San Francisco (n=38) and Zuckerberg San Francisco General Hospital (n=28). Most patients were diagnosed with COVID-19 in the third trimester of pregnancy (69%), and most infections were mild (60%). There was no specific placental pathologic feature based on the timing or severity of COVID-19. There was a higher frequency of placental features associated with response to infection in the placentas from infections before 20 weeks of gestation than that from infections after 20 weeks of gestation (P=.001). There was no difference in maternal vascular malperfusion by the timing of infection; however, features of severe maternal vascular malperfusion were only found in the placentas of patients with SARS-CoV-2 infection in the second and third trimesters of pregnancy, not in the placentas of patients with COVID-19 in the first trimester of pregnancy. CONCLUSION Placentas from patients with COVID-19 showed no specific pathologic feature, regardless of the timing or severity of the disease. There was a higher proportion of placentas from patients with COVID-19-positive tests in earlier gestations with evidence of placental infection-associated features. Future studies should focus on understanding how these placental features in SARS-CoV-2 infections go on to affect pregnancy outcomes.
Collapse
Affiliation(s)
- Chiara M Corbetta-Rastelli
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Drs Corbetta-Rastelli and Gaw).
| | - Marie Altendahl
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Ms Altendahl and Drs Goldstein and Afshar)
| | - Cynthia Gasper
- Department of Pathology, University of California, San Francisco, San Francisco, CA (Dr Gasper)
| | - Jeffrey D Goldstein
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Ms Altendahl and Drs Goldstein and Afshar); Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA (Dr Goldstein)
| | - Yalda Afshar
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA (Ms Altendahl and Drs Goldstein and Afshar); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA (Dr Afshar)
| | - Stephanie L Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Drs Corbetta-Rastelli and Gaw)
| |
Collapse
|
12
|
Abstract
The COVID-19 (SARS-Cov-2) pandemic has put a strain on healthcare systems around the world from December 2019 in China, and then rapidly spreading worldwide. The impact of the virus on the entire population and its differential effect on various age groups was unknown at the outset, specifically its severity in elders, children or those living with other comorbidities, thus defining the syndemic, rather than pandemic, character of the infection. The effort of clinicians was initially to organize differential paths to isolate cases or contacts. This impacted the maternal-neonatal care adding an additional burden to this dyad and raising several questions. Can SARS-Cov-2 infection in the first days of life put the health of the newborn at risk? Could the separation of a healthy newborn from an infected mother create further physical and psychological health problems in the dyad? The rapid and massive research effort in these three years of the pandemic has provided wide answers to these initial questions. In this review, we report epidemiological data, clinical features, complications, and management of the neonates affected by SARS-Cov-2 infection.
Collapse
Affiliation(s)
- Alfonso Galderisi
- Department of Woman and Child's Health, University of Padova, Padova, Italy; Yale University, Department of Pediatrics, New Haven, CT, USA
| | - Gianluca Lista
- Neonatal Intensive Care Unit, Buzzi Children's Hospital, Milan, Italy
| | | | - Daniele Trevisanuto
- Department of Woman and Child's Health, University of Padova, Padova, Italy.
| |
Collapse
|
13
|
Trinh QD, Pham NTK, Takada K, Ushijima H, Komine-Aizawa S, Hayakawa S. Roles of TGF-β1 in Viral Infection during Pregnancy: Research Update and Perspectives. Int J Mol Sci 2023; 24:ijms24076489. [PMID: 37047462 PMCID: PMC10095195 DOI: 10.3390/ijms24076489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
Transforming growth factor-beta 1 (TGF-β1) is a pleiotropic growth factor playing various roles in the human body including cell growth and development. More functions of TGF-β1 have been discovered, especially its roles in viral infection. TGF-β1 is abundant at the maternal-fetal interface during pregnancy and plays an important function in immune tolerance, an essential key factor for pregnancy success. It plays some critical roles in viral infection in pregnancy, such as its effects on the infection and replication of human cytomegalovirus in syncytiotrophoblasts. Interestingly, its role in the enhancement of Zika virus (ZIKV) infection and replication in first-trimester trophoblasts has recently been reported. The above up-to-date findings have opened one of the promising approaches to studying the mechanisms of viral infection during pregnancy with links to corresponding congenital syndromes. In this article, we review our current and recent advances in understanding the roles of TGF-β1 in viral infection. Our discussion focuses on viral infection during pregnancy, especially in the first trimester. We highlight the mutual roles of viral infection and TGF-β1 in specific contexts and possible functions of the Smad pathway in viral infection, with a special note on ZIKV infection. In addition, we discuss promising approaches to performing further studies on this topic.
Collapse
Affiliation(s)
- Quang Duy Trinh
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Ngan Thi Kim Pham
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kazuhide Takada
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hiroshi Ushijima
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Shihoko Komine-Aizawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Satoshi Hayakawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Foetal Intrapartum Compromise at Term: Could COVID-19 Infection Be Involved? A Case Report. Medicina (B Aires) 2023; 59:medicina59030552. [PMID: 36984557 PMCID: PMC10054388 DOI: 10.3390/medicina59030552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
The impact of the SARS-CoV-2 infection on pregnancy has been studied and many reports have been published, mainly focussing on complications and in utero transmission with neonatal consequences. Although the effects of other viruses on foetuses are well known, the impact of maternal COVID-19 during pregnancy is not completely understood. We report a case of acute foetal intrapartum hypoxia without other risk factors than maternal COVID-19 disease 2 weeks previous to birth at term. Placental histological changes suggested that the viral infection could have been the culprit for the unfavourable outcome during labour. The neonate was promptly delivered by Caesarean section. Neonatal intensive care was started, including therapeutic hypothermia. The procedure was successful, the evolution of the neonate was favourable, and she was discharged after 10 days. Follow-up at 2 months of life indicated a normal neurological development but a drop in head growth. The case raises the idea that pregnancies with even mild COVID-19 symptoms may represent the cause of neonate compromise in a low-risk pregnancy. An important follow-up in the neonatal period and infancy is required to identify and treat any subsequent conditions. Further long-term studies are necessary to identify a cause–effect relationship between COVID-19 pregnancies and the whole spectrum of neonatal and infant consequences.
Collapse
|
16
|
Reis ZSN, Pires MC, Ramos LEF, Sales TLS, Delfino-Pereira P, Martins KPMP, Garbini AF, Gomes AGDR, Pessoa BP, Matos CC, Cimini CCR, Rempel C, Ponce D, Aranha FFMG, Anschau F, Crestani GP, Grizende GMS, Bastos GAN, Goedert GMDS, Menezes LSM, Carneiro M, Tolfo MF, Corrêa MAM, Amorim MMD, Guimarães Júnior MH, Durães PAA, Rosa PMDS, Martelli PJDL, Almeida RSCD, Martins RC, Alvarenga SP, Boersma E, Aguiar RALPD, Marcolino MS. Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score. BMC Pregnancy Childbirth 2023; 23:18. [PMID: 36627576 PMCID: PMC9830611 DOI: 10.1186/s12884-022-05310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died. METHODS This multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score. RESULTS From 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641-0.944) and 0.704 (95% IC: 0.617-0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001). CONCLUSIONS The ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.
Collapse
Affiliation(s)
- Zilma Silveira Nogueira Reis
- Department of Gynecology and Obstetrics, University Hospital. Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
| | - Magda Carvalho Pires
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Lucas Emanuel Ferreira Ramos
- Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil
| | - Thaís Lorenna Souza Sales
- Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Chanadour, Divinópolis, MG, 35501-296, Brazil.
| | - Polianna Delfino-Pereira
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/CNPq), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
| | | | - Andresa Fontoura Garbini
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | - Bruno Porto Pessoa
- Hospital Júlia Kubitschek, R. Dr. Cristiano Rezende, Belo Horizonte, 2745, Brazil
| | - Carolina Cunha Matos
- Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo Horizonte, Brazil
| | - Christiane Corrêa Rodrigues Cimini
- Hospital Santa Rosália, R. Dr. Onófre, 575, Teófilo Otoni, Brazil
- Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil
| | - Claudete Rempel
- Hospital Bruno Born, Av. Benjamin Constant, 881, Lajeado, Brazil
| | - Daniela Ponce
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho" and Hospital das Clínicas da Faculdade de Medicina de Botucatu, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, Brazil
| | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil
| | | | | | | | | | | | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz do Sul, Brazil
| | - Marcia Ffner Tolfo
- Faculdade Integrada de Santa Maria, R. José do Patrocínio, 26, Santa Maria, Brazil
| | - Maria Augusta Matos Corrêa
- Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil
| | | | | | | | | | - Petrônio José de Lima Martelli
- Centro de Ciências Médicas, Universidade Federal de Pernambuco, Hospital das Clínicas da Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, Brazil
| | | | | | - Samuel Penchel Alvarenga
- Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Chanadour, Divinópolis, MG, 35501-296, Brazil
| | - Eric Boersma
- Department of Cardiology, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Regina Amélia Lopes Pessoa de Aguiar
- Department of Gynecology and Obstetrics, University Hospital. Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Institute for Health Technology Assessment (IATS/CNPq), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil
- University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena 190, Belo Horizonte, Brazil
| |
Collapse
|
17
|
Kumar D, Verma S, Mysorekar IU. COVID-19 and pregnancy: clinical outcomes; mechanisms, and vaccine efficacy. Transl Res 2023; 251:84-95. [PMID: 35970470 PMCID: PMC9371980 DOI: 10.1016/j.trsl.2022.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 02/04/2023]
Abstract
As the COVID-19 pandemic continues into its third year, emerging data indicates increased risks associated with SARS-CoV-2 infection during pregnancy, including pre-eclampsia, intrauterine growth restriction, preterm birth, stillbirth, and risk of developmental defects in neonates. Here, we review clinical reports to date that address different COVID-19 pregnancy complications. We also document placental pathologies induced by SARS-CoV-2 infection, entry mechanisms in placental cells, and immune responses at the maternal-fetal interface. Since new variants of SARS-CoV-2 are emerging with characteristics of higher transmissibility and more effective immune escape strategies, we also briefly highlight the genomic and proteomic features of SARS-CoV-2 investigated to date. Vector and mRNA-based COVID-19 vaccines continue to be rolled out globally. However, because pregnant individuals were not included in the vaccine clinical trials, some pregnant individuals have safety concerns and are hesitant to take these vaccines. We describe the recent studies that have addressed the effectiveness and safety of the current vaccines during pregnancy. This review also sheds light on important areas that need to be carefully or more fully considered with respect to understanding SARS-CoV-2 disease mechanisms of concern during pregnancy.
Collapse
Affiliation(s)
- Deepak Kumar
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Sonam Verma
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Indira U Mysorekar
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
18
|
Gupta A, Kamity R, Sharma R, Caprio M, Mally P, Verma S. Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic. Am J Perinatol 2022; 39:1764-1778. [PMID: 35738288 DOI: 10.1055/s-0042-1749635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic caused significant mortality and morbidity in people of all age groups worldwide. Given the uncertainty regarding the mode of transmission and potential effects of COVID-19 on pregnant mothers and their newborns, guidelines for taking care of maternal-newborn dyads have evolved tremendously since the pandemic began. There has been an enormous influx of published materials regarding the outcomes of mothers and newborns. Still, multiple knowledge gaps regarding comprehensive information about risk to the mothers and newborns exist, which need to be addressed. Current evidence suggests that mothers with symptomatic COVID-19 infection are at increased risk of severe illness during pregnancy, with a higher need for respiratory support and premature deliveries. Neonates born to mothers with COVID-19 are at increased risk of needing intensive care; however, most newborns do well after birth. As new mutant variants arise, we need to be cautious while proactively understanding any new evolving patterns. All leading health authorities strongly recommend COVID-19 vaccination before or during pregnancy to reduce the risk of maternal morbidities and benefit from passing antibodies to newborns prenatally and via breastmilk. Additionally, there are racial, ethnic, and socioeconomic disparities in outcomes and vaccination coverage for pregnant women. This article summarizes the rapidly evolving evidence for the last 1.5 years and aims to help health care professionals care for mothers with COVID-19 and their newborns. KEY POINTS: · COVID-19 in pregnancy can cause perinatal morbidities.. · Breastfeeding and breast milk are safe for newborns.. · COVID-19 vaccination reduces the risk for morbidities..
Collapse
Affiliation(s)
- Arpit Gupta
- Division of Neonatology, Department of Pediatrics, NYC Health, Hospitals/Metropolitan, New York City, New York
| | - Ranjith Kamity
- Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, New York City, New York
| | - Rishika Sharma
- Department of Pediatrics, Family Healthcare Network, Visalia, California
| | - Martha Caprio
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| | - Pradeep Mally
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| |
Collapse
|
19
|
Rad HS, Röhl J, Stylianou N, Allenby MC, Bazaz SR, Warkiani ME, Guimaraes FSF, Clifton VL, Kulasinghe A. Corrigendum: The effects of COVID-19 on the placenta during pregnancy. Front Immunol 2022; 13:998406. [PMID: 36159853 PMCID: PMC9496642 DOI: 10.3389/fimmu.2022.998406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Habib Sadeghi Rad
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joan Röhl
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nataly Stylianou
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mark C. Allenby
- School of Chemical Engineering, University of Queensland, St Lucia, QLD, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sajad Razavi Bazaz
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Majid E. Warkiani
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Vicki L. Clifton
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Arutha Kulasinghe
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- The University of Queensland Diamantina Institute (UQDI), Brisbane, QLD, Australia
- *Correspondence: Arutha Kulasinghe,
| |
Collapse
|
20
|
Tanna R, Dugarte HJN, Kurakula S, Muralidharan V, Das A, Kanigalpula SPR, Mendez IE, Afaq M, Bassi R, Shah K, Saddiq Z. Review of Impact of COVID-19 on Maternal, Neonatal Outcomes, and Placental Changes. Cureus 2022; 14:e28631. [PMID: 36106265 PMCID: PMC9450993 DOI: 10.7759/cureus.28631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Coronavirus disease (COVID-19), caused by SARS-CoV-2, is a disease that has caused a global impact. COVID-19 is transmitted through airborne droplets, respiratory secretions, and direct contact. The pandemic has affected individuals of different ages, and studying the impact of COVID-19 on maternal and newborn outcomes is critical. In this review, we highlight the impact of COVID-19 infection in pregnancy and its repercussion in the maternal-fetal binomial. Physiological changes that occur during pregnancy have significant effects on the immune system, cardiopulmonary system, and coagulation, and these changes can result in an altered response to COVID-19 infection. The symptoms, risk factors, and maternal health consequences of COVID-19 were discussed. In addition, the impact of newborns born to mothers with COVID-19 was reviewed. Finally, placental changes and vertical transmission of COVID-19 during pregnancy were also discussed in this review.
Collapse
|
21
|
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.
Collapse
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.
| |
Collapse
|
22
|
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.
Collapse
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.
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
COVID-19: the possibility, ways, mechanisms, and interruptions of mother-to-child transmission. Arch Gynecol Obstet 2022; 307:1687-1696. [PMID: 35665849 PMCID: PMC9166277 DOI: 10.1007/s00404-022-06639-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Background In December 2019, novel coronavirus pneumonia was detected in Wuhan, Hubei Province, China, and as the epidemic spread, such cases emerged worldwide. Recently, the World Health Organization (WHO) named a new mutant Omicron (B.1.1.529), which disrupts the binding of most antibodies to the S protein and has a greater ability to break through the vaccine, posing a serious risk to population safety. Positive pregnant women give birth to positive newborns despite appropriate isolation measures taken by medical staff, suggesting that we may have vertical transmission of the novel coronavirus. This article analyzes and studies the possible vertical transmission path of the new coronavirus in the perinatal period of pregnant women and the antibody-dependent enhancement (ADE), and puts forward effective preventive measures for positive pregnant women to provide further reference for clinical work. Methods We searched multiple databases, including PubMed, CNKI, Google Scholar, WHO COVID-19 database, and CDC database. Search terms included COVID-19, SARS-CoV-2, vertical transmission, Omicron, Vaginal, Breast Feeding, Vaccine, Neonatal, Severe acute respiratory syndrome coronavirus, Pregnancy, and Semen. Selection criteria The following criteria were also met: (1) positive maternal novel coronavirus nucleic acid test; (2) reporting of neonatal outcome; (3) language in Chinese or English; (4) study date or location indicated; (5) no suspected or confirmed duplicated reports. Results There is evidence of vertical transmission, and the risk of possible vertical transmission is 5.7% (75/1314). The article listed four possible vertical transmission routes, namely placental transmission, vaginal upstream transmission, breastfeeding transmission and monocyte, and macrophage transmission route, with placental transmission being the most probable. Meanwhile, SARS-CoV-2 may also enter the placenta to infect the fetus through antibody-dependent enhanced substitution mechanism. We recommend three methods for early surveillance of vertical transmission, namely nucleic acid testing, antibody screening, and antigen testing, and analyze their advantages and disadvantages. Finally, the article provides recommendations in four areas: labor management, neonatal management, nosocomial infection prevention and control, and vaccination. As well as suggesting effective preventive measures for positive pregnant women and analyzing the advantages and disadvantages of vaccination, it is recommended that pregnant women should be vaccinated promptly, but considering that the vaccine may cause fever, it is recommended to consider vaccination cautiously in the first trimester of pregnancy. Conclusion The article concludes that vertical transmission is possible, with placental transmission being the most likely, and that the risk of possible vertical transmission is 5.7% (75/1314). Good personal protection, patient isolation, ward disinfection, and vaccination are the best means of interrupting SARS-CoV-2.
Collapse
|
25
|
Motwani R, Deshmukh V, Kumar A, Kumari C, Raza K, Krishna H. Pathological involvement of placenta in COVID-19: a systematic review. LE INFEZIONI IN MEDICINA 2022; 30:157-167. [PMID: 35693050 PMCID: PMC9177177 DOI: 10.53854/liim-3002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
The mammalian placenta, which is responsible for bonding between the mother and the fetus, is one of the first organs to develop. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection has caused a great threat to public health and affected almost all the organs including the placenta. Owing to limited available data on vertical transmission and pathological changes in the placenta of SARS-CoV-2 positive patients, we aim to review and summarize histopathological and ultrastructural changes in the placental tissue following SARS-CoV-2 infection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were used for review writing. Multiple studies have reported significant pathological changes in the placental tissue of SARS-CoV-2 positive mothers. On the other hand, some studies have demonstrated either no or very little involvement of the placental tissue. The most common pathological changes reported are fetal and maternal vascular malformation, villitis of unknown etiology, thrombus formation in the intervillous space and sub-chorionic space, and chorangiosis. Reports on vertical transmission are less in number. The observations of this review present a strong base for the pathological involvement of the placenta in SARS-CoV-2 infected mothers. However, a smaller number of original studies have been done until now, and most of them have small sample sizes and lack matched control groups, which are the big limitations for drawing an effective conclusion at this stage. Antenatal care can be improved by a better understanding of the correlation between maternal SARS-CoV-2 infection and placental pathology in COVID-19.
Collapse
Affiliation(s)
- Rohini Motwani
- Department of Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad (Telangana), India
| | - Vishwajit Deshmukh
- Department of Anatomy, All India Institute of Medical Sciences, Nagpur (Maharashtra), India
| | - Ashutosh Kumar
- Department of Anatomy, All India Institute of Medical Sciences, Patna (Bihar), India
| | - Chiman Kumari
- Department of Anatomy, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Khursheed Raza
- Department of Anatomy, All India Institute of Medical Sciences, Deoghar (Jharkhand), India
| | - Hare Krishna
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
26
|
Chandrasekar V, Singh AV, Maharjan RS, Dakua SP, Balakrishnan S, Dash S, Laux P, Luch A, Singh S, Pradhan M. Perspectives on the Technological Aspects and Biomedical Applications of Virus‐Like Particles/Nanoparticles in Reproductive Biology: Insights on the Medicinal and Toxicological Outlook. ADVANCED NANOBIOMED RESEARCH 2022. [DOI: 10.1002/anbr.202200010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Ajay Vikram Singh
- German Federal Institute for Risk Assessment (BfR) Department of Chemical and Product Safety Max-Dohrn-Straße 8-10 10589 Berlin Germany
| | - Romi Singh Maharjan
- German Federal Institute for Risk Assessment (BfR) Department of Chemical and Product Safety Max-Dohrn-Straße 8-10 10589 Berlin Germany
| | | | | | - Sagnika Dash
- Obstetrics and Gynecology Apollo Clinic Qatar 23656 Doha Qatar
| | - Peter Laux
- German Federal Institute for Risk Assessment (BfR) Department of Chemical and Product Safety Max-Dohrn-Straße 8-10 10589 Berlin Germany
| | - Andreas Luch
- German Federal Institute for Risk Assessment (BfR) Department of Chemical and Product Safety Max-Dohrn-Straße 8-10 10589 Berlin Germany
| | - Suyash Singh
- Department of Neurosurgery All India Institute of Medical Sciences Raebareli UP 226001 India
| | - Mandakini Pradhan
- Department of Fetal Medicine Sanjay Gandhi Post Graduate Institute of Medical Sciences Reabareli Road Lucknow UP 226014 India
| |
Collapse
|
27
|
Kato M, Yamaguchi K, Maegawa Y, Komine-Aizawa S, Kondo E, Ikeda T. Intrauterine fetal death during COVID-19 pregnancy: Typical fetal heart rate changes, coagulopathy, and placentitis. J Obstet Gynaecol Res 2022; 48:1978-1982. [PMID: 35605975 PMCID: PMC9348471 DOI: 10.1111/jog.15302] [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] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 01/09/2023]
Abstract
Although various perinatal outcomes in coronavirus disease 2019 (COVID‐19) pregnancies have been reported, the fetal and neonatal consequences of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection remain unclear. Several reports of miscarriages and stillbirths have been recorded, but vertical transmission by SARS‐CoV‐2 is considered very rare, and the cause remains unknown. We report a case of a 22‐year‐old uncomplicated Japanese woman infected with SARS‐CoV‐2 during the second trimester, resulting in intrauterine fetal death due to placental insufficiency associated with COVID‐19 placentitis. This report emphasizes the importance of longitudinal assessment of fetal well‐being by fetal heart rate monitoring and early detection of maternal coagulation dysfunction representing SARS‐CoV‐2 inflammation to manage COVID‐19 in pregnancy.
Collapse
Affiliation(s)
- Maya Kato
- Department of Obstetrics and Gynecology, Mie Central Medical Center, Mie, Japan
| | - Kyohei Yamaguchi
- Department of Obstetrics and Gynecology, Mie Central Medical Center, Mie, Japan
| | - Yuka Maegawa
- Department of Obstetrics and Gynecology, Mie Central Medical Center, Mie, Japan
| | - Shihoko Komine-Aizawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University, Mie, Japan
| |
Collapse
|
28
|
Moriarty K, Yu M, Hussain N, Zgutka K, Sanders MM, Harigopal M, Wang J, Wang X, Hui P, Liu C, Sink D, Shields A. COVID-19 & differential effects in twins: Insights from Placenta Pathology. Placenta 2022; 124:62-66. [PMID: 35640456 PMCID: PMC9121647 DOI: 10.1016/j.placenta.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 10/26/2022]
|
29
|
Goh GKM, Dunker AK, Foster JA, Uversky VN. Computational, Experimental, and Clinical Evidence of a Specific but Peculiar Evolutionary Nature of (COVID-19) SARS-CoV-2. J Proteome Res 2022; 21:874-890. [PMID: 35142523 PMCID: PMC8864774 DOI: 10.1021/acs.jproteome.2c00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 11/30/2022]
Abstract
The shell disorder models have predicted that SARS-CoV-2 is of a specific but peculiar evolutionary nature. All coronaviruses (CoVs) closely related to SARS-CoV-2 have been found to have the hardest outer shells (M protein) among CoVs. This hard shell (low M percentage of intrinsic disorder (PID)) is associated with burrowing animals, for example, pangolins, and is believed to be responsible for the high contagiousness of SARS-CoV-2 because it will be more resistant to antimicrobial enzymes found in saliva/mucus. Incoming clinical and experimental data do support this along with a prediction based on another aspect of the shell (N, inner shell) disorder models that SARS-CoV-1 is more virulent than SARS-CoV-2 because SARS-CoV-2 produces fewer virus copies in vital organs even if large amounts of infections particles are shed orally and nasally. A phylogenetic study using M reveals a closer relationship of SARS-CoV to pangolin-CoVs than the bat-RaTG13 found in Yunnan, China. Previous studies may have been confused by recombinations that were poorly handled. The shell disorder models suggest that a pangolin-CoV strain may have entered the human population in 2017 or before as an attenuated virus, which could explain why SARS-CoV is found to be highly adapted to humans.
Collapse
Affiliation(s)
| | - A. Keith Dunker
- Center for Computational Biology and Bioinformatics,
Indiana University School of Medicine, Indianapolis, Indiana
46202, United States
| | - James A. Foster
- Department of Biological Sciences,
University of Idaho, Moscow, Idaho 83844, United
States
- Institute for Bioinformatics and Evolutionary Studies,
University of Idaho, Moscow, Idaho 83844, United
States
| | - Vladimir N. Uversky
- Department of Molecular Medicine, USF Health Byrd
Alzheimer’s Research Institute, Morsani College of Medicine,
University of South Florida, Tampa, Florida 33620,
United States
- Laboratory of New Methods in Biology, Institute for
Biological Instrumentation of the Russian Academy of Sciences, Federal
Research Center “Pushchino Scientific Center for Biological Research of the
Russian Academy of Sciences”, Pushchino, Moscow Region 142290,
Russia
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Jash S, Sharma S. Pathogenic Infections during Pregnancy and the Consequences for Fetal Brain Development. Pathogens 2022; 11:pathogens11020193. [PMID: 35215136 PMCID: PMC8877441 DOI: 10.3390/pathogens11020193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
Pathogens comprised of viruses, bacteria, gut microbiome, and parasites are a leading cause of ever-emerging diseases in humans. Studying pathogens for their ability to cause diseases is a topic of critical discussion among scientists and pharmaceutical centers for effective drug development that diagnose, treat, and prevent infection-associated disorders. Pathogens impact health either directly by invading the host or by eliciting an acute inflammatory immune response. This paradigm of inflammatory immune responses is even more consequential in people who may be immunocompromised. In this regard, pregnancy offers an altered immunity scenario, which may allow the onset of severe diseases. Viruses, such as Influenza, HIV, and now SARS-CoV-2, associated with the COVID-19 pandemic, raise new concerns for maternal and fetal/neonatal health. Intrauterine bacterial and parasitic infections are also known to impact pregnancy outcomes and neonatal health. More importantly, viral and bacterial infections during pregnancy have been identified as a common contributor to fetal brain development defects. Infection-mediated inflammatory uterine immune milieu is thought to be the main trigger for causing poor fetal brain development, resulting in long-term cognitive impairments. The concept of in utero programming of childhood and adult disorders has revolutionized the field of neurodevelopment and its associated complications. Recent findings in mice and humans clearly support the idea that uterine immunity during pregnancy controls the health trajectory of the child and considerably influences the cognitive function and mental health. In this review, we focus on the in utero programming of autism spectrum disorders (ASD) and assess the effects of pathogens on the onset of ASD-like symptoms.
Collapse
|
32
|
Dadgar S, Mahmoudinia M, Akbari A, Zandieh E, Attaranzadeh A, Hoseinpour S, Jahanpak N, Tavanaee Sani A, Mohammadi SA. Placental infection with SARS-CoV-2, analysis of 16 cases and literature review. Arch Gynecol Obstet 2022; 305:1359-1367. [PMID: 35088195 PMCID: PMC8794612 DOI: 10.1007/s00404-021-06372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022]
Abstract
Purpose Since December 2019, the whole world has been affected by coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)]. However, the effects of COVID-19 infection on pregnancy and fetal transmission are still unclear. Therefore, this study was conducted to evaluate placenta samples regarding detection of SARS-CoV-2 RNA in women affected with COVID-19.
Method This study was a part of a cohort study carried out on pregnant women with a diagnosis of COVID-19 infection who had been admitted to the Imam Reza Hospital in Mashhad, Iran, from March 20 to August 5, 2020. Clinical and laboratory information of all the patients was collected and chest computed tomography (CT) scans were reviewed. Totally, 16 placental tissue were prepared for real time polymerase chain reaction (RT-PCR) testing. All samples were tested by PowerChek PCR real-time kit (South Korea) with 2 target genes (E gene and Rd Rp gene), and Pishtaz Teb kit, (Iran) with 2 target genes (N gene and RdRp gene).
Result In the first RT-PCR kit by PowerChek kit, 6 samples were positive for a single gene (E gene) and 2 samples were positive for both genes (E gene and Rd Rp gene). In the second RT-PCR kit by Pishtaz Teb kit, 3 samples were positive for two genes (N gene and RdRp gene).
Conclusion This present study showed that infection of placenta with SARS-CoV-2 may occur in pregnancy. However, whether this infection leads to neonatal infection and serious complication in pregnancy remains unclear.
Collapse
Affiliation(s)
- Salmeh Dadgar
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihe Mahmoudinia
- Department of Obstetrics, Faculty of Medicines, Maternal and Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Azam Akbari
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elaheh Zandieh
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Armin Attaranzadeh
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajjad Hoseinpour
- Department of Molecular Genetic, Medical Laboratory, Imam Hosein Hospital, Mashhad, Iran
| | | | | | | |
Collapse
|
33
|
Liu Y, Hao H, Lan T, Jia R, Cao M, Zhou L, Zhao Z, Pan W. Physiological and pathological roles of Ang II and Ang- (1-7) in the female reproductive system. Front Endocrinol (Lausanne) 2022; 13:1080285. [PMID: 36619582 PMCID: PMC9817105 DOI: 10.3389/fendo.2022.1080285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
The local Renin-Angiotensin System (RAS) has been demonstrated to exist in a wide range of tissues and organs, In the female reproductive system, it is mainly found in the ovary, uterus and placenta. The RAS system is made up of a series of active substances and enzymes, in addition to the circulating endocrine renin-angiotensin system. The active peptides Angiotensin II (Ang II) and Angiotensin (1-7) (Ang-(1-7)), in particular, appear to have distinct activities in the local RAS system, which also controls blood pressure and electrolytes. Therefore, in addition to these features, angiotensin and its receptors in the reproductive system seemingly get involved in reproductive processes, such as follicle growth and development, as well as physiological functions of the placenta and uterus. In addition, changes in local RAS components may induce reproductive diseases as well as pathological states such as cancer. In most tissues, Ang II and Ang- (1-7) seem to maintain antagonistic effects, but this conclusion is not always true in the reproductive system, where they play similar functions in some physiological and pathological roles. This review investigated how Ang II, Ang- (1-7) and their receptors were expressed, localized, and active in the female reproductive system. This review also summarized their effects on follicle development, uterine and placental physiological functions. The changes of local RAS components in a series of reproductive system diseases including infertility related diseases and cancer and their influence on the occurrence and development of diseases were elucidated. This article reviews the physiological and pathological roles of Ang II and Ang- (1-7) in female reproductive system,a very intricate system of tissue factors that operate as agonists and antagonists was found. Besides, the development of novel therapeutic strategies targeting components of this system may be a research direction in future.
Collapse
Affiliation(s)
- Yuanyuan Liu
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haomeng Hao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tingting Lan
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Jia
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Shenzhen Zhongshan Urology Hospital, Shenzhen, Guangdong, China
| | - Mingya Cao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liang Zhou
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiming Zhao
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Wensen Pan, ; Zhiming Zhao,
| | - Wensen Pan
- Second Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- *Correspondence: Wensen Pan, ; Zhiming Zhao,
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Long Version)]. Z Geburtshilfe Neonatol 2021; 226:e1-e35. [PMID: 34918334 DOI: 10.1055/a-1688-9398] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).
Collapse
Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Deutschland
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Deutschland
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Deutschland
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rolf Schlösser
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Deutschland
| | | |
Collapse
|
36
|
Nomoto M, Kotani T, Miki R, Ushida T, Imai K, Iitani Y, Tano S, Wang J, Moriyama Y, Kobayashi T, Mimura N, Iriyama T, Kikkawa F, Kajiyama H. Upregulation of ENDOU in cytotrophoblasts from placenta complicated with preeclampsia and fetal growth restriction. J Clin Biochem Nutr 2021; 69:280-285. [PMID: 34857990 PMCID: PMC8611368 DOI: 10.3164/jcbn.21-37] [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: 03/17/2021] [Accepted: 05/04/2021] [Indexed: 11/22/2022] Open
Abstract
Placental hypoplasia is associated with the pathophysiology of fetal growth restriction and preeclampsia. The placenta consists of differentiated trophoblasts, including cytotrophoblasts, syncytiotrophoblasts, and extravillous trophoblasts. Cytotrophoblasts are thought to have stem-like characteristics and the ability to differentiate into syncytiotrophoblasts and extravillous trophoblasts. However, it is poorly understood whether isolated cytotrophoblasts derived from hypoplastic placentas have specific features compared with those in normal placentas. This study aimed to determine the features of cytotrophoblasts in hypoplastic placentas. Differentially expressed proteins between isolated cytotrophoblasts from hypoplastic placenta with fetal growth restriction and those from the normal placenta were determined by liquid chromatography-tandem mass spectrometry. Among 6,802 proteins, 1,253 and 2,129 proteins were more than 2-fold upregulated and downregulated, respectively. Among them, ENDOU (endonuclease, poly(U) specific), which has high homology with the coronavirus endoribonuclease nonstructural protein 15 (Nsp15), showed a significantly increased expression in cytotrophoblasts from the placenta with fetal growth restriction related to preeclampsia compared with those in normal control placenta. These results provide insight into the pathological mechanisms of placental hypoplasia and additional information on preeclamptic symptoms in cases of SARS-CoV-2 infected placenta, although further investigation is needed.
Collapse
Affiliation(s)
- Masataka Nomoto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.,Department of Obstetrics and Gynecology, Handa City Hospital, 2-29 Toyo-cho, Handa City, Aichi 475-8599, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.,Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Rika Miki
- Laboratory of Bell Research Center‑Department of Obstetrics and Gynecology Collaborative Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.,Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Sho Tano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Jingwen Wang
- Laboratory of Bell Research Center‑Department of Obstetrics and Gynecology Collaborative Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Fujita Health University, School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Tomoko Kobayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Nobuko Mimura
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-655, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-655, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| |
Collapse
|
37
|
Arthurs AL, Jankovic-Karasoulos T, Roberts CT. COVID-19 in pregnancy: What we know from the first year of the pandemic. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166248. [PMID: 34461257 PMCID: PMC8397492 DOI: 10.1016/j.bbadis.2021.166248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/21/2021] [Accepted: 08/14/2021] [Indexed: 02/08/2023]
Abstract
The COVID-19 pandemic has infected nearly 178 million people and claimed the lives of over 3.8 million in less than 15 months. This has prompted a flurry of research studies into the mechanisms and effects of SARS-CoV-2 viral infection in humans. However, studies examining the effects of COVID-19 in pregnant women, their placentae and their babies remain limited. Furthermore, reports of safety and efficacy of vaccines for SARS-CoV-2 in pregnancy are limited. This review concisely summarises the case studies and research on COVID-19 in pregnancy, to date. It also reviews the mechanism of infection with SARS-CoV-2, and its reliance and effects upon the renin-angiotensin-aldosterone system. Overall, the data suggest that infection during pregnancy can be dangerous at any time, but this risk to both the mother and fetus, as well as placental damage, increases during the third trimester. The possibility of vertical transmission, which is explored in this review, remains contentious. However, maternal infection with SARS-CoV-2 can increase risk of miscarriage, preterm birth and stillbirth, which is likely due to damage to the placenta.
Collapse
Affiliation(s)
- Anya Lara Arthurs
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5042, Australia.
| | | | - Claire Trelford Roberts
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5042, Australia.
| |
Collapse
|
38
|
Aharon D, Gounko D, Lee JA, Copperman AB, Flisser E. The Impact of the Coronavirus Disease 19 Pandemic on Early Pregnancy Outcomes Among Patients Undergoing In Vitro Fertilization Treatment. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:473-478. [PMID: 34841393 PMCID: PMC8617588 DOI: 10.1089/whr.2021.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/14/2022]
Abstract
Objective: To determine if pregnancy rates (PRs) or pregnancy loss rates (PLRs) were altered in patients undergoing single, euploid frozen-thawed embryo transfer (FET) during the initial peak of the Coronavirus Disease 19 (COVID-19) pandemic. Materials and Methods: This was a retrospective cohort study performed in a single academic center. Patients undergoing single, euploid FET cycles from January to May 2017–2020 were included. Cycles with FET performed in January–May of 2020 (“COVID-surge cohort”) were compared to cycles with FET performed in January–May of 2017–2019 (“pre-COVID cohort”). Pregnancy rate (PR), clinical pregnancy rate (CPR), pregnancy loss rate (PLR), and clinical pregnancy loss rate (CLR) were compared between the cohorts. Results: A total of 2629 single, euploid FET cycles were included: 2070 from January to May, 2017–2019 and 559 from January to May 2020. PR was similar when comparing FET performed from January to May 2020 (COVID-surge) to those performed from January to May, 2017–2019 (pre-COVID) (77.6% vs. 73.7%, p = 0.06), while CPR was higher among the COVID-surge compared to the pre-COVID cohort (65.5% vs. 60.0%, p = 0.02). No differences were seen in PLR and CLR among the COVID-surge and pre-COVID cohorts (28.3% vs. 32.0%, p = 0.08; 15.0% vs. 16.5%, p = 0.50). PR, CPR, PLR, and CLR were similar when comparing individual months between the cohorts. Adjusted analysis showed no differences in PR, CPR, PLR, or CLR when comparing the cohorts overall or when comparing corresponding individual months in the two time periods. Conclusion: PRs and PLRs were not decreased when SARS-CoV-2 transmission was widespread in our geographic area, suggesting that high COVID-19 transmission does not compromise early pregnancy outcomes.
Collapse
Affiliation(s)
- Devora Aharon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Reproductive Medicine Associates of New York, New York, New York, USA
| | - Dmitry Gounko
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Joseph A Lee
- Reproductive Medicine Associates of New York, New York, New York, USA
| | - Alan B Copperman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Reproductive Medicine Associates of New York, New York, New York, USA
| | - Eric Flisser
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Reproductive Medicine Associates of New York, New York, New York, USA
| |
Collapse
|
39
|
The Current Evidence Regarding COVID-19 and Pregnancy: Where Are We Now and Where Should We Head to Next? Viruses 2021; 13:v13102000. [PMID: 34696430 PMCID: PMC8541470 DOI: 10.3390/v13102000] [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] [Received: 07/23/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the volume of publications dedicated to unraveling the biological characteristics and clinical manifestations of SARS-CoV-2, available data on pregnant patients are limited. In the current review of literature, we present an overview on the developmental course, complications, and adverse effects of COVID-19 on pregnancy. A comprehensive review of the literature was performed in PubMed/Medline, Embase, and Cochrane Central databases up to June 2021. This article collectively presents what has been so far reported on the identified critical aspects, namely complications during pregnancy, delivery challenges, neonatal health care, potential routes of viral transmission, including vertical transmission or breastfeeding, along with the risks involved in the vaccination strategy during pregnancy. Despite the fact that we are still largely navigating uncharted territory, the observed publication explosion in the field is unprecedented. The overwhelming need for data is undoubtable, and this serves as the driver for the plethora of publications witnessed. Nonetheless, the quality of data sourced is variable. In the midst of the frenzy for reporting on SARS-CoV-2 data, monitoring this informational overload is where we should head to next, considering that poor quality research may in fact hamper our attempts to prevail against this unparalleled pandemic outbreak.
Collapse
|
40
|
Lesieur E, Torrents J, Fina F, Zandotti C, Blanc J, Collardeau-Frachon S, Gazin C, Sirgant D, Mezouar S, Otmani Idrissi M, Lepidi H, Bretelle F, Mege JL, Daniel L, Fritih R. Congenital Infection of Severe Acute Respiratory Syndrome Coronavirus 2 With Intrauterine Fetal Death: A Clinicopathological Study With Molecular Analysis. Clin Infect Dis 2021; 75:e1092-e1100. [PMID: 34553751 PMCID: PMC8500004 DOI: 10.1093/cid/ciab840] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Observations of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from mother to fetus have recently been described in the literature. However, the consequences of such transmission, whether fetal or neonatal, are poorly understood. METHODS From a case of in utero fetal death at 24+2 weeks of gestation that occurred 7 days after the diagnosis of symptomatic SARS-CoV-2 infection in the mother, we isolated the incriminating virus by immunochemistry and molecular techniques in several fetal tissues, with a variant analysis of the SARS-CoV-2 genome. RESULTS The fetal demise could be explained by the presence of placental histological lesions, such as histiocytic intervillositis and trophoblastic necrosis, in addition to fetal tissue damage. We observed mild fetal growth retardation and visceral damage to the liver, causing hepatocellular damage and hemosiderosis. To the best of our knowledge, this is the first report in the literature of fetal demise secondary to maternal-fetal transmission of SARSCoV- 2 with a congenital infection and a pathological description of placental and fetal tissue damage. CONCLUSIONS SARS-CoV-2 was identified in both specimens using 3 independent techniques (immunochemistry, real-time quantitative polymerase chain reaction, and realtime digital polymerase chain reaction). Furthermore, the incriminating variant has been identified.
Collapse
Affiliation(s)
- Emmanuelle Lesieur
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France,Prenatal Diagnosis Center, Department of Obstetrics and Gynaecology, La Conception Hospital, Aix Marseille University, Boulevard Baille, 13005 Marseille, France,Correspondence: Dr. Emmanuelle Lesieur, Prenatal Diagnosis Center, Department of Obstetrics and Gynaecology, La Conception Hospital, Aix Marseille University, Boulevard Baille, 13005 Marseille. Phone: + 33 491 384 257, mail:
| | - Julia Torrents
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France
| | - Frédéric Fina
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France,ID Solutions, Grabels, France
| | - Christine Zandotti
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Julie Blanc
- Department of Obstetrics and Gynaecology, Nord Hospital, APHM, Chemin des Bourrely, 13015, Marseille, France,EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, 13284, Marseille, France
| | - Sophie Collardeau-Frachon
- Institut de Pathologie Multisite, Groupement Hospitalier Est, Hospices Civils de Lyon, France; Université Claude Bernard Lyon 1, France
| | - Céline Gazin
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Delphine Sirgant
- Department of Obstetrics and Gynaecology, Ste Musse Hospital, 54, rue Henri Sainte Claire Deville, 83000, Toulon, France
| | - Soraya Mezouar
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Myriem Otmani Idrissi
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Hubert Lepidi
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France
| | - Florence Bretelle
- Prenatal Diagnosis Center, Department of Obstetrics and Gynaecology, La Conception Hospital, Aix Marseille University, Boulevard Baille, 13005 Marseille, France,Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Jean-Louis Mege
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Laurent Daniel
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France,Aix Marseille University - INSERM 1263 - INRAE 1260, France
| | - Radia Fritih
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France
| |
Collapse
|
41
|
Rad H, Röhl J, Stylianou N, Allenby M, Bazaz S, Warkiani ME, Guimaraes FSF, Clifton VL, Kulasinghe A. The Effects of COVID-19 on the Placenta During Pregnancy. Front Immunol 2021; 12:743022. [PMID: 34603330 PMCID: PMC8479199 DOI: 10.3389/fimmu.2021.743022] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/26/2021] [Indexed: 12/21/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. The virus primarily affects the lungs where it induces respiratory distress syndrome ranging from mild to acute, however, there is a growing body of evidence supporting its negative effects on other system organs that also carry the ACE2 receptor, such as the placenta. The majority of newborns delivered from SARS-CoV-2 positive mothers test negative following delivery, suggesting that there are protective mechanisms within the placenta. There appears to be a higher incidence of pregnancy-related complications in SARS-CoV-2 positive mothers, such as miscarriage, restricted fetal growth, or still-birth. In this review, we discuss the pathobiology of COVID-19 maternal infection and the potential adverse effects associated with viral infection, and the possibility of transplacental transmission.
Collapse
Affiliation(s)
- Habib Sadeghi Rad
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joan Röhl
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nataly Stylianou
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mark C. Allenby
- School of Chemical Engineering, University of Queensland, St Lucia, QLD, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sajad Razavi Bazaz
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Majid E. Warkiani
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Vicki L. Clifton
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Arutha Kulasinghe
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- The University of Queensland Diamantina Institute (UQDI), Brisbane, QLD, Australia
| |
Collapse
|
42
|
Turgut E, Ayhan SG, Oluklu D, Tokalioglu EO, Tekin OM, Sahin D. Fetal pulmonary artery Doppler evaluation in pregnant women after recovery from COVID-19. Int J Gynaecol Obstet 2021; 155:450-454. [PMID: 34499751 PMCID: PMC9087611 DOI: 10.1002/ijgo.13916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/06/2021] [Indexed: 12/02/2022]
Abstract
Objective To evaluate fetal lung development using pulmonary artery Doppler in pregnant women who had recovered from COVID‐19. Methods The prospective case–control study included 41 pregnant women who had recovered from COVID‐19 and 43 healthy pregnant women (control group). All the women in the study group had been diagnosed with COVID‐19 and had completed a quarantine period. Results The demographic data of patients were similar in the groups (P > 0.05). Main pulmonary artery peak systolic velocity was higher and pulsatility indices were lower in pregnant women who recovered from COVID‐19 compared to the controls (P < 0.001, P = 0.001). Acceleration time, ejection time, and acceleration/ejection time ratio (PATET) of the fetal MPA Doppler were significantly decreased in pregnant women who recovered from COVID‐19 (P < 0.001, P = 0.036, and P = 0.002, respectively). The patients who had recovered from COVID‐19 were divided into two groups: those treated with expectant management and those treated in hospital. The pulmonary artery acceleration time and PATET ratio were significantly lower in the group treated in the hospital (P = 0.023 and P = 0.045, respectively). Conclusion Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID‐19 disease. Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID‐19 disease.
Collapse
Affiliation(s)
- Ezgi Turgut
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Eda Ozden Tokalioglu
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
43
|
Chaubey I, Vignesh R, Babu H, Wagoner I, Govindaraj S, Velu V. SARS-CoV-2 in Pregnant Women: Consequences of Vertical Transmission. Front Cell Infect Microbiol 2021; 11:717104. [PMID: 34568094 PMCID: PMC8458876 DOI: 10.3389/fcimb.2021.717104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/19/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ishaan Chaubey
- The Center for Advanced Studies in Science, Math, and Technology at Wheeler High School, Marietta, GA, United States
| | - Ramachandran Vignesh
- Preclinical Department, Faculty of Medicine, Royal College of Medicine Perak, Universiti Kuala Lumpur, Ipoh, Malaysia
| | - Hemalatha Babu
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Isabelle Wagoner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Sakthivel Govindaraj
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Vijayakumar Velu
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory Vaccine Center, Emory University, Atlanta, GA, United States
| |
Collapse
|
44
|
Diffuse trophoblast damage is the hallmark of SARS-CoV-2-associated fetal demise. Mod Pathol 2021; 34:1704-1709. [PMID: 34006935 PMCID: PMC8130566 DOI: 10.1038/s41379-021-00827-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 02/04/2023]
Abstract
Placental pathology in SARS-CoV-2-infected pregnancies seems rather unspecific. However, the identification of the placental lesions due to SARS-CoV-2 infection would be a significant advance in order to improve the management of these pregnancies and to identify the mechanisms involved in a possible vertical transmission. The pathological findings in placentas delivered from 198 SARS-CoV-2-positive pregnant women were investigated for the presence of lesions associated with placental SARS-CoV-2 infection. SARS-CoV-2 infection was investigated in placental tissues through immunohistochemistry, and positive cases were further confirmed by in situ hybridization. SARS-CoV-2 infection was also investigated by RT-PCR in 33 cases, including all the immunohistochemically positive cases. Nine cases were SARS-CoV-2-positive by immunohistochemistry, in situ hybridization, and RT-PCR. These placentas showed lesions characterized by villous trophoblast necrosis with intervillous space collapse and variable amounts of mixed intervillous inflammatory infiltrate and perivillous fibrinoid deposition. Such lesions ranged from focal to massively widespread in five cases, resulting in intrauterine fetal death. Two of the stillborn fetuses showed some evidence of SARS-CoV-2 positivity. The remaining 189 placentas did not show similar lesions. The strong association between trophoblastic damage and placenta SARS-CoV-2 infection suggests that this lesion is a specific marker of SARS-CoV-2 infection in placenta. Diffuse trophoblastic damage, massively affecting chorionic villous tissue, can result in fetal death associated with COVID-19 disease.
Collapse
|
45
|
Figueiro-Filho EA, Hobson SR, Farine D, Yudin MH. Highly expressed ACE-2 receptors during pregnancy: A protective factor for SARS-COV-2 infection? Med Hypotheses 2021; 153:110641. [PMID: 34256245 PMCID: PMC8262774 DOI: 10.1016/j.mehy.2021.110641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/25/2021] [Accepted: 07/04/2021] [Indexed: 01/10/2023]
Abstract
While previous viral pandemics showed that pregnancy was a risk factor for susceptibility and adverse outcomes, current evidence is conflicting whether SARS-CoV-2 infection during pregnancy is more severe than in the general population, with relatively low maternal and fetal/neonatal mortality rates. SARS-CoV-2 is known to enter host cells via the ACE-2 receptors, competitively occupying their binding sites. In theory, viral invasion can lead to a reduction in available ACE-2 receptors and consequently an unbalanced regulation between the ACE-AngII-AT1 axis and the ACE-2-Ang-(1-7)-MAS axis, thus enhancing pathological vasoconstriction, fibrosis, inflammation and thrombotic processes. We hypothesize that the normal pregnant state of highly expressed ACE-2 receptors leads to higher Ang-(1-7) levels and consequently more vasodilation and anti-inflammatory response to SARS-COV-2 infection. We suggest that this up-regulation of ACE-2 receptors in human gestation may actually be clinically protective and propose a potential research line to investigate this hypothesis, which may lead to future novel therapeutics.
Collapse
Affiliation(s)
- Ernesto Antonio Figueiro-Filho
- Mount Sinai Hospital, Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
| | - Sebastian R Hobson
- Mount Sinai Hospital, Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Dan Farine
- Mount Sinai Hospital, Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Mark H Yudin
- Saint Michael's Hospital, Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| |
Collapse
|
46
|
Popescu DE, Cioca A, Muresan C, Navolan D, Gui A, Pop O, Marcovici T, Ilie C, Craina M, Boia M. A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death. ACTA ACUST UNITED AC 2021; 57:medicina57070667. [PMID: 34203545 PMCID: PMC8304331 DOI: 10.3390/medicina57070667] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 01/01/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has rapidly evolved into a worldwide pandemic causing a serious global public health problem. The risk of vertical transmission of SARS-CoV-2 is still debated, and the consequences of this virus on pregnant women and their fetuses remain unknown. We report a case of pregnancy complicated with hydrops fetalis that developed 7 weeks after recovery from a mild SARS-CoV-2 infection, leading to intrauterine death of the foetus. Evidence of SARS-CoV-2 placentitis was demonstrated by the presence of viral particles in the placenta identified by immunohistochemistry. As we excluded all possible etiological factors for non-immunologic hydrops fetalis, we believe that the fetal consequences of our case are related to vertical transmission of SARS-CoV-2 virus. To the best of our knowledge, this is the second reported case in the literature of COVID-19 infection complicated with hydrops fetalis and intrauterine fetal demise.
Collapse
Affiliation(s)
- Daniela Eugenia Popescu
- Department of Neonatology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania; (D.E.P.); (M.B.)
- Department of Neonatology, Premiere Hospital, Regina Maria Health Network, Calea Aradului, No.113, 300645 Timişoara, Romania
| | - Andreea Cioca
- Department of Pathology, Premiere Hospital, Regina Maria Health Network, Calea Aradului, No.113, 300645 Timişoara, Romania
- Correspondence: ; Tel.: +40-722-244-330
| | - Cezara Muresan
- Department of Obstetrics and Gynecology, Premiere Hospital, Regina Maria Health Network, Calea Aradului, No.113, 300645 Timişoara, Romania; (C.M.); (A.G.)
- Department of Obstetrics and Gynecology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania; (D.N.); (M.C.)
| | - Dan Navolan
- Department of Obstetrics and Gynecology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania; (D.N.); (M.C.)
| | - Arina Gui
- Department of Obstetrics and Gynecology, Premiere Hospital, Regina Maria Health Network, Calea Aradului, No.113, 300645 Timişoara, Romania; (C.M.); (A.G.)
| | - Ovidiu Pop
- Department of Morphological Sciences, University of Oradea, Universitatii Street, No.1, 410087 Oradea, Romania;
| | - Tamara Marcovici
- Department of Pediatrics, First Pediatric Clinic, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania;
| | - Constantin Ilie
- Department of Neonatology, Regina Maria Health Network, Aristide Demetriade Street, No.1, 300088 Timisoara, Romania;
| | - Marius Craina
- Department of Obstetrics and Gynecology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania; (D.N.); (M.C.)
| | - Marioara Boia
- Department of Neonatology, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania; (D.E.P.); (M.B.)
| |
Collapse
|
47
|
Li Q, Wang W, Pei C, Zhao Y, Liu R, Zhang W, Huang L, Li T, Huang J. Expression of SARS-CoV-2 entry genes ACE2 and TMPRSS2 at single cell resolution in the peripartum decidua. Am J Transl Res 2021; 13:4389-4400. [PMID: 34150021 PMCID: PMC8205712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
Angiotensin-converting enzyme 2 (ACE2) is the key receptor for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, the susceptibility of the decidua to infection during the peripartum period has not been explored, even though this may affect vertical transmission. The objective of this study was to investigate the expression of ACE2 and related genes in the decidua during delivery. Here, single-cell RNA sequencing was used to characterize the transcriptomes of decidual cells before and after the onset of labor. During the peripartum period, ACE2 expression was highly heterogeneous. ACE2 was expressed principally in decidual stromal cells, uterine smooth muscle cells, and extravillous trophoblasts. Comparison of the transcriptomes of ACE2-positive and ACE2-negative cells indicated that ACE2-positive cells exhibited integrin clusters on the cell surface interactions. ACE2-positive cells were compared before and after labor onset. After delivery, the number of ACE2-positive cells was slightly higher than before delivery. Before labor onset, ACE2-positive decidual stromal cells were in the regulation of membrane protein ectodomain proteolysis cluster. After labor onset, the upregulated genes changed to include cell junction assembly genes. The susceptibility of decidual cells to SARS-CoV-2 infection is thus heterogeneous during the peripartum period.
Collapse
Affiliation(s)
- Qi Li
- Department of Obstetrics and Gynecology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Weinan Wang
- Department of Obstetrics, Xiangya Hospital Central South UniversityChangsha, China
| | - Chenlin Pei
- Department of Obstetrics, Xiangya Hospital Central South UniversityChangsha, China
| | - Yanhua Zhao
- Department of Obstetrics, Xiangya Hospital Central South UniversityChangsha, China
| | - Rong Liu
- Department of Obstetrics, Xiangya Hospital Central South UniversityChangsha, China
| | - Weishe Zhang
- Department of Obstetrics, Xiangya Hospital Central South UniversityChangsha, China
- Hunan Engineering Research Center of Early Life Development and Disease PreventionChangsha, China
| | - Lihui Huang
- Department of Obstetrics and Gynecology, Changsha Hospital for Maternal and Child Health CareChangsha, China
| | - Tieping Li
- Department of Obstetrics and Gynecology, Changsha Hospital for Maternal and Child Health CareChangsha, China
| | - Jingrui Huang
- Department of Obstetrics, Xiangya Hospital Central South UniversityChangsha, China
| |
Collapse
|
48
|
Naveed M, Naeem M, ur Rahman M, Gul Hilal M, Kakakhel M, Ali G, Hassan A. Review of potential risk groups for coronavirus disease 2019 (COVID-19). New Microbes New Infect 2021; 41:100849. [PMID: 33614041 PMCID: PMC7879740 DOI: 10.1016/j.nmni.2021.100849] [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: 10/06/2020] [Revised: 01/17/2021] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
The current pandemic of coronavirus disease 19 (COVID-19) is a global issue caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies have revealed that this virus results in poorer consequences and a higher rate of mortality in older adults and those with comorbidities such as cardiovascular disease, hypertension, diabetes and prolonged respiratory illness. In this review, we discuss in detail the potential groups at risk of COVID-19 and outline future recommendations to mitigate community transmission of COVID-19. The rate of COVID-19 was high in healthcare workers, smokers, older adults, travellers and pregnant women. Furthermore, patients with severe medical complications such as heart disease, hypertension, respiratory illness, diabetes mellitus and cancer are at higher risk of disease severity and mortality. Therefore, special effort and devotion are needed to diminish the threat of SARS-CoV-2 infection. Proper vaccination, use of sanitizers for handwashing and complete lockdown are recommended to mitigate the chain of COVID-19 transmission.
Collapse
Affiliation(s)
- M. Naveed
- Institute of Microbiology, School of Life Sciences, Lanzhou University, Tianshui Road No. 222, Lanzhou, 730000, China
| | - M. Naeem
- Department of Microbiology, University of Swabi, Khyber PakhtunKhwa, Pakistan
| | - M. ur Rahman
- College of Life Sciences, Northwest University, Xian, Shaanxi Province, 710069, China
| | - M. Gul Hilal
- Institute of Occupational and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - M.A. Kakakhel
- MOE Key Laboratory of Cell Activities and Stress Adaptations, School of Life Sciences, Lanzhou University, Lanzhou, 730000, China
| | - G. Ali
- MOE Key Laboratory of Cell Activities and Stress Adaptations, School of Life Sciences, Lanzhou University, Lanzhou, 730000, China
| | - A. Hassan
- Bioengineering College of Chongqing University, Chongqing, China
| |
Collapse
|
49
|
Nangaku M, Kadowaki T, Yotsuyanagi H, Ohmagari N, Egi M, Sasaki J, Sakamoto T, Hasegawa Y, Ogura T, Chiba S, Node K, Suzuki R, Yamaguchi Y, Murashima A, Ikeda N, Morishita E, Yuzawa K, Moriuchi H, Hayakawa S, Nishi D, Irisawa A, Miyamoto T, Suzuki H, Sone H, Fujino Y. The Japanese Medical Science Federation COVID-19 Expert Opinion English Version. JMA J 2021; 4:148-162. [PMID: 33997449 PMCID: PMC8118966 DOI: 10.31662/jmaj.2021-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/05/2021] [Indexed: 01/22/2023] Open
Abstract
In 2020, the COVID-19 pandemic has had unprecedented impacts on various aspects of the world. Each academic society has published a guide and/or guidelines on how to cope with COVID-19 separately. As the one and only nationwide association of academic societies that represent medical science in Japan, JMSF has decided to publish the expert opinion to help patients and care providers find specifically what they want. This expert opinion is a summary of recommendations by many academic societies and will be updated when necessary. Patients that each academic society targets differ even though they suffer from the same COVID-19, and recommendations can be different in a context-dependent manner. Readers are supposed to be flexible and adjustable when they use this expert opinion.
Collapse
Affiliation(s)
- Masaomi Nangaku
- The COVID-19 expert opinion committee of the Japan Medical Science Federation
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a massive impact on human lives worldwide. While the airborne SARS-CoV-2 primarily affects the lungs, viremia is not uncommon. As placental trophoblasts are directly bathed in maternal blood, they are vulnerable to SARS-CoV-2. Intriguingly, the human fetus is largely spared from SARS-CoV-2 infection. We tested whether the human placenta expresses the main SARS-CoV-2 entry factors angiotensin-converting enzyme 2 (ACE2), transmembrane protease serine 2 (TMPRSS2), and furin and showed that ACE2 and TMPRSS2 are expressed in the trophoblast rather than in other placental villous cells. While furin is expressed in the main placental villous cell types, we surveyed, trophoblasts exhibit the highest expression. In line with the expression of these entry factors, we demonstrated that a SARS-CoV-2 pseudovirus could enter primary human trophoblasts. Mechanisms underlying placental defense against SARS-CoV-2 infection likely involve postentry processing, which may be germane for mitigating interventions against SARS-CoV-2. IMPORTANCE Pregnant women worldwide have been affected by COVID-19. As the virus is commonly spread to various organs via the bloodstream and because human placental trophoblasts are directly bathed in maternal blood, feto-placental infection by SARS-CoV-2 seems likely. However, despite the heightened risk to pregnant women, thus far the transmission risk of COVID-19 to the feto-placental unit seems extremely low. This has been recently attributed to a negligible expression of SARS-CoV-2 entry factors in the human placenta. We therefore sought to explore the expression of the entry factors ACE2 and TMPRSS2 in the different cell types of human placental villi. Using a combination of transcriptome sequencing (RNA-seq), real-time quantitative PCR (RT-qPCR), in situ hybridization, and immunofluorescence, we found that trophoblasts, but not the other main villous cell types, express ACE2 and TMPRSS2, with a broad expression of furin. Correspondingly, we also showed that primary human trophoblasts are permissive to entry of SARS-CoV-2 pseudovirus particles.
Collapse
|