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Li A, Schwartz DA, Vo A, VanAbel R, Coler C, Li E, Lukman B, Del Rosario B, Vong A, Li M, Adams Waldorf KM. Impact of SARS-CoV-2 infection during pregnancy on the placenta and fetus. Semin Perinatol 2024; 48:151919. [PMID: 38897829 DOI: 10.1016/j.semperi.2024.151919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Pregnant people and their fetuses are vulnerable to adverse health outcomes from coronavirus 2019 disease (COVID-19) due to infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been associated with higher rates of maternal mortality, preterm birth, and stillbirth. While SARS-CoV-2 infection of the placenta and vertical transmission is rare, this may be due to the typically longer time interval between maternal infection and testing of the placenta and neonate. Placental injury is evident in cases of SARS-CoV-2-associated stillbirth with massive perivillous fibrin deposition, chronic histiocytic intervillositis, and trophoblast necrosis. Maternal COVID-19 can also polarize fetal immunity, which may have long-term effects on neurodevelopment. Although the COVID-19 pandemic continues to evolve, the impact of emerging SARS-CoV-2 variants on placental and perinatal injury/mortality remains concerning for maternal and perinatal health. Here, we highlight the impact of COVID-19 on the placenta and fetus and remaining knowledge gaps.
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Affiliation(s)
- Amanda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - David A Schwartz
- Perinatal Pathology Consulting, Atlanta, Georgia, United States of America
| | - Andrew Vo
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Roslyn VanAbel
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Celeste Coler
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America; School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Edmunda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Bryan Lukman
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Briana Del Rosario
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Ashley Vong
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Miranda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America; School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America; School of Medicine, University of Washington, Seattle, Washington, United States of America; Department of Global Health, University of Washington, Seattle, Washington, United States of America.
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McKissic D, Perez FA, Puia-Dumitrescu M, Ryan R, Hendrixson DT, Billimoria Z, DiGeronimo R, Sawyer T. Maternal COVID-19 Infection Associated with Fetal Systemic Inflammatory Complications in COVID-19-Negative Neonates: A Case-Series. Am J Perinatol 2024; 41:e1451-e1458. [PMID: 38134940 DOI: 10.1055/a-2234-8064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVE This study aimed to examine fetal and neonatal inflammatory and neurologic complications associated with maternal coronavirus disease 2019 (COVID-19) infection. STUDY DESIGN Case-series using a convenience sample of neonates cared for in a large referral-based children's hospital neonatal intensive care unit between September 2021 and May 2022. RESULTS We identified seven neonates with exposure to maternal severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) and a presentation consistent with inflammatory complications. All had some degree of neurologic injury with neuroimaging findings including restricted diffusion indicating injury in the white matter, cortex, deep gray structures, and splenium of the corpus callosum as well as intracranial hemorrhage. In addition, many infants had cytopenia and abnormal coagulation studies. Placental pathology, when available, revealed inflammation, clot with calcifications, and hematomas with associated infarcts. CONCLUSION Neonates born to mothers with SARS-CoV-2, even when negative for the virus themselves, may have complications consistent with a systemic inflammatory syndrome. Placental pathology as well as neurologic imaging in infants with neurologic findings may help to support this diagnosis. KEY POINTS · A systemic inflammatory response may cause illness in babies born to mothers with a history of COVID-19.. · Inflammatory markers and placental pathology are helpful in supporting this diagnosis.. · Consider neuroimaging in infants of mothers with a history of COVID-19 with neurologic findings..
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Affiliation(s)
- Devin McKissic
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Francisco A Perez
- Department of Radiology, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Mihai Puia-Dumitrescu
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Ramah Ryan
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - D Taylor Hendrixson
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
- Division of Infectious Disease, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Zeenia Billimoria
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Robert DiGeronimo
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Taylor Sawyer
- Division of Neonatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
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Khodavandi P, Khodavandi A, Alizadeh F, Gholizadeh L. Possibility of intrauterine transmission from mother to fetus/newborn: Systematic review and meta-analysis of diagnostic methods to detect SARS-CoV-2 infection. Eur J Obstet Gynecol Reprod Biol 2024; 295:181-200. [PMID: 38367392 DOI: 10.1016/j.ejogrb.2024.02.026] [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: 11/01/2023] [Revised: 02/03/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
Several studies have reported vertical transmission of SARS-CoV-2; however, information regarding intrauterine transmission based on diagnostic methods to detect SARS-CoV-2 infection is scarce. A systematic review and meta-analysis was conducted to identify and explore the studies that attempt to ascertain the possibility of intrauterine transmission of SARS-CoV-2 infection according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. The results demonstrate that SARS-CoV-2 can be transmitted intrauterine, as detected by clinical manifestations (1.00, 95 % CI: 1.00 - 1.00, 0.51, 95 % CI: 0.22 - 0.80), imaging (0.50, 95 % CI: 0.24 - 0.76, 0.03, 95 % CI: 0.00 - 0.17), molecular (1. 00, 95 % CI: 1.00 - 1.00, 0.92, 95 % CI: 0.77 - 1.00), immunological (0.32, 95 % CI: 0.10 - 0.57, 0.34, 95 % CI: 0.11 - 0.61), and histological approaches (0.79, 95 % CI: 0.52 - 0.98) in maternal and fetal/neonatal specimens, respectively. The possibility of intrauterine transmission of SARS-CoV-2 from mother to fetus/newborn was 41 % (95 % CI 0.37 - 0.45). We might confirm/verify the intrauterine transmission of SARS-CoCV-2 from mother to fetus/newborn.
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Affiliation(s)
| | - Alireza Khodavandi
- Department of Biology, Gachsaran Branch, Islamic Azad University, Gachsaran, Iran.
| | - Fahimeh Alizadeh
- Department of Biology, Gachsaran Branch, Islamic Azad University, Gachsaran, Iran
| | - Lida Gholizadeh
- Department of Nursing and Midwifery, Gachsaran Branch, Islamic Azad University, Gachsaran, Iran
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Şahan YÖ, Sakcak B, Göncü Ayhan Ş, Tanaçan A, Kibar Gül AE, Şahin D, İlker Çetin İ. The influence of maternal COVID-19 on cardiac functions: From fetal life to infancy. Echocardiography 2024; 41:e15736. [PMID: 38284669 DOI: 10.1111/echo.15736] [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: 06/07/2023] [Revised: 10/29/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE To evaluate both short and mid-term effects of maternal COVID-19 on cardiac functions of fetuses and children. METHODS The present case-control study was conducted on 36 pregnant women who had COVID-19 infection in the second trimester of pregnancy and 30 pregnant women as healthy controls. Fetal, neonatal, and infant cardiac functions were compared between the groups. Assessment of fetal cardiac functions were performed in the last trimester of the pregnancy at least 6 weeks after the recovery of infection. The first postnatal echo was performed within the first 2 weeks and the follow-up (second) echo was performed in the 6-8 weeks of life. RESULTS The demographic data were similar between groups. Interventricular septum and left ventricular posterior wall end-diastolic dimensions were significantly higher in the study group in both fetal, neonatal, and infant periods. Impaired diastolic functions of right and left ventricles were detected and myocardial performance indexes with tissue doppler imaging of both lateral walls and septum were significantly higher than controls at all periods. CONCLUSION Maternal COVID-19 seems to have a global impact on the cardiac functions of babies in the short and mid-term periods after maternal recovery.
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Affiliation(s)
- Yasemin Özdemir Şahan
- Department of Pediatric Cardiology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Bedri Sakcak
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Şule Göncü Ayhan
- Department of Obstetrics and Gynecology, Division of Perinatology, Memorial Bahcelievler Hospital, İstanbul, Turkey
| | - Atakan Tanaçan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Esin Kibar Gül
- Department of Pediatric Cardiology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - İbrahim İlker Çetin
- Department of Pediatric Cardiology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Siramdas D, Anudeep P, Subramanian P, Chitgupikar S. Case Series of Multisystem Inflammatory Syndrome in Neonates (MIS-N) With a Link to Coagulopathy. Cureus 2023; 15:e49681. [PMID: 38161855 PMCID: PMC10756854 DOI: 10.7759/cureus.49681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Multisystem inflammatory syndrome in neonates (MIS-N) is an emerging clinical entity observed in neonates born to mothers with exposure to the SARS-CoV-2 virus before or during the antenatal period. Methods We report 18 neonates diagnosed with MIS-N from retrospectively collected data. A total of 18 neonates (13 term and five late-preterm; 10 males) admitted to the neonatal intensive care unit (NICU) of a tertiary care medical institute, between June 2021 to November 2022, were diagnosed with MIS-N. Results The median age of presentation of the 18 neonates was 1.5 days of life. All the neonates were positive for SARS-CoV-2 IgG antibodies and had elevated D-dimer levels. Respiratory system involvement was the most common (12 of 18 neonates: 66.67%). Ten out of 18 neonates (55.55%) had coagulopathy. Seven of the ten neonates with coagulopathy had central nervous system (CNS) involvement as seizures and/or intracerebral infarcts/bleeds. Cardiovascular and gastrointestinal system involvement was observed in nine (50%) and seven (38.89%) neonates, respectively. One out of 18 neonates died due to intraventricular and cerebral hemorrhage. The mortality rate was 5.55% (n=1). Ten of 18 neonates with coagulopathy required fresh frozen plasma along with repeated therapeutic doses of injection vitamin K. Eight neonates (44.44%) required human intravenous immunoglobulin (IVIG), and three neonates (16.67%) required steroids and IVIG for recovery along with supportive care. Conclusion Coagulopathy can be one of the salient features of presentation in MIS-N. In the immediate post-pandemic era, it is essential that MIS-N is considered in the differential diagnosis of neonates presenting with intracerebral bleeds/infarcts. IVIG and steroids might play an important role in the treatment of neonates with MIS-N.
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Affiliation(s)
- Deepthi Siramdas
- Pediatrics, MediCiti Institute of Medical Sciences, Hyderabad, IND
| | - Peddi Anudeep
- Pediatrics, MediCiti Institute of Medical Sciences, Hyderabad, IND
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He YF, Liu JQ, Hu XD, Li HM, Wu N, Wang J, Jiang ZG. Breastfeeding vs. breast milk transmission during COVID-19 pandemic, which is more important? Front Pediatr 2023; 11:1253333. [PMID: 37744448 PMCID: PMC10511770 DOI: 10.3389/fped.2023.1253333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
The catastrophic coronavirus disease 2019 (COVID-19) pandemic has raised many health questions, and whether breast milk from SARS-CoV-2 infected mothers may be a vector for SARS-CoV-2 transmission has become a hot topic of concern worldwide. Currently, there are extremely limited and conflicting data on the risk of infection in infants through breastfeeding. For this reason, we investigated almost all current clinical studies and systematically analyzed the presence of SARS-CoV-2 and antibodies in the breast milk of mothers infected with SARS-CoV-2, their effects on newborns, and the mechanisms involved. A total of 82 studies were included in this review, of which 66 examined the presence of SARS-CoV-2 in breast milk samples from mothers diagnosed with COVID-19, 29 reported results of antibody detection of SARS-CoV-2 in breast milk, and 13 reported both nucleic acid and antibody test results. Seventeen studies indicated the presence of detectable SARS-CoV-2 nucleic acid in breast milk samples, and only two studies monitored viral activity, both of which reported that infectious viruses could not be cultured from RNA-positive breast milk samples. All 29 studies indicated the presence of at least one of the three antibodies, IgA, IgG and IgM, in breast milk. Five studies indicated the presence of at least one antibody in the serum of breastfed newborns. No COVID-19-related deaths were reported in all 1,346 newborns. Our study suggests that direct breastfeeding does not pose an additional risk of infection to newborns and that breast milk is a beneficial source of anti-SARS-CoV-2 antibodies that provide passive immune protection to infants. In addition, direct breastfeeding would provide maternal benefits. Our review supports the recommendation to encourage direct breastfeeding under appropriate infection control guidelines. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: 458043.
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Affiliation(s)
- Yan-fei He
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun-qiang Liu
- Department of Thoracic Surgery, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao-dong Hu
- Department of Endocrinology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hu-ming Li
- Department of Respiratory Medicine, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ni Wu
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Wang
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhi-gang Jiang
- Department of Statistics, Zunyi Medical University, Zunyi, China
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Aguilar-Caballero D, Capcha JMC, Caballero V, Young KC, Duara S, Borchetta M, Gonzalez I, Saad AG, Webster KA, Shehadeh LA, Bandstra ES, Schmidt AF. Case report: Fatal lung hyperinflammation in a preterm newborn with SARS-CoV-2 infection. Front Pediatr 2023; 11:1144230. [PMID: 37287630 PMCID: PMC10242137 DOI: 10.3389/fped.2023.1144230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
Vertical transmission of SARS-CoV-2 from mother to fetus is widely accepted. Whereas most infected neonates present with mild symptoms or are asymptomatic, respiratory distress syndrome (RDS) and abnormal lung images are significantly more frequent in COVID-19 positive neonates than in non-infected newborns. Fatality is rare and discordant meta-analyses of case reports and series relating perinatal maternal COVID-19 status to neonatal disease severity complicate their extrapolation as prognostic indicators. A larger database of detailed case reports from more extreme cases will be required to establish therapeutic guidelines and allow informed decision making. Here we report an unusual case of a 28 weeks' gestation infant with perinatally acquired SARS-CoV-2, who developed severe protracted respiratory failure. Despite intensive care from birth with first line anti-viral and anti-inflammatory therapy, respiratory failure persisted, and death ensued at 5 months. Lung histopathology showed severe diffuse bronchopneumonia, and heart and lung immunohistochemistry confirmed macrophage infiltration, platelet activation and neutrophil extracellular trap formation consistent with late multisystem inflammation. To our knowledge, this is the first report of SARS CoV-2 pulmonary hyperinflammation in a preterm newborn with fatal outcome.
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Affiliation(s)
- Daniela Aguilar-Caballero
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Jose M. C. Capcha
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Veronica Caballero
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Karen C. Young
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Shahnaz Duara
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Michael Borchetta
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivan Gonzalez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ali G. Saad
- Division of Anatomic Pathology, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keith A. Webster
- Integene International, LLC, Miami, FL, United States
- Baylor College of Medicine, Everglades Biopharma, Cullen Eye Institute, Houston, TX, United States
| | - Lina A. Shehadeh
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emmalee S. Bandstra
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Augusto F. Schmidt
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
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Coler B, Wu TY, Carlson L, Burd N, Munson J, Dacanay M, Cervantes O, Esplin S, Kapur RP, Feltovich H, Adams Waldorf KM. Diminished antiviral innate immune gene expression in the placenta following a maternal SARS-CoV-2 infection. Am J Obstet Gynecol 2023; 228:463.e1-463.e20. [PMID: 36126729 PMCID: PMC9482164 DOI: 10.1016/j.ajog.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 is caused by the SARS-CoV-2 virus and is associated with critical illness requiring hospitalization, maternal mortality, stillbirth, and preterm birth. SARS-CoV-2 has been shown to induce placental pathology. However, substantial gaps exist in our understanding of the pathophysiology of COVID-19 disease in pregnancy and the long-term impact of SARS-CoV-2 on the placenta and fetus. To what extent a SARS-CoV-2 infection of the placenta alters the placental antiviral innate immune response is not well understood. A dysregulated innate immune response in the setting of maternal COVID-19 disease may increase the risk of inflammatory tissue injury or placental compromise and may contribute to deleterious pregnancy outcomes. OBJECTIVE We sought to determine the impact of a maternal SARS-CoV-2 infection on placental immune response by evaluating gene expression of a panel of 6 antiviral innate immune mediators that act as biomarkers of the antiviral and interferon cytokine response. Our hypothesis was that a SARS-CoV-2 infection during pregnancy would result in an up-regulated placental antiviral innate immune response. STUDY DESIGN We performed a case-control study on placental tissues (chorionic villous tissues and chorioamniotic membrane) collected from pregnant patients with (N=140) and without (N=24) COVID-19 disease. We performed real-time quantitative polymerase chain reaction and immunohistochemistry, and the placental histopathology was evaluated. Clinical data were abstracted. Fisher exact test, Pearson correlations, and linear regression models were used to examine proportions and continuous data between patients with active (<10 days since diagnosis) vs recovered COVID-19 (>10 days since diagnosis) at the time of delivery. Secondary regression models adjusted for labor status as a covariate and evaluated potential correlation between placental innate immune gene expression and other variables. RESULTS SARS-CoV-2 viral RNA was detected in placental tissues from 5 women with COVID-19 and from no controls (0/24, 0%). Only 1 of 5 cases with detectable SARS-CoV-2 viral RNA in placental tissues was confirmed to express SARS-CoV-2 nucleocapsid and spike proteins in syncytiotrophoblast cells. We detected a considerably lower gene expression of 5 critical innate immune mediators (IFNB, IFIT1, MXA, IL6, IL1B) in the chorionic villi and chorioamniotic membranes from women with active or recovered COVID-19 than controls, which remained significant after adjustment for labor status. There were minimal correlations between placental gene expression and other studied variables including gestational age at diagnosis, time interval between COVID-19 diagnosis and delivery, prepregnancy body mass index, COVID-19 disease severity, or placental pathology. CONCLUSION A maternal SARS-CoV-2 infection was associated with an impaired placental innate immune response in chorionic villous tissues and chorioamniotic membranes that was not correlated with gestational age at COVID-19 diagnosis, time interval from COVID-19 diagnosis to delivery, maternal obesity, disease severity, or placental pathology.
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Affiliation(s)
- Brahm Coler
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Tsung-Yen Wu
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Lindsey Carlson
- Women and Newborn Research, Intermountain Health Care, Salt Lake City, UT
| | - Nicole Burd
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Jeff Munson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Matthew Dacanay
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Sean Esplin
- Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, UT
| | - Raj P Kapur
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA; Department of Pathology, Seattle Children's Hospital, Seattle, WA
| | - Helen Feltovich
- Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, UT.
| | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA.
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9
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Ramaswamy VV, Abiramalatha T, Pullattayil S AK, Trevisanuto D. Multisystem inflammatory disease in neonates (MIS-N) due to maternal COVID-19. Semin Fetal Neonatal Med 2023; 28:101431. [PMID: 37061425 DOI: 10.1016/j.siny.2023.101431] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
Multisystem inflammatory disease in neonates (MIS-N) is a disease of immune dysregulation presenting in the newborn period. Thouvgh its etiopathogenesis is proposed to be similar to multisystem inflammatory disease in Children (MIS-C), the exact pathophysiology is largely unknown as of present. The definition of MIS-N is contentious. The evidence for its incidence, the clinical features, profile of raised inflammatory markers, treatment strategies and outcomes stem from case reports, case series and cohort studies with small sample sizes. Though the incidence of MIS-N in severe acute respiratory syndrome caused by the coronavirus CoVID-2 (SARS-CoV-2) infected asymptomatic neonates is low, its incidence in symptomatic neonates is relatively higher. Further, amongst the neonates who are treated as MIS-N, the mortality rate is high. The review also evaluates the various other unresolved aspects of MIS-N from limited published literature and identifies knowledge gaps which could be areas of future research.
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Affiliation(s)
| | | | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.
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10
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Nielsen SY, Hvidman LE, Aabakke AJM, Olsen TE, Johnsen IBG, Bogaard PW, Petersen A, Westergaard HB, Sørensen A, Hedermann G, Rønneberg ET, Thisted D, Boris J, Andersen LLT, Eggers AGH, Lindved BF, Henriksen TB. SARS-CoV-2 placentitis and severe pregnancy outcome after maternal infection: A Danish case series. Acta Obstet Gynecol Scand 2023; 102:567-576. [PMID: 36958983 PMCID: PMC10072246 DOI: 10.1111/aogs.14541] [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: 11/27/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION SARS-CoV-2 infection during pregnancy may cause viral inflammation of the placenta, resulting in fetal demise even without fetal or newborn infection. The impact of timing of the infection and the mechanisms that cause fetal morbidity and mortality are not well understood. MATERIAL AND METHODS To describe placental pathology from women with confirmed SARS-CoV-2 infection during pregnancy, a SARS-CoV-2 immunohistochemistry-positive placenta and late miscarriage, stillbirth, neonatal death, or medically indicated birth due to fetal distress. RESULTS The triad of trophoblastic necrosis, inflammatory intervillous infiltrates, and increased perivillous fibrinoid deposition was present in all 17 placentas; the pregnancies resulted in eight stillbirths, two late miscarriages (19 and 21 weeks' gestation), and seven liveborn children, two of which died shortly after delivery. The severity of maternal COVID-19 was not reflected by the extent of the placental lesions. In only one case, SARS-CoV-2 was detected in lung tissue samples from the fetus. The majority events (miscarriage, stillbirth, fetal distress resulting in indicated birth, or livebirth, but neonatal death) happened shortly after maternal SARS-CoV-2 infection was diagnosed. Seven of eight sequenced cases were infected with the Delta (B.1.617.2) virus strain. CONCLUSION We consolidate findings from previous case series describing extensive SARS-CoV-2 placentitis and placental insufficiency leading to fetal hypoxia. We found sparse evidence to support the notion that SARS-CoV-2 virus had infected the fetus or newborn.
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Affiliation(s)
- Stine Y Nielsen
- Department of Clinical Microbiology, Lillebaelt University Hospital, Vejle, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Lone E Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna J M Aabakke
- Department of Obstetrics and Gynecology, University of Copenhagen, Nordsjaelland, Hillerød, Denmark
- Department of Obstetrics and Gynecology, University of Copenhagen, Holbaek, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tina E Olsen
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Iben B G Johnsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Pauline W Bogaard
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Astrid Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Hanne B Westergaard
- Department of Obstetrics and Gynecology, University of Copenhagen, Nordsjaelland, Hillerød, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Gitte Hedermann
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Dorthe Thisted
- Department of Obstetrics and Gynecology, University of Copenhagen, Holbaek, Denmark
| | - Jane Boris
- Department of Obstetrics and Gynecology, Gødstrup Hospital, Herning, Denmark
| | - Lise L T Andersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Anne G H Eggers
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Slagelse Sygehus, Slagelse, Denmark
| | - Birgitte F Lindved
- Department of Obstetrics and Gynecology, Regional Hospital Horsens, Horsens, Denmark
| | - Tine B Henriksen
- Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Clinical Institute, Aarhus University, Aarhus, Denmark
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11
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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.
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12
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Multisystem inflammatory syndrome in neonates (MIS-N): a systematic review. Eur J Pediatr 2023; 182:2283-2298. [PMID: 36877274 PMCID: PMC9986661 DOI: 10.1007/s00431-023-04906-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/16/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
Recently, a new pattern of multisystem inflammatory syndrome following an infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged globally. The initial cases were described in the adult population followed by sporadic cases in the pediatric population also. By the end of 2020, similar reports were recognised in the neonatal age group. The purpose of this study was to systematically review clinical characteristics, laboratory parameters, treatment, and outcomes of neonates with multisystem inflammatory syndrome in neonates (MIS-N). A systematic review was conducted after registering with PROSPERO and electronic databases including MEDLINE, EMBASE, PubMed, SCOPUS, Google Scholar, and Web of Science were searched from January 1st 2020 till September 30th 2022. A total of 27 studies describing 104 neonates were analysed. The mean gestation age and birth weight was 35.9 ± 3.3 weeks and 2255.7 ± 783.7 g respectively. A large proportion (91.3%) of the reported cases belonged to the South-East Asian region. The median age of presentation was 2 days (range: 1-28 days) with cardiovascular system being the predominant system involved in 83.65% followed by respiratory (64.42%). Fever was noted in only 20.2%. Commonly elevated inflammatory markers were IL-6 in 86.7% and D-dimer in 81.1%. Echocardiographic evaluation suggested ventricular dysfunction in 35.8% and dilated coronary arteries in 28.3%. Evidence of SARS-CoV-2 antibodies (IgG or IgM) was seen in 95.9% neonates and evidence of maternal SARS-CoV-2 infection, either as history of COVID infection or positive antigen or antibody test, was noted in 100% of the cases. Early MIS-N was reported in 58 (55.8%) cases, late MIS-N in 28 (26.9%), and 18 cases (17.3%) did not report the timing of presentation. There was a statistically increased proportion of preterm infants (67.2%, p < 0.001), and a trend towards increased low birth weight infants, in the early MIS-N group when compared to the infants with late MIS-N. Fever (39.3%), central nervous system (50%), and gastrointestinal manifestations (57.1%) were significantly higher in the late MIS-N group (p = 0.03, 0.02, 0.01 respectively). The anti-inflammatory agents used for the treatment of MIS-N included steroids 80.8% which were given for a median of 10 (range 3-35) days and IVIg in 79.2% with a median of 2 (range 1-5) doses. The outcomes were available for 98 cases, of whom 8 (8.2%) died during treatment in hospital and 90 (91.8%) were successfully discharged home. Conclusion: MIS-N has a predilection for late preterm males with predominant cardiovascular involvement. The diagnosis is challenging in neonatal period due to overlap with neonatal morbidities and a high risk of suspicion is warranted, especially in presence of supportive maternal and neonatal clinical history. The major limitation of the review was inclusion of case reports and case series, and highlights need of global registries for MIS-N. What is Known: • A new pattern of multisystem inflammatory syndrome following SARS-CoV-2 infection has emerged in adult population with sporadic cases now being reported in neonates. What is New: • MIS-N is an emerging condition with a heterogeneous spectrum and has a predilection for late preterm male infants. Cardiovascular system is the predominant system involved followed by respiratory, however fever remains an uncommon presentation unlike other age-groups. There are two subtypes based on timing of presentation, with early MIS-N being reported more in preterm and low-birth weight infants.
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13
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Wong YP, Tan GC, Khong TY. SARS-CoV-2 Transplacental Transmission: A Rare Occurrence? An Overview of the Protective Role of the Placenta. Int J Mol Sci 2023; 24:ijms24054550. [PMID: 36901979 PMCID: PMC10002996 DOI: 10.3390/ijms24054550] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
The outbreak of the coronavirus disease 2019 (COVID-19) pandemic, caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global public health crisis, causing substantial concern especially to the pregnant population. Pregnant women infected with SARS-CoV-2 are at greater risk of devastating pregnancy complications such as premature delivery and stillbirth. Irrespective of the emerging reported cases of neonatal COVID-19, reassuringly, confirmatory evidence of vertical transmission is still lacking. The protective role of the placenta in limiting in utero spread of virus to the developing fetus is intriguing. The short- and long-term impact of maternal COVID-19 infection in the newborn remains an unresolved question. In this review, we explore the recent evidence of SARS-CoV-2 vertical transmission, cell-entry pathways, placental responses towards SARS-CoV-2 infection, and its potential effects on the offspring. We further discuss how the placenta serves as a defensive front against SARS-CoV-2 by exerting various cellular and molecular defense pathways. A better understanding of the placental barrier, immune defense, and modulation strategies involved in restricting transplacental transmission may provide valuable insights for future development of antiviral and immunomodulatory therapies to improve pregnancy outcomes.
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Affiliation(s)
- Yin Ping Wong
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Department of Pathology, SA Pathology, Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia
- Correspondence: (Y.P.W.); (G.C.T.)
| | - Geok Chin Tan
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Correspondence: (Y.P.W.); (G.C.T.)
| | - T. Yee Khong
- Department of Pathology, SA Pathology, Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia
- Department of Pathology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
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14
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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.
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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.
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15
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Hisey JC, Patterson BM, Tsai AJ, Khan AM. COVID-19 via intrauterine transmission in a critically ill preterm infant: A case report. J Neonatal Perinatal Med 2022; 15:837-844. [PMID: 36155532 DOI: 10.3233/npm-221094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A preterm infant was born emergently at 29 weeks gestation to a mother with active coronavirus disease 2019 (COVID-19). Clinical presentation and evaluation were consistent with in utero transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The neonate experienced progressive, refractory respiratory failure and catastrophic intracranial hemorrhage which ultimately led to limitation of care.
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Affiliation(s)
- J C Hisey
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - B M Patterson
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - A J Tsai
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - A M Khan
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
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16
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Boyce TG, Chacko EM, Mascola MA, Joshi A, Verwoerd CG, Winder AA, Hale SJ. Fatal COVID-19 in a neonate after probable late intrauterine transmission. J Neonatal Perinatal Med 2022; 15:845-849. [PMID: 35988227 DOI: 10.3233/npm-221002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report the case of a 35-week gestation infant girl born by emergent cesarean section for fetal distress in a woman with recent coronavirus disease 2019 (COVID-19). Tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using polymerase chain reaction (PCR) on the infant at 24 and 48 hours of life were negative. However, at 72 hours of life, the infant's respiratory status worsened, and a repeat SARS-CoV-2 PCR was positive. The infant developed leukopenia, thrombocytopenia, and progressive respiratory failure, and died on the ninth day of life. Pathologic examination of the placenta revealed findings consistent with COVID-19 placentitis, and SARS-CoV-2 RNA staining was positive, suggesting intrauterine transmission of the infection.
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Affiliation(s)
- T G Boyce
- Pediatric Infectious Diseases, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - E M Chacko
- Pediatrics, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - M A Mascola
- Maternal-Fetal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - A Joshi
- Neonatology, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - C G Verwoerd
- Neonatology, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - A A Winder
- Neonatology, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - S J Hale
- Aspirus Stevens Point Hospital, Pathology, Stevens Point, Wisconsin, USA
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17
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Smith RR, Driver KC, Karber BF, Luciano AA, Berg MT, Prado IV, Teper JE. A case report: Hypoxic ischemic encephalopathy & pneumonia in a neonate after SARS-CoV-2 intrauterine transmission. J Neonatal Perinatal Med 2022; 15:851-858. [PMID: 36031910 DOI: 10.3233/npm-221026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Severe acute respiratory coronavirus 2 (SARS-CoV-2) is primarily transmitted via respiratory droplet or aerosol route. However, there is mounting evidence for intrauterine transmission. We report on a late preterm infant with suspected intrauterine acquisition of SARS-CoV-2 who experienced birth depression, hypoxic ischemic encephalopathy, multisystem organ involvement, and late onset COVID-19 pneumonia [22].
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Affiliation(s)
- R R Smith
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - K C Driver
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - B F Karber
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - A A Luciano
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - M T Berg
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
| | - I V Prado
- HCA Florida Brandon Hospital, Brandon, Florida
| | - J E Teper
- HCA Florida Brandon Hospital, Brandon, Florida.,Johns Hopkins All Children's Hospital, Maternal Fetal & Neonatal Institute St. Petersburg, Florida
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18
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Sichitiu J, Bourgon N, Guilleminot T, Bessieres B, Leruez-Ville M, Ville Y. Third trimester placentitis: an underreported complication of SARS-CoV-2 infection. Am J Obstet Gynecol MFM 2022; 4:100703. [PMID: 35931366 PMCID: PMC9345653 DOI: 10.1016/j.ajogmf.2022.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
SARS-CoV-2-related placentitis shows distinctive histologic characteristics, and its impact on perinatal outcomes is increasingly under scrutiny. We present two such cases in the third trimester displaying mild maternal clinical symptoms and associated with maternal coagulopathy, reduced fetal movements, and nonreassuring fetal heart rate tracing. Both cases resulted in emergency cesarean deliveries. Our cases and a review of the literature highlight that SARS-CoV-2 undermines placental function and thus greatly impacts late-term pregnancies, even in the absence of severe systemic disease.
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Affiliation(s)
- Joanna Sichitiu
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Sichitiu, Bourgon, and Ville).
| | - Nicolas Bourgon
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Sichitiu, Bourgon, and Ville); University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville)
| | - Tiffany Guilleminot
- University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville); Virology Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Ms Guilleminot and Dr Leruez-Ville)
| | - Bettina Bessieres
- University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville); Department of Histology, Embryology and Cytogenetics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Dr Bessieres)
| | - Marianne Leruez-Ville
- University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville); Virology Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Ms Guilleminot and Dr Leruez-Ville)
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Sichitiu, Bourgon, and Ville); University of Paris - EHU 7328, Paris University, Paris, France (Dr Bourgon, Ms Guilleminot, and Drs Bessieres, Leruez-Ville, and Ville)
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19
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Priya SP, Sunil PM, Varma S, Brigi C, Isnadi MFAR, Jayalal JA, Shadamarshan RA, Kumar SS, Kumari NV, Kumar RPR. Direct, indirect, post-infection damages induced by coronavirus in the human body: an overview. Virusdisease 2022; 33:429-444. [PMID: 36311173 PMCID: PMC9593972 DOI: 10.1007/s13337-022-00793-9] [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: 08/19/2021] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Severe acute respiratory syndrome Coronavirus-2 invades the cells via ACE2 receptor and damages multiple organs of the human body. Understanding the pathological manifestation is mandatory to endure the rising post-infection sequel reported in patients with or without comorbidities. Materials and methods Our descriptive review emphasises the direct, indirect and post-infection damages due to COVID-19. We have performed an electronic database search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with selective inclusion and exclusion criteria. Results The included studies substantiated the extensive damages in the multiple organs due to direct and indirect consequences of COVID-19. After an apparent recovery, the prolonged presentation of the symptoms manifests as post-COVID that can be related with persisting viral antigens and dysregulated immune response. Conclusion A few of the symptoms of respiratory, cardiovascular, and neuropsychiatric systems that persist or reappear as post-COVID manifestations. Vaccination and preventive programs will effectively reduce the prevalence but, the post-COVID, a multisystem manifestation, will be a significant tribulation to the medical profession. However, the issue can be managed by implementing public health programs, rehabilitation services, and telemedicine virtual supports to raise awareness and reduce panic.
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Affiliation(s)
- Sivan Padma Priya
- Department of Basic Medical Sciences, RAK College of Dental Sciences, RAK Medical and Health Sciences, Ras Al Khaimah, UAE
| | - P. M. Sunil
- Department of Oral Pathology and Microbiology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala India ,Centre for Stem Cells and Regenerate Medicine, Malabar Medical College, Calicut, Kerala India
| | - Sudhir Varma
- Department of Clinical Sciences, College of Dentistry, Center for Medical and Bio-Allied Health Science Research, Ajman University, Ajman, UAE ,Saveetha Dental College and Hospitals, Chennai, India
| | - Carel Brigi
- Molecular Medicine and Translational Research, University of Sharjah, Sharjah, UAE
| | - Mohammad Faruq Abd Rachman Isnadi
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - J. A. Jayalal
- Department of Surgery, Kanyakumari Medical College and Hospital, Asaripallam, India
| | - R. Arunkumar Shadamarshan
- Dental Officer and Graded Specialist (Oral and Maxillofacial Surgery), Indo Bhutan Friendship Hospital, IMTRAT, Thimpu Bhutan, 11001 Bhutan
| | - S. Suresh Kumar
- Centre for Materials Engineering and Regenerative Medicine,, Bharath Institute of Higher Eduction and Research, Chennai, 600073 Tamil Nadu India
| | - Neela Vasantha Kumari
- Department of Medical Microbiology and Parasitology, Universiti Putra Malaysia (UPM), Serdang, Selangor 43400 Malaysia
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20
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Gürel S, Yıldırım Ş. Increased Rate of Spontaneous Pneumothorax in Infants of COVID-19 Positive Mothers. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1755209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Objective The epidemiological and clinical characteristics of neonates born to women infected with coronavirus disease 2019 (COVID-19) during pregnancy were assessed, and the correlation between this infection and spontaneous pneumothorax in neonates born to mothers with COVID-19 was evaluated in the present study.
Methods Records of 14 neonates in the neonatal intensive care unit with pneumothorax were collected and analyzed. Pregnant women were routinely screened for COVID-19 before birth. This study only included the neonates of mothers positive for severe acute respiratory syndrome coronavirus 2 immunoglobulin Mand immunoglobulin G and developing spontaneous pneumothorax. Antenatal, natal and postnatal risk factors, data related to demographic, epidemiological and clinical characteristics, treatment strategies, and breastfeeding history were obtained from medical records.
Results The gestational age of the 14 neonates was 30 to 38 weeks. One male infant was born by normal spontaneous vaginal delivery, while all other infants were born by C-section. Though the mothers did not have a diagnosis of COVID-19 in their charts, they all reported one or more symptoms when interviewed. No mother had received a COVID-19 vaccination before or during pregnancy. No mother had undergone a hospital visit or doctor examination due to suspicion of COVID and COVID polymerase chain reaction test. COVID antibody titers were present during admission to hospital before birth.
Conclusion The infants of pregnant cases with symptomatic or asymptomatic COVID-19 may develop respiratory distress and pneumothorax. Observational data obtained from case series similar to what is presented here may be accepted as a potential first step to producing hypotheses to test with preclinical or clinical models if it can be expanded in larger cohorts.
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Affiliation(s)
- Selçuk Gürel
- Department of Pediatrics, Uşak Öztan Hospital, Uşak, Turkey
| | - Şule Yıldırım
- Department of Pediatrics, Uşak Öztan Hospital, Uşak, Turkey
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21
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Ezechukwu HC, Shi J, Fowora MA, Diya CA, Elfaki F, Adegboye OA. Fetoplacental transmission and placental response to SARS-CoV-2: Evidence from the literature. Front Med (Lausanne) 2022; 9:962937. [PMID: 36052328 PMCID: PMC9426356 DOI: 10.3389/fmed.2022.962937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/26/2022] [Indexed: 01/05/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a dreadful novel coronavirus with global health concerns among pregnant women. To date, the vertical transmission of SARS-CoV-2 during pregnancy remains controversial. We briefly report recent findings of placental response to SARS-CoV-2 infection and updates on vertical transmission. We systematically searched PubMed and Google Scholar databases according to PRISMA guidelines for studies reporting the effects of SARS-CoV-2 infection on the placenta and possibility of vertical transmission. We identified 45 studies reporting 1,280 human placentas that were analyzed by molecular pathology methods and 11,112 placenta-derived cells from a publicly available database that was analyzed using bioinformatics tools. The main finding of this study is that the SARS-CoV-2 canonical entry receptors (ACE2 and TMPRSS2) are abundantly expressed on the placenta during the first trimester, and this expression diminishes across gestational age. Out of 45 eligible studies identified, 24 (53.34%) showed no evidence of vertical transmission, 15 (33.33%) supported the hypothesis of very rare, low possibility of vertical transmission and 6 (13.33%) were indecisive and had no comment on vertical transmission. Furthermore, 433 placentas from 12 studies were also identified for placental pathology investigation. There was evidence of at least one form of maternal vascular malperfusion (MVM), 57/433 (13.1%), fetal vascular malperfusion (FVM), 81/433 (18.7%) and placental inflammation with excessive infiltration of CD3+ CD8+ lymphocytes, CD68+ macrophages and CD20+ lymphocytes in most of the eligible studies. Decidual vasculopathy (3.2%), infarction (3.2%), chronic histiocytic intervillositis (6.0%), thrombi vasculopathy (5.1%) were also observed in most of the MVM and FVM reported cases. The results indicated that SARS-CoV-2 induces placenta inflammation, and placenta susceptibility to SARS-CoV-2 decreases across the pregnancy window. Thus, SARS-CoV-2 infection in early pregnancy may adversely affect the developing fetus.
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Affiliation(s)
- Henry C. Ezechukwu
- Department of Medical Biochemistry, EKO University of Medicine and Health Sciences, Lagos, Nigeria
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Jiahua Shi
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Muinah A. Fowora
- Department of Medical Biochemistry, EKO University of Medicine and Health Sciences, Lagos, Nigeria
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Cornelius A. Diya
- Department of Medical Biochemistry, EKO University of Medicine and Health Sciences, Lagos, Nigeria
| | - Faiz Elfaki
- Department of Mathematics, Physics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Oyelola A. Adegboye
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
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22
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Deroubaix A, Kramvis A. Imaging Techniques: Essential Tools for the Study of SARS-CoV-2 Infection. Front Cell Infect Microbiol 2022; 12:794264. [PMID: 35937687 PMCID: PMC9355083 DOI: 10.3389/fcimb.2022.794264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/21/2022] [Indexed: 01/08/2023] Open
Abstract
The world has seen the emergence of a new virus in 2019, SARS-CoV-2, causing the COVID-19 pandemic and millions of deaths worldwide. Microscopy can be much more informative than conventional detection methods such as RT-PCR. This review aims to present the up-to-date microscopy observations in patients, the in vitro studies of the virus and viral proteins and their interaction with their host, discuss the microscopy techniques for detection and study of SARS-CoV-2, and summarize the reagents used for SARS-CoV-2 detection. From basic fluorescence microscopy to high resolution techniques and combined technologies, this article shows the power and the potential of microscopy techniques, especially in the field of virology.
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Affiliation(s)
- Aurélie Deroubaix
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Life Sciences Imaging Facility, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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23
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Gesaka SR, Obimbo MM, Wanyoro A. Coronavirus disease 2019 and the placenta: A literature review. Placenta 2022; 126:209-223. [PMID: 35872511 PMCID: PMC9293390 DOI: 10.1016/j.placenta.2022.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/13/2022] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of multiple organs and organ systems. Due to the novelty of the disease, there is a need to review emerging literature to understand the profile of SARS-CoV-2 in the placenta. This review sought to evaluate the literature on the mediators, mechanism of entry, pathogenesis, detection, and pathology of SARS-CoV-2 in the placenta. Systematic literature searches found 96 eligible studies. Our review revealed that SARS-CoV-2 canonical mediators, angiotensin-converting enzyme-2 (ACE2), and transmembrane serine protease-2 (TMPRSS2) are variably expressed in various placenta compartments, including the villous cytotrophoblasts, syncytiotrophoblasts (STBs), and extravillous trophoblasts (EVTs) throughout pregnancy. Placental SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs), including basigin (BSG/CD147), dipeptidyl peptidase-4 (DPP4/CD26), cathepsin B/L (CTL B/L), furin, interferon-induced transmembrane protein (IFITM1-3), and lymphocyte antigen 6E (LY6E) may increase or reduce the permissiveness of the placenta to SARS-CoV-2. EVTs express genes that code for proteins that may drive viral pathogenesis in the placenta. Viral RNA, proteins, and particles were detected primarily in the STBs by in situ hybridization, immunohistochemistry, electron microscopy, and polymerase chain reaction. Placental pathology in SARS-CoV-2-infected placentas included maternal and fetal vascular malperfusion and a generally nonspecific inflammatory-immune response. The localization of SARS-CoV-2 receptors, proteases, and genes involved in coding proteins that drive viral pathogenesis in the placenta predisposes the placenta to SARS-CoV-2 infection variably in all pregnancy trimesters, with antecedent placental pathology. There is a need for further studies to explicate the mechanism of entry and pathogenesis of SARS-CoV-2 in the placenta.
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Affiliation(s)
- Samwel R Gesaka
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya.
| | - Moses M Obimbo
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya; Department of Human Anatomy, University of Nairobi, Nairobi, Kenya; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
| | - Anthony Wanyoro
- Basic Clinical and Translational (BCT) Research Laboratory, University of Nairobi, Nairobi, Kenya; Department of Obstetrics and Gynecology, Kenyatta University, Nairobi, Kenya.
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24
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Zaigham M, Gisselsson D, Sand A, Wikström AK, von Wowern E, Schwartz DA, Iorizzo L, Nelander M, Blomberg M, Papadogiannakis N, Holmström S, Leijonhfvud Å, Sengpiel V. Clinical-pathological features in placentas of pregnancies with SARS-CoV-2 infection and adverse outcome: case series with and without congenital transmission. BJOG 2022; 129:1361-1374. [PMID: 35243759 PMCID: PMC9111112 DOI: 10.1111/1471-0528.17132] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/03/2022] [Accepted: 02/14/2022] [Indexed: 01/03/2023]
Abstract
Objective To correlate clinical outcomes to pathology in SARS‐CoV‐2 infected placentas in stillborn and live‐born infants presenting with fetal distress. Design Retrospective, observational. Setting Nationwide. Population Five stillborn and nine live‐born infants from 13 pregnant women infected with SARS‐CoV‐2 seeking care at seven different maternity units in Sweden. Methods Clinical outcomes and placental pathology were studied in 14 cases (one twin pregnancy) of maternal SARS‐CoV‐2 infection with impaired fetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus‐related pathology on the villous capillary endothelium, trophoblast and other cells. Main outcome measures Maternal and fetal clinical outcomes and placental pathology in stillborn and live‐born infants. Results Reduced fetal movements were reported (77%) and time from onset of maternal COVID‐19 symptoms to signs of fetal distress among live‐born infants was 6 (3–12) days and to diagnosis of stillbirth 11 (2–25) days. Two of the live‐born infants died during the postnatal period. Signs of fetal distress led to emergency caesarean section in all live‐born infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one live‐born neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillositis and trophoblast necrosis were associated with SARS‐CoV‐2 placental infection and congenital transmission. Conclusions SARS‐CoV‐2 can cause rapid placental dysfunction with subsequent acute fetal hypoxia leading to intrauterine fetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillositis and trophoblast degeneration. SARS‐CoV‐2 can cause rapid placental dysfunction and intrauterine fetal compromise. Linked article: This article is commented on by Yves Ville, pp. 1375 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17162. This article includes Author Insights, a video abstract available at: https://vimeo.com/bjogabstracts/authorinsights17132
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Affiliation(s)
- Mehreen Zaigham
- Obstetrics & Gynaecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynaecology, Skåne University Hospital, Lund, Sweden
| | - David Gisselsson
- Clinical Genetics and Pathology, Laboratory Medicine, Skåne University Hospital, Lund, Sweden.,Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anna Sand
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma von Wowern
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Lund, Sweden.,Perinatal and Cardiovascular Epidemiology, Institution of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Linda Iorizzo
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science Helsingborg, Lund University, Lund, Sweden
| | - Maria Nelander
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynaecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Holmström
- Department of Obstetrics and Gynaecology, Halland Hospital, Varberg, Sweden
| | - Åsa Leijonhfvud
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science Helsingborg, Lund University, Lund, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Gothenburg, Sweden
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25
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Horn LC, Krücken I, Hiller GGR, Niedermair M, Perac K, Pietsch C, Höhn AK. Placental pathology in sudden intrauterine death (SIUD) in SARS-CoV-2-positive oligosymptomatic women. Arch Gynecol Obstet 2022; 307:1811-1822. [PMID: 35716208 PMCID: PMC9206072 DOI: 10.1007/s00404-022-06614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/05/2022] [Indexed: 11/21/2022]
Abstract
Background Pregnant women are also susceptible to SARS-CoV-2. Although an infection of the placenta may be rare, pregnancy may occasionally be affected by intrauterine failure. The knowledge of placental morphology on sudden intrauterine demise is still limited. Methods Fetal and placental tissue of two cases of sudden intrauterine death in the second trimester were analysed morphologically and by immunohistochemistry. One case was evaluated by RT-PCR. Results Both mothers were tested positive for the Alpha variant of SARS-CoV-2 but were oligosymptomatic for COVID-19. Unexpected sudden intrauterine death (SIUD) occurred at 15 + 2 and 27 + 3 weeks of gestation. One fetus demonstrated an intrauterine growth restriction. No malformations nor inflammatory changes were observed in either fetus on autopsy. In contrast to the placentas, the fetal tissue was negative for SARS-CoV-2 on immunohistochemical and RT-PCR analyses. Macroscopically, the placentas showed an increased consistency with a white, reticular cutting surface covering about 95% of the whole placenta. Only very focal histiocytic chronic intervillositis was noted histologically. Massive perivillous fibrin deposits with extensive necroses of the villous trophoblast were present in more than 90% of the placental tissue. Immunohistochemical staining was strong and diffusely positive for SARS-CoV-2 in the villous trophoblast and rarely within the villous stromal cells. Placental SARS-CoV-2 infection was confirmed by RT-PCR. Conclusion Sudden intrauterine death may occur in mothers who are oligosymptomatic for COVID-19. Acute placental failure is responsible for SIUD, demonstrated by massive perivillous fibrin deposits and extensive necroses of the villous trophoblast with SARS-CoV-2-positivity based on immunohistochemical staining and RT-PCR. Detailed histopathological examination of placental and fetal tissue is mandatory to verify SARS-CoV-2 and to evaluate the pathogenesis and functionality of this disease.
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Affiliation(s)
- Lars-Christian Horn
- Division of Breast Gynecologic and Perinatal Pathology, Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany.
| | - Irene Krücken
- Division of Breast Gynecologic and Perinatal Pathology, Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany
| | - Grit Gesine Ruth Hiller
- Division of Breast Gynecologic and Perinatal Pathology, Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany
| | - Maria Niedermair
- Institute of Clinical and Molecular Pathology, City Hospital Wels-Grieskirchen, Grieskirchen, Austria
| | - Kristina Perac
- Institute of Clinical and Molecular Pathology, City Hospital Wels-Grieskirchen, Grieskirchen, Austria
| | - Corinna Pietsch
- Institute of Medical Microbiology and Virology, University Hospital of Leipzig, Leipzig, Germany
| | - Anne Kathrin Höhn
- Division of Breast Gynecologic and Perinatal Pathology, Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany
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26
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Hendriks B, van Uitert E, Schoenmakers S, Duvekot JJ, Gommers D, Cornette JMJ, van de Sande D, van Bommel J, van Kampen JJA, Cornette J. Gravid uterine torsion after prone positioning in SARS-CoV2 (COVID-19)-related acute respiratory distress syndrome. J Surg Case Rep 2022; 2022:rjac289. [PMID: 35769307 PMCID: PMC9230700 DOI: 10.1093/jscr/rjac289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
A multiparous pregnant patient was admitted to the intensive care unit in her third trimester of pregnancy for prone positioning mechanical ventilation after developing SARS-CoV2 (COVID-19)-related acute respiratory distress syndrome. Repositioning in left lateral tilt was followed by uterine contractions and cardiotocography alterations. Preterm caesarean section was performed based on persistent foetal tachycardia and suspected foetal distress, followed by a per-operative diagnosis of uterine levotorsion. This case report is the first to explore a potential causal link between prolonged prone positioning in late pregnancy and postural gravid uterine torsion and highlights the need for appropriate foetal monitoring during prone positioning mechanical ventilation support.
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Affiliation(s)
- Bavo Hendriks
- Department of Uro-Gynaecology, Ghent University Hospital (Universitair Ziekenhuis Gent) , Corneel Heymanslaan 10, B-9000 Ghent , Belgium
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
| | - Evelyne van Uitert
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC University Medical Center , Room Ne-413, Doctor Molewaterplein 40, 3015 GD Rotterdam , The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center , Wytemaweg 80, 3015 CN Rotterdam , The Netherlands
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27
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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.
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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
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28
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Response to "Diffuse trophoblast damage is the hallmark of SARS-CoV-2-associated fetal demise.". Mod Pathol 2022; 35:850-851. [PMID: 34845304 PMCID: PMC8629101 DOI: 10.1038/s41379-021-00975-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/18/2023]
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29
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Multisystem Inflammatory Syndrome in Neonates Born to Mothers with SARS-CoV-2 Infection (MIS-N) and in Neonates and Infants Younger Than 6 Months with Acquired COVID-19 (MIS-C): A Systematic Review. Viruses 2022; 14:v14040750. [PMID: 35458480 PMCID: PMC9024762 DOI: 10.3390/v14040750] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 12/25/2022] Open
Abstract
(1) Introduction: There is an increasing literature describing neonates born to mothers with SARS-CoV-2 infection (MIS-N) and infants infected with SARS-CoV-2 who presented with a severe disease (MIS-C). (2) Methods: To investigate clinical features of multisystem inflammatory syndrome in neonates and infants under six months of age, we used a systematic search to retrieve all relevant publications in the field. We screened in PubMed, EMBASE and Scopus for data published until 10 October 2021. (3) Results: Forty-eight articles were considered, including 29 case reports, six case series and 13 cohort studies. Regarding clinical features, only 18.2% of MIS-N neonates presented with fever; differently from older children with MIS-C, in which gastrointestinal symptoms were the most common manifestation, we displayed that cardiovascular dysfunction and respiratory distress are the prevalent findings both in neonates with MIS-N and in neonates/infants with MIS-C. (4) Conclusions: We suggest that all infants with suspected inflammatory disease should undergo echocardiography, due to the possibility of myocardial dysfunction and damage to the coronary arteries observed both in neonates with MIS-N and in neonates/infants with MIS-C. Moreover, we also summarize how they were treated and provide a therapeutic algorithm to suggest best management of these fragile infants.
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30
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Stillbirth after COVID-19 in Unvaccinated Mothers Can Result from SARS-CoV-2 Placentitis, Placental Insufficiency, and Hypoxic Ischemic Fetal Demise, Not Direct Fetal Infection: Potential Role of Maternal Vaccination in Pregnancy. Viruses 2022; 14:v14030458. [PMID: 35336864 PMCID: PMC8950737 DOI: 10.3390/v14030458] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
Stillbirth is a recently recognized complication of COVID-19 in pregnant women. Other congenitally transmitted infections from viruses, bacteria and parasites can cause stillbirth by infecting fetal organs following transplacental transmission of the agent from the maternal bloodstream. However, recent research on pregnant women with COVID-19 having stillbirths indicates that there is another mechanism of stillbirth that can occur in placentas infected with SARS-CoV-2. In these cases, viral infection of the placenta results in SARS-CoV-2 placentitis, a combination of concurrent destructive findings that include increased fibrin deposition which typically reaches the level of massive perivillous fibrin deposition, chronic histiocytic intervillositis and trophoblast necrosis. These three pathological lesions, in some cases together with placental hemorrhage, thrombohematomas and villitis, result in severe and diffuse placental parenchymal destruction. This pathology can involve greater than one-half of the placental volume, averaging 77% in the largest study of 68 cases, effectively rendering the placenta incapable of performing its function of oxygenating the fetus. This destructive placental process can lead to stillbirth and neonatal death via malperfusion and placental insufficiency which is independent of fetal infection. Fetal autopsies show no evidence that direct infection of fetal organs is contributory. Because all mothers examined have been unvaccinated, maternal vaccination may prevent viremia and consequent placental infection.
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31
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Peng Z, Zhang J, Shi Y, Yi M. Research progresses in vertical transmission of SARS-CoV-2 among infants born to mothers with COVID-19. Future Virol 2022. [PMID: 35173797 PMCID: PMC8833011 DOI: 10.2217/fvl-2021-0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Zhoujie Peng
- Department of Neonatology, Chongqing University Three Gorges Hospital; Department of Neonatology, Chongqing Three Gorges Central Hospital, 165 Xin Cheng Road, Wanzhou District, Chongqing, 404000, China
| | - Jing Zhang
- Department of Neonatology, Chongqing University Three Gorges Hospital; Department of Neonatology, Chongqing Three Gorges Central Hospital, 165 Xin Cheng Road, Wanzhou District, Chongqing, 404000, China
| | - Yuan Shi
- Department of Neonatology, Children’s Hospital, Chongqing Medical University, National Clinical Research Center for Child Health & Disorders; China International Science & Technology Cooperation Base of Child Development & Critical Disorders No.136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, China
| | - Ming Yi
- Department of Neonatology, Chongqing University Three Gorges Hospital; Department of Neonatology, Chongqing Three Gorges Central Hospital, 165 Xin Cheng Road, Wanzhou District, Chongqing, 404000, China
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32
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Schwartz DA, Avvad-Portari E, Babál P, Baldewijns M, Blomberg M, Bouachba A, Camacho J, Collardeau-Frachon S, Colson A, Dehaene I, Ferreres JC, Fitzgerald B, Garrido-Pontnou M, Gerges H, Hargitai B, Helguera-Repetto AC, Holmström S, Irles CL, Leijonhfvud Å, Libbrecht S, Marton T, McEntagart N, Molina JT, Morotti R, Nadal A, Navarro A, Nelander M, Oviedo A, Oyamada Otani AR, Papadogiannakis N, Petersen AC, Roberts DJ, Saad AG, Sand A, Schoenmakers S, Sehn JK, Simpson PR, Thomas K, Valdespino-Vázquez MY, van der Meeren LE, Van Dorpe J, Verdijk RM, Watkins JC, Zaigham M. Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries. Arch Pathol Lab Med 2022; 146:660-676. [PMID: 35142798 DOI: 10.5858/arpa.2022-0029-sa] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Perinatal death is an increasingly important problem as the COVID-19 pandemic continues, but the mechanism of death has been unclear. OBJECTIVE.— To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for SARS-CoV-2. DESIGN.— Case-based retrospective clinico-pathological analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. RESULTS.— All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25/68) and chronic villitis (32%; 22/68). The majority (19, 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. CONCLUSIONS.— The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
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Affiliation(s)
| | - Elyzabeth Avvad-Portari
- Department of Pathology, Fernandes Figueira Institute, FIOCRUZ - Rio de Janeiro, Brazil (Avvad-Portari)
| | - Pavel Babál
- Department of Pathology, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Babál)
| | - Marcella Baldewijns
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns)
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden (Blomberg)
| | - Amine Bouachba
- Institut de Pathologie Multisite des Hospices Civils de Lyon, Lyon, France; SOFFOET-Société Française de Foetopathologie, Paris, France (Bouachba)
| | - Jessica Camacho
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Camacho)
| | - Sophie Collardeau-Frachon
- Department of Pathology, Hopital Femme-Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 and SOFFOET-Société Française de Foetopathologie, Paris France (Collardeau-Frachon)
| | - Arthur Colson
- Department of Obstetrics, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium (Colson)
| | - Isabelle Dehaene
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Dehaene)
| | - Joan Carles Ferreres
- Pathology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Barcelona, Spain (Ferreres)
| | - Brendan Fitzgerald
- Department of Pathology, Cork University Hospital, Wilton, Cork, Republic of Ireland (Fitzgerald)
| | - Marta Garrido-Pontnou
- Pathology Department, Hospital Universitari Vall d'Hebron, Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain (Garrido-Pontnou)
| | - Hazem Gerges
- Department of Obstetrics and Gynaecology, Doncaster and Bassetlaw NHS Teaching Hospitals, Women's Hospital, Doncaster, United Kingdom (Gerges)
| | - Beata Hargitai
- Division of Perinatal Pathology, Department of Cellular Pathology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Hargitai)
| | - A Cecilia Helguera-Repetto
- Immunobiochemistry Department, National Institute of Perinatology, Mexico City, Mexico (Helguera-Repetto)
| | - Sandra Holmström
- Department of Obstetrics and Gynaecology, Halland Hospital, Varberg, Sweden (Holmström)
| | - Claudine Liliane Irles
- Department of Physiology and Cellular Development, National Institute of Perinatology "Isidro Espinosa de los Reyes", Mexico City, Mexico (Irles)
| | - Åsa Leijonhfvud
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science Helsingborg, Lund University, Lund, Sweden (Leijonhfvud)
| | - Sasha Libbrecht
- Department of Pathological Anatomy, Antwerp University Hospital, Edegem, Belgium (Libbrecht)
| | - Tamás Marton
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham, United Kingdom (Marton)
| | - Noel McEntagart
- Histopathology, Rotunda Hospital, Dublin, Republic of Ireland (McEntagart)
| | - James T Molina
- Pathology and Laboratory Medicine, CHRISTUS Hospital St. Elizabeth, 2830 Calder St, Beaumont, Texas (Molina)
| | - Raffaella Morotti
- Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, Connecticut (Morotti)
| | - Alfons Nadal
- Pathology Department, Hospital Clínic, Barcelona, Spain (Nadal).,Department of Basic Clinical Practice, School of Medicine, Universitat de Barcelona, and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (Nadal)
| | - Alexandra Navarro
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Navarro)
| | - Maria Nelander
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Nelander)
| | - Angelica Oviedo
- Department of Pathology and Laboratory Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico (Oviedo)
| | | | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Department of Pathology, Karolinska University Hospital, Stockholm, Sweden (Papadogiannakis)
| | - Astrid C Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark (Petersen)
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Roberts)
| | - Ali G Saad
- Pediatric Pathology and Neuropathology, Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, Florida (Saad)
| | - Anna Sand
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Obstetrics and Gynaecology, Karolinska University Hospital, Solna, Stockholm, Sweden (Sand)
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Schoenmakers)
| | - Jennifer K Sehn
- Department of Pathology, St. Louis University School of Medicine, St. Louis, Missouri (Sehn)
| | - Preston R Simpson
- Department of Pathology, CHRISTUS Hospital St. Elizabeth, 2830 Calder St., Beaumont, Texas (Simpson)
| | - Kristen Thomas
- Department of Pathology, NYU Langone Health - Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, New York (Thomas)
| | | | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (van der Meeren).,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands (van der Meeren)
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium (Van Dorpe)
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Verdijk)
| | - Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Watkins)
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Institution of Clinical Sciences Lund, Lund University, Sweden (Zaigham).,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden (Zaigham)
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Neonates and COVID-19: state of the art : Neonatal Sepsis series. Pediatr Res 2022; 91:432-439. [PMID: 34961785 PMCID: PMC8712275 DOI: 10.1038/s41390-021-01875-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022]
Abstract
The SARS-CoV-2 pandemic has had a significant impact worldwide, particularly in middle- and low-income countries. While this impact has been well-recognized in certain age groups, the effects, both direct and indirect, on the neonatal population remain largely unknown. There are placental changes associated, though the contributions to maternal and fetal illness have not been fully determined. The rate of premature delivery has increased and SARS-CoV-2 infection is proportionately higher in premature neonates, which appears to be related to premature delivery for maternal reasons rather than an increase in spontaneous preterm labor. There is much room for expansion, including long-term data on outcomes for affected babies. Though uncommon, there has been evidence of adverse events in neonates, including Multisystem Inflammatory Syndrome in Children, associated with COVID-19 (MIS-C). There are recommendations for reduction of viral transmission to neonates, though more research is required to determine the role of passive immunization of the fetus via maternal vaccination. There is now considerable evidence suggesting that the severe visitation restrictions implemented early in the pandemic have negatively impacted the care of the neonate and the experiences of both parents and healthcare professionals alike. Ongoing collaboration is required to determine the full impact, and guidelines for future management. IMPACT: Comprehensive review of current available evidence related to impact of the COVID-19 pandemic on neonates, effects on their health, impact on their quality of care and indirect influences on their clinical course, including comparisons with other age groups. Reference to current evidence for maternal experience of infection and how it impacts the fetus and then neonate. Outline of the need for ongoing research, including specific areas in which there are significant gaps in knowledge.
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34
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Al-Saadi EAKD, Abdulnabi MA. Hematological changes associated with COVID-19 infection. J Clin Lab Anal 2022; 36:e24064. [PMID: 34783405 PMCID: PMC8646489 DOI: 10.1002/jcla.24064] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The unresolved COVID-19 pandemic considerably impacts the health services in Iraq and worldwide. Consecutive waves of mutated virus increased virus spread and further constrained health systems. Although molecular identification of the virus by polymerase chain reaction is the only recommended method in diagnosing COVID-19 infection, radiological, biochemical, and hematological studies are substantially important in risk stratification, patient follow-up, and outcome prediction. AIM This narrative review summarized the hematological changes including the blood indices, coagulative indicators, and other associated biochemical laboratory markers in different stages of COVID-19 infection, highlighting the diagnostic and prognostic significance. METHODS Literature search was conducted for multiple combinations of different hematological tests and manifestations with novel COVID-19 using the following key words: "hematological," "complete blood count," "lymphopenia," "blood indices," "markers" "platelet" OR "thrombocytopenia" AND "COVID-19," "coronavirus2019," "2019-nCoV," OR "SARS-CoV-2." Articles written in the English language and conducted on human samples between December 2019 and January 2021 were included. RESULTS Hematological changes are not reported in asymptomatic or presymptomatic COVID-19 patients. In nonsevere cases, hematological changes are subtle, included mainly lymphocytopenia (80.4%). In severe, critically ill patients and those with cytokine storm, neutrophilia, lymphocytopenia, elevated D-dimer, prolonged PT, and reduced fibrinogen are predictors of disease progression and adverse outcome. CONCLUSION Monitoring hematological changes in patients with COVID-19 can predict patients needing additional care and stratify the risk for severe course of the disease. More studies are required in Iraq to reflect the hematological changes in COVID-19 as compared to global data.
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Affiliation(s)
| | - Marwa Ali Abdulnabi
- Department of pathology, Al-Kindy College of Medicine University of Baghdad, Baghdad, Iraq
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35
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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).
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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
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36
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Favre G, Mazzetti S, Gengler C, Bertelli C, Schneider J, Laubscher B, Capoccia R, Pakniyat F, Ben Jazia I, Eggel-Hort B, de Leval L, Pomar L, Greub G, Baud D, Giannoni E. Decreased Fetal Movements: A Sign of Placental SARS-CoV-2 Infection with Perinatal Brain Injury. Viruses 2021; 13:v13122517. [PMID: 34960786 PMCID: PMC8706116 DOI: 10.3390/v13122517] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 01/23/2023] Open
Abstract
Neonatal COVID-19 is rare and mainly results from postnatal transmission. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), however, can infect the placenta and compromise its function. We present two cases of decreased fetal movements and abnormal fetal heart rhythm 5 days after mild maternal COVID-19, requiring emergency caesarean section at 29 + 3 and 32 + 1 weeks of gestation, and leading to brain injury. Placental examination revealed extensive and multifocal chronic intervillositis, with intense cytoplasmic positivity for SARS-CoV-2 spike antibody and SARS-CoV-2 detection by RT-qPCR. Vertical transmission was confirmed in one case, and both neonates developed extensive cystic peri-ventricular leukomalacia.
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Affiliation(s)
- Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
| | - Sara Mazzetti
- Clinic of Pediatrics, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (S.M.); (B.L.)
| | - Carole Gengler
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.G.); (L.d.L.)
| | - Claire Bertelli
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.B.); (G.G.)
| | - Juliane Schneider
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (J.S.); (E.G.)
| | - Bernard Laubscher
- Clinic of Pediatrics, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (S.M.); (B.L.)
- Department of Pediatrics, Réseau Hospitalier Neuchâtelois, 2000 Neuchâtel, Switzerland
| | - Romina Capoccia
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Fatemeh Pakniyat
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Inès Ben Jazia
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Béatrice Eggel-Hort
- Department of Obstetrics and Gynecology, Hôpital du Valais—Centre Hospitalier du Valais Romand—Site de Sion, 1951 Sion, Switzerland;
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.G.); (L.d.L.)
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
- Midwifery Department, School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.B.); (G.G.)
- Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
- Correspondence: ; Tel.: +41-79-556-13-51
| | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (J.S.); (E.G.)
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Figueiredo CP, Fontes-Dantas FL, da Poian AT, Clarke JR. SARS-CoV-2-associated cytokine storm during pregnancy as a possible risk factor for neuropsychiatric disorder development in post-pandemic infants. Neuropharmacology 2021; 201:108841. [PMID: 34666076 PMCID: PMC8519783 DOI: 10.1016/j.neuropharm.2021.108841] [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: 04/30/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 01/23/2023]
Abstract
A strong association between perinatal viral infections and neurodevelopmental disorders has been established. Both the direct contact of the virus with the developing brain and the strong maternal immune response originated by viral infections can impair proper neurodevelopment. Coronavirus disease 2019 (COVID-19), caused by the highly-infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently responsible for a large global outbreak and is a major public health issue. While initial studies focused on the viral impact on the respiratory system, increasing evidence suggest that SARS-CoV-2 infects other organs and tissues including the mature brain. While studies continue to determine the neuropathology associated to COVID-19, the consequences of SARS-CoV-2 infection to the developing brain remain largely unexplored. The present review discusses evidence suggesting that SARS-CoV-2 infection may have persistent effects on the course of pregnancy and on brain development. Studies have shown that several proinflammatory mediators which are increased in the SARS-CoV-2-associated cytokine storm, are also modified in other viral infections known to increase the risk of neurodevelopmental disorders. In this sense, further studies should assess the genuine effects of SARS-CoV-2 infection during pregnancy and delivery along with an extended follow-up of the offspring, including neurocognitive, neuroimaging, and electrophysiological examination. It also remains to be determined whether and by which mechanisms SARS-CoV-2 intrauterine and early life infection could lead to an increased risk of developing neuropsychiatric disorders, such as autism (ASD) and schizophrenia (SZ), in the offspring.
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Affiliation(s)
- Claudia P Figueiredo
- School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil; Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | | | - Andrea T da Poian
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Julia R Clarke
- School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil; Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil.
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Milbak J, Holten VMF, Axelsson PB, Bendix JM, Aabakke AJM, Nielsen L, Friis MB, Jensen CAJ, Løkkegaard ECL, Olsen TE, Rode L, Clausen TD. A prospective cohort study of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy evaluating SARS-CoV-2 antibodies in maternal and umbilical cord blood and SARS-CoV-2 in vaginal swabs. Acta Obstet Gynecol Scand 2021; 100:2268-2277. [PMID: 34719780 PMCID: PMC8653183 DOI: 10.1111/aogs.14274] [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: 05/30/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022]
Abstract
Introduction Evidence about the consequences of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in pregnancy is rapidly increasing; however, data on antibody response and risk of transmission during pregnancy and delivery are still limited. The aim of this study was to evaluate if SARS‐CoV‐2 is detectable in vaginal swabs and whether antibodies against SARS‐CoV‐2 are present in maternal and umbilical cord blood of pregnant women with confirmed SARS‐CoV‐2. Material and methods A single‐unit prospective cohort study in Denmark including pregnant women with SARS‐CoV‐2 infection confirmed by a pharyngeal swab between August 20, 2020, and March 1, 2021, who gave birth during the same period. All patients admitted to the maternity ward and antepartum clinic were screened for SARS‐CoV‐2 infection. A maternal blood sample and vaginal swabs were collected at inclusion. If included antepartum, these samples were repeated intrapartum when an umbilical cord blood sample was also collected. Swabs were analyzed for SARS‐CoV‐2 and blood samples were analyzed for SARS‐CoV‐2 total antibodies. Placental and neonatal swabs as well as placental histopathological examinations were performed on clinical indications. Results We included 28 women, of whom four had serious maternal or fetal outcomes including one case of neonatal death. Within the first 8 days after confirmed SARS‐CoV‐2 infection, SARS‐CoV‐2 was detectable in two vaginal swabs (2/28) and SARS‐CoV‐2 antibodies were detected in 1 of 13 women. From 16 days after confirmed infection, antibodies were observed in 19 of 21 of women. Antibodies in cord blood were not detected during the first 16 days after confirmed infection (n = 7). However, from 26 days, antibodies were present in 16 of 17 cord blood samples of seropositive mothers. Placental examination in two cases of severe fetal outcomes preceded by reduced fetal movements revealed SARS‐CoV‐2 in swabs and severe histopathological abnormalities. Conclusions SARS‐CoV‐2 was detected in only 2 of 28 vaginal swabs within 8 days after confirmed infection in pregnant women. Our data suggest that maternal seroconversion occurs between days 8 and 16, whereas antibodies in cord blood of seropositive mothers were present in the majority from 26 days after confirmed infection. Additional data are needed regarding timing of seroconversion for the mother and appearance of antibodies in cord blood.
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Affiliation(s)
- Julie Milbak
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Victoria M F Holten
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Paul Bryde Axelsson
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Jane Marie Bendix
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Anna J M Aabakke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Holbaek, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Martin Barfred Friis
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Claus A J Jensen
- Department of Clinical Biochemistry, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tina Elisabeth Olsen
- Department of Pathology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Tine Dalsgaard Clausen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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39
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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.
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40
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Schwartz DA, Bugatti M, Santoro A, Facchetti F. Molecular Pathology Demonstration of SARS-CoV-2 in Cytotrophoblast from Placental Tissue with Chronic Histiocytic Intervillositis, Trophoblast Necrosis and COVID-19. J Dev Biol 2021; 9:jdb9030033. [PMID: 34449643 PMCID: PMC8395857 DOI: 10.3390/jdb9030033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022] Open
Abstract
A subset of placentas from pregnant women having the SARS-CoV-2 infection have been found to be infected with the coronavirus using molecular pathology methods including immunohistochemistry and RNA in situ hybridization. These infected placentas can demonstrate several unusual findings which occur together—chronic histiocytic intervillositis, trophoblast necrosis and positive staining of the syncytiotrophoblast for SARS-CoV-2. They frequently also have increased fibrin deposition, which can be massive in some cases. Syncytiotrophoblast is the most frequent fetal-derived cell type to be positive for SARS-CoV-2. It has recently been shown that in a small number of infected placentas, villous stromal macrophages, termed Hofbauer cells, and villous capillary endothelial cells can also stain positive for SARS-CoV-2. This report describes a placenta from a pregnant woman with SARS-CoV-2 that had chronic histiocytic intervillositis, trophoblast necrosis, increased fibrin deposition and positive staining of the syncytiotrophoblast for SARS-CoV-2. In addition, molecular pathology testing including RNAscope and immunohistochemistry for SARS-CoV-2 and double-staining immunohistochemistry using antibodies to E-cadherin and GATA3 revealed that cytotrophoblast cells stained intensely for SARS-CoV-2. All of the cytotrophoblast cells that demonstrated positive staining for SARS-CoV-2 were in direct physical contact with overlying syncytiotrophoblast that also stained positive for the virus. The pattern of cytotrophoblast staining for SARS-CoV-2 was patchy, and there were chorionic villi having diffuse positive staining of the syncytiotrophoblast for SARS-CoV-2, but without staining of cytotrophoblast. This first detailed description of cytotrophoblast involvement by SARS-CoV-2 adds another fetal cell type from infected placentas that demonstrate viral staining.
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Affiliation(s)
- David A. Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Mattia Bugatti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.B.); (A.S.); (F.F.)
| | - Amerigo Santoro
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.B.); (A.S.); (F.F.)
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.B.); (A.S.); (F.F.)
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41
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Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms. Viruses 2021; 13:v13081670. [PMID: 34452534 PMCID: PMC8402730 DOI: 10.3390/v13081670] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although the risk for transplacental transmission of SARS-CoV-2 is rare, placental infections with adverse functional consequences have been reported. This study aims to analyse histological placental findings in pregnancies complicated by SARS-CoV-2 infection and investigate its correlation with clinical symptoms and perinatal outcomes. We want to determine which pregnancies are at-risk to prevent adverse pregnancy outcomes related to COVID-19 in the future. METHODS A prospective, longitudinal, multicentre, cohort study. All pregnant women presenting between April 2020 and March 2021 with a nasopharyngeal RT-PCR-confirmed SARS-CoV-2 infection were included. Around delivery, maternal, foetal and placental PCR samples were collected. Placental pathology was correlated with clinical maternal characteristics of COVID-19. RESULTS Thirty-six patients were included, 33 singleton pregnancies (n = 33, 92%) and three twin pregnancies (n = 3, 8%). Twenty-four (62%) placentas showed at least one abnormality. Four placentas (4/39, 10%) showed placental staining positive for the presence of SARS-CoV-2 accompanied by a unique combination of diffuse, severe inflammatory placental changes with massive perivillous fibrin depositions, necrosis of syncytiotrophoblast, diffuse chronic intervillositis, and a specific, unprecedented CD20+ B-cell infiltration. This SARS-CoV-2 placental signature seems to correlate with foetal distress (75% vs. 15.6%, p = 0.007) but not with the severity of maternal COVID-19 disease. CONCLUSION We describe a unique placental signature in pregnant patients with COVID-19, which has not been reported in a historical cohort. We show that the foetal environment can be seriously compromised by disruption of placental function due to local, devastating SARS-CoV-2 infection. Maternal clinical symptoms did not predict the severity of the SARS-CoV-2-related placental signature, resulting in a lack of adequate identification of maternal criteria for pregnancies at risk. Close foetal monitoring and pregnancy termination in case of foetal distress can prevent adverse pregnancy outcomes due to COVID-19 related placental disease.
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Watkins JC, Torous VF, Roberts DJ. Defining Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Placentitis: A Report of 7 Cases with Confirmatory In Situ Hybridization, Distinct Histomorphologic Features, and Evidence of Complement Deposition. Arch Pathol Lab Med 2021; 145:1341-1349. [PMID: 34338723 DOI: 10.5858/arpa.2021-0246-sa] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT -Case reports and rare case series have demonstrated variable placental pathology in the setting of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In rare small studies demonstrating infection of the placental parenchyma, histologic manifestations have included variable degrees of histiocytic intervillositis, perivillous fibrin deposition, and syncytiotrophoblast necrosis. OBJECTIVE -To characterize the placental pathological features of SARS-CoV-2 infected placentas, irrespective of fetal-maternal transmission, and to examine the frequency of C4d activation in such cases. DESIGN -Retrospective study of seven placentas from mothers with active SARS-CoV-2 infection and placental infection as demonstrated by RNA in situ hybridization. RESULTS -Six placentas were from live-born neonates (5 singletons, 1 non-fused diamniotic-dichorionic twin placenta), and one was from a stillbirth. Five of the eight neonates (including the stillbirth) tested negative for SARS-CoV-2, and all were negative for neonatal infection. The remaining three neonates were well at time of discharge. All placentas were positive for SARS-CoV-2 infection by RNA in situ hybridization and demonstrated variable degrees of histiocytic intervillositis, perivillous fibrin deposition, and trophoblast necrosis. Three cases demonstrated features of fetal vascular malperfusion. CD68 highlighted intervillous histiocytes. C4d expression was present along the villous borders in 6 of 7 cases. CONCLUSIONS -SARS-CoV-2 placentitis is defined by the triad of histiocytic intervillositis, perivillous fibrin deposition, and trophoblast necrosis. The features may occur in cases without confirmed transplacental transmission. The damage caused by SARS-CoV-2 placentitis is likely mediated by complement activation.
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Affiliation(s)
- Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Vanda F Torous
- Department of Pathology, Massachusetts General Hospital, Boston, MA
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Schwartz DA, Baldewijns M, Benachi A, Bugatti M, Bulfamante G, Cheng K, Collins RRJ, Debelenko L, De Luca D, Facchetti F, Fitzgerald B, Levitan D, Linn RL, Marcelis L, Morotti D, Morotti R, Patanè L, Prevot S, Pulinx B, Saad AG, Schoenmakers S, Strybol D, Thomas K, Tosi D, Toto V, van der Meeren LE, Verdijk RM, Vivanti AJ, Zaigham M. Hofbauer cells and coronavirus disease 2019 (COVID-19) in pregnancy: Molecular pathology analysis of villous macrophages, endothelial cells, and placental findings from 22 placentas infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with and without fetal transmission. Arch Pathol Lab Med 2021; 145:1328-1340. [PMID: 34297794 DOI: 10.5858/arpa.2021-0296-sa] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can undergo maternal-fetal transmission, heightening interest in the placental pathology findings from this infection. Transplacental SARS-CoV-2 transmission is typically accompanied by chronic histiocytic intervillositis together with necrosis and positivity of syncytiotrophoblast for SARSCoV-2. Hofbauer cells are placental macrophages that have been involved in viral diseases including HIV and Zika virus, but their involvement in SARS-CoV-2 in unknown. OBJECTIVE - To determine whether SARS-CoV-2 can extend beyond the syncytiotrophoblast to enter Hofbauer cells, endothelium and other villous stromal cells in infected placentas of liveborn and stillborn infants. DESIGN - Case-based retrospective analysis by 29 perinatal and molecular pathology specialists of placental findings from a preselected cohort of 22 SARS-CoV-2-infected placentas delivered to pregnant women testing positive for SARS-CoV-2 from 7 countries. Molecular pathology methods were used to investigate viral involvement of Hofbauer cells, villous capillary endothelium, syncytiotrophoblast and other fetal-derived cells. RESULTS - Chronic histiocytic intervillositis and trophoblast necrosis was present in all 22 placentas (100%). SARS-CoV-2 was identified in Hofbauer cells from 4/22 placentas (18%). Villous capillary endothelial staining was positive in 2/22 cases (9%), both of which also had viral positivity in Hofbauer cells. Syncytiotrophoblast staining occurred in 21/22 placentas (95%). Hofbauer cell hyperplasia was present in 3/22 placentas (14%). In the 7 cases having documented transplacental infection of the fetus, 2 occurred in placentas with Hofbauer cell staining positive for SARS-CoV-2. CONCLUSIONS - SARS-CoV-2 can extend beyond the trophoblast into the villous stroma, involving Hofbauer cells and capillary endothelial cells, in a small number of infected placentas. Most cases of SARS-CoV-2 transplacental fetal infection occur without Hofbauer cell involvement.
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Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA
| | | | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, Clamart, France
| | - Mattia Bugatti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Gaetano Bulfamante
- Hospital Complex for Pathological Anatomy and Medical Genetics, ASST Santi Paolo e Carlo, Milan, Italy Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Rebecca R J Collins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Larisa Debelenko
- Department of Pediatric and Perinatal Pathology, Columbia University Medical Center, New York, NY
| | - Danièle De Luca
- Neonatology Division of Pediatrics, Transportation and Neonatal Critical Care APHP, Paris Saclay University Hospitals, Medical Center "A.Béclère" & Physiopathology and Therapeutic Innovation Unit, Paris-Saclay University, Paris, France
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Brendan Fitzgerald
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - Daniel Levitan
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Rebecca L Linn
- Department of Pathology & Lab Medicine, Perelman School of Medicine at the University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Denise Morotti
- Pathology Unit and Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raffaella Morotti
- Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, CT
| | - Luisa Patanè
- Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sophie Prevot
- Division of Pathology, Bicêtre Hospital, Paris Saclay University Hospitals, APHP, Le Kremlin-Bicêtre, France
| | - Bianca Pulinx
- Department of Clinical Biology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Ali G Saad
- Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, FL
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - David Strybol
- Department of Pathology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Kristen Thomas
- Department of Pathology, NYU Langone Health, Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, NY
| | - Delfina Tosi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Valentina Toto
- Hospital Complex for Pathological Anatomy and Medical Genetics, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, and Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, APHP, Université Paris Saclay, Clamart, France
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Skåne University Hospital, Malmö, Sweden and Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Mendoza-Hernández M, Huerta-Niño de Rivera I, Yoldi-Negrete M, Saviñon-Tejeda P, Franco-Cendejas R, López-Jácome LE, Navarro-Castellanos I. Probable Case of Vertical Transmission of SARS-CoV-2 in a Newborn in Mexico. Neonatology 2021; 118:364-367. [PMID: 33957638 PMCID: PMC8247818 DOI: 10.1159/000514710] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Much remains unknown about the transmission of the SARS-CoV-2 virus. Pregnant women are considered part of the risk population, and vertical transmission of other coronaviruses has been suggested; however, this type of transmission in SARS-CoV-2 is believed to be unlikely. CASE REPORT A newborn delivered in term via cesarean section to an asymptomatic but COVID-19-positive 35-year-old woman started with respiratory distress in the first 30 min of life. A chest radiograph revealed pneumothorax and ground glass opacities. Ventilatory support with continuous positive airway pressure was needed. Given the respiratory failure and the positive test from the mother, the patient was sampled for SARS-CoV-2 (RT-PCR) at minute 30 of life, with a positive result reported at 36 h of life. No complications had been present during pregnancy, and cardiac screening and blood cultures revealed no other etiologies. CONCLUSION Vertical transmission was highly likely in this case. Clinicians should be alert and report similar cases.
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Affiliation(s)
| | | | - María Yoldi-Negrete
- Department of Research, “Subdirección de Investigaciones Clínicas”, National Institute of health Psychiatry “Ramón de la Fuente Muñíz”, Mexico City, Mexico
| | | | - Rafael Franco-Cendejas
- Department of Infectious Disease, National Institute of Mental Health Rehabilitation, Mexico City, Mexico
| | - Luis Esaú López-Jácome
- Department of Infectious Disease, National Institute of Mental Health Rehabilitation, Mexico City, Mexico
| | - Iñaki Navarro-Castellanos
- Pediatric Cardiology Department, CHU Sainte-Justine, Université de Montréal, Montreal, Québec, Canada
- Pediatric Cardiology Department, Hospital “Regional Lic. Adolfo López Mateos”, “Instituto de Seguridad y Servicios Sociales”, Mexico City, Mexico
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Bahadur G, Bhat M, Acharya S, Janga D, Cambell B, Huirne J, Yoong W, Govind A, Pardo J, Homburg R. Retrospective observational RT-PCR analyses on 688 babies born to 843 SARS-CoV-2 positive mothers, placental analyses and diagnostic analyses limitations suggest vertical transmission is possible. Facts Views Vis Obgyn 2021; 13:53-66. [PMID: 33889861 PMCID: PMC8051196 DOI: 10.52054/fvvo.13.1.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Research question Is there vertical transmission (from mother to baby antenatally or intrapartum) after SARS-CoV-2 (COVID-19) infected pregnancy? Study design A systematic search related to SARS-CoV-2 (COVID-19), pregnancy, neonatal complications, viral and vertical transmission. The duration was from December 2019 to May 2020. Results A total of 84 studies with 862 COVID positive women were included. Two studies had ongoing pregnancies while 82 studies included 705 babies, 1 miscarriage and 1 medical termination of pregnancy (MTOP). Most publications (50/84, 59.5%), reported small numbers (<5) of positive babies. From 75 studies, 18 babies were COVID-19 positive. The first reverse transcription polymerase chain reaction (RT-PCR) diagnostic test was done in 449 babies and 2 losses, 2nd RT-PCR was done in 82 babies, IgM tests were done in 28 babies, and IgG tests were done in 28 babies. On the first RT-PCR, 47 studies reported time of testing while 28 studies did not. Positive results in the first RT-PCR were seen in 14 babies. Earliest tested at birth and the average time of the result was 22 hours. Three babies with negative first RT-PCR became positive on the second RT-PCR at day 6, day 7 and at 24 hours which continued to be positive at 1 week. Four studies with a total of 4 placental swabs were positive demonstrating SARS-CoV-2 localised in the placenta. In 2 studies, 10 tests for amniotic fluid were positive for SARS-CoV-2. These 2 babies were found to be positive on RT-PCR on serial testing. Conclusion Diagnostic testing combined with incubation period and placental pathology indicate a strong likelihood that intrapartum vertical transmission of SARS-CoV-2 (COVID-19) from mother to baby is possible.
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Affiliation(s)
- G Bahadur
- Reproductive Medicine Unit/Obstetrics and Gynaecology Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK.,Homerton Fertility Unit, Homerton University Hospital, Homerton Row, London E9 6SR,UK
| | - M Bhat
- Ayrshire Fertility Unit, University Hospital Crosshouse, Kilmarnock, Scotland
| | - S Acharya
- Ayrshire Fertility Unit, University Hospital Crosshouse, Kilmarnock, Scotland
| | - D Janga
- Reproductive Medicine Unit/Obstetrics and Gynaecology Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK
| | - B Cambell
- Reproductive Medicine Unit/Obstetrics and Gynaecology Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK
| | - J Huirne
- University Medical Centers Amsterdam, Research Institute Reproduction and Development. Amsterdam, The Netherlands
| | - W Yoong
- Reproductive Medicine Unit/Obstetrics and Gynaecology Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK
| | - A Govind
- Reproductive Medicine Unit/Obstetrics and Gynaecology Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK
| | - J Pardo
- Reproductive Medicine Unit/Obstetrics and Gynaecology Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK
| | - R Homburg
- Homerton Fertility Unit, Homerton University Hospital, Homerton Row, London E9 6SR,UK
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Smeele HT, Perez-Garcia LF, Grimminck K, Schoenmakers S, Mulders AG, Dolhain RJ. Systemic lupus erythematosus and COVID-19 during pregnancy. Lupus 2021; 30:1188-1191. [PMID: 33715506 PMCID: PMC8120627 DOI: 10.1177/09612033211002270] [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] [Indexed: 01/11/2023]
Abstract
Background: The ongoing corona virus disease 2019 (COVID-19) pandemic is having a worldwide impact. Valuable information on the clinical characteristics of COVID-19 in pregnant patients with an autoimmune disease, such as systemic lupus erythematosus (SLE), is currently lacking. Methods: Herein, we describe the clinical presentation of 2 pregnant patients with SLE and mild symptomatic COVID-19 infection. Results: In both pregnant SLE patients, a watchful-waiting approach without initiation of treatment for COVID-19 was taken. No adverse outcomes were reported and both pregnancies resulted in healthy neonates born at term. In one patient we observed a flare in SLE disease activity, most likely attributed to discontinuing SLE treatment. Conclusion: Our report highlights the importance of multidisciplinary collaboration between health care professionals as well as individualized treatment decisions during unprecedented periods such as the current COVID-19 pandemic. Discontinuation of immunosuppressive drugs during the acute phase of a COVID-19 infection should be considered on a case-by-case basis. Maternal treatment decisions should be in line with current recommendations for treatment of rheumatic and musculoskeletal diseases during COVID-19 infection and in line with treatment of COVID- 19 during pregnancy.
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Affiliation(s)
- Hieronymus Tw Smeele
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Luis F Perez-Garcia
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Koen Grimminck
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Gynaecology and Obstetrics, Reiner de Graaf Gasthuis, Delft, The Netherlands
| | - Sam Schoenmakers
- Department of Gynaecology and Obstetrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemarie Gmgj Mulders
- Department of Gynaecology and Obstetrics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Radboud Jem Dolhain
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Samara A, Herlenius E. Is There an Effect of Fetal Mesenchymal Stem Cells in the Mother-Fetus Dyad in COVID-19 Pregnancies and Vertical Transmission? Front Physiol 2021; 11:624625. [PMID: 33679426 PMCID: PMC7928412 DOI: 10.3389/fphys.2020.624625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
Because of the polysystemic nature of coronavirus disease 2019 (COVID-19), during the present pandemic, there have been serious concerns regarding pregnancy, vertical transmission, and intrapartum risk. The majority of pregnant patients with COVID-19 infection present with mild or asymptomatic course of the disease. Some cases were hospitalized, and few needed intensive care unit admission, or mechanical ventilation. There have also been scarce case reports where neonates required mechanical ventilation post COVID-19 pregnancies. Without approved therapies other than dexamethasone, advanced mesenchymal cell therapy is one immunomodulatory therapeutic approach that is currently explored and might hold great promise. We suggest that the circulating fetal stem cells might have an immune-protective effect to mothers and contribute to the often mild and even asymptomatic post-COVID-19 pregnancies. Thus, COVID-19 pregnancies come forth as a paradigm to be further and more comprehensively approached, to understand both the mechanism and action of circulating stem cells in immunoprotection and hypoxia in microcirculation.
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Affiliation(s)
- Athina Samara
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden
| | - Eric Herlenius
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden
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Singh M, Bansal V, Feschotte C. A Single-Cell RNA Expression Map of Human Coronavirus Entry Factors. Cell Rep 2020; 32:108175. [PMID: 32946807 PMCID: PMC7470764 DOI: 10.1016/j.celrep.2020.108175] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/15/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
To predict the tropism of human coronaviruses, we profile 28 SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs) using single-cell transcriptomics across various healthy human tissues. SCARFs include cellular factors both facilitating and restricting viral entry. Intestinal goblet cells, enterocytes, and kidney proximal tubule cells appear highly permissive to SARS-CoV-2, consistent with clinical data. Our analysis also predicts non-canonical entry paths for lung and brain infections. Spermatogonial cells and prostate endocrine cells also appear to be permissive to SARS-CoV-2 infection, suggesting male-specific vulnerabilities. Both pro- and anti-viral factors are highly expressed within the nasal epithelium, with potential age-dependent variation, predicting an important battleground for coronavirus infection. Our analysis also suggests that early embryonic and placental development are at moderate risk of infection. Lastly, SCARF expression appears broadly conserved across a subset of primate organs examined. Our study establishes a resource for investigations of coronavirus biology and pathology.
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Affiliation(s)
- Manvendra Singh
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USA.
| | - Vikas Bansal
- Biomedical Data Science and Machine Learning Group, German Center for Neurodegenerative Diseases, Tübingen 72076, Germany; Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen 37075, Germany.
| | - Cédric Feschotte
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY 14853, USA.
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