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Parker SE, Annapragada B, Chestnut I, Fuchs J, Lee A, Sabharwal V, Wachman E, Yarrington C. Trimester and severity of SARS-CoV-2 infection during pregnancy and risk of hypertensive disorders in pregnancy. Hypertens Pregnancy 2024; 43:2308922. [PMID: 38279906 PMCID: PMC10962656 DOI: 10.1080/10641955.2024.2308922] [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] [Received: 05/27/2023] [Accepted: 01/17/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE SARS-CoV-2 infection during pregnancy has been linked with an increased risk of hypertensive disorders of pregnancy (HDP). The aim of this study was to examine how both trimester and severity of SARS-CoV-2 infection impact HDP. METHODS We conducted a cohort study of SARS-CoV-2-infected individuals during pregnancy (n = 205) and examined the association between trimester and severity of infection with incidence of HDP using modified Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI). We stratified the analysis of trimester by severity to understand the role of timing of infection among those with similar symptomatology and also examined timing of infection as a continuous variable. RESULTS Compared to a reference cohort from 2018, SARS-CoV-2 infection did not largely increase the risk of HDP (RR: 1.17; CI:0.90, 1.51), but a non-statistically significant higher risk of preeclampsia was observed (RR: 1.33; CI:0.89, 1.98), in our small sample. Among the SARS-CoV-2 cohort, severity was linked with risk of HDP, with infections requiring hospitalization increasing the risk of HDP compared to asymptomatic/mild infections. Trimester of infection was not associated with risk of HDP, but a slight decline in the risk of HDP was observed with later gestational week of infection. Among patients with asymptomatic or mild symptoms, SARS-CoV-2 in the first trimester conferred a higher risk of HDP compared to the third trimester (RR: 1.70; CI:0.77, 3.77), although estimates were imprecise. CONCLUSION SARS-CoV-2 infection in early pregnancy may increase the risk of HDP compared to infection later in pregnancy.
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Affiliation(s)
| | | | - Idalis Chestnut
- Department of Epidemiology, Boston University School of Public Health
| | - Jessica Fuchs
- Department of Epidemiology, Boston University School of Public Health
| | - Annette Lee
- Department of Epidemiology, Boston University School of Public Health
| | - Vishakha Sabharwal
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine
| | - Elisha Wachman
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine
| | - Christina Yarrington
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine
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2
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Lucot-Royer L, Nallet C, Vouga M, Puyraveau M, Mauny F, Marty-Quinternet S, Bertholdt C, Bory JP, Devalland C, Canaguier M, Copolla C, Eszto ML, Montoya Y, Roesch M, Reviron S, Riethmuller D, Rufenacht E, Simon E, Mottet N. Analysis of the transplacental transmission of SARS CoV-2 virus and antibody transfer according to the gestational age at maternal infection. Sci Rep 2024; 14:3458. [PMID: 38342940 PMCID: PMC10859378 DOI: 10.1038/s41598-024-53580-5] [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: 10/01/2023] [Accepted: 02/02/2024] [Indexed: 02/13/2024] Open
Abstract
To quantify transplacental transmission of SARS-CoV-2 virus and antibody transfer in pregnant women and their newborns according to the gestational age at maternal infection. A prospective observational multicenter study including pregnant women with a positive RT-PCR or a positive serology for SARS-CoV-2 and compatible symptoms, from April to December 2020, in 11 French maternities. The study was designed to obtain a systematic collection of mother-infant dyad's samples at birth. SARS-CoV-2 viral load was measured by RT-PCR. IgG and IgM antibodies against the SARS-CoV-2 spike protein were measured by enzyme-linked immunosorbent assay. Antibody concentrations and transplacental transfer ratios were analyzed according to the gestational age at maternal infection. The primary outcome was the rate of SARS CoV-2 materno-fetal transmission at birth. The secondary outcome was the quantification of materno-fetal antibody transfer. Maternal and neonatal outcomes at birth were additionally assessed. Among 165 dyads enrolled, one congenital infection was confirmed {n = 1 (0.63%) IC95% [0.02%; 3.48%]}. The average placental IgG antibody transfer ratio was 1.27 (IC 95% [0.69-2.89]). The transfer ratio increased with increasing time between the onset of maternal infection and delivery (P Value = 0.0001). Maternal and neonatal outcomes were reassuring. We confirmed the very low rate of SARS-CoV-2 transplacental transmission (< 1%). Maternal antibody transfer to the fetus was more efficient when the infection occurred during the first and second trimester of pregnancy.
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Affiliation(s)
- Louise Lucot-Royer
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Camille Nallet
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Manon Vouga
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Marc Puyraveau
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Frederic Mauny
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Solène Marty-Quinternet
- Nanomedicine Lab, Imagery and Therapeutics, EA4662, University of Franche-Comte, 25000, Besançoon, France
| | - Charline Bertholdt
- Department of Obstetrics and Gynecology, University Hospital of Nancy, Nancy Hopital Central, 54000, Nancy, France
| | - Jean-Paul Bory
- Department of Obstetrics and Gynecology, University Hospital of Reims, 51092, Reims, France
| | - Christine Devalland
- Department of Obstetrics and Gynecology, Hopital Nord Franche Comté, 90400, Trévenans, France
| | - Margaux Canaguier
- Department of Obstetrics and Gynecology, Hopital Nord Franche Comté, 90400, Trévenans, France
| | - Camille Copolla
- Department of Obstetrics and Gynecology, Groupe Hospitalier de la Haute-Saone, 70000, Vesoul, France
| | - Marie-Laure Eszto
- Department of Obstetrics and Gynecology, CHR Metz-Thionville, 57100, Thionville, France
| | - Yohny Montoya
- Department of Obstetrics and Gynecology, CHR Metz-Thionville, 57100, Thionville, France
| | - Marion Roesch
- Department of Obstetrics and Gynecology, CHR Metz-Thionville, 57100, Thionville, France
| | - Sandrine Reviron
- Department of Obstetrics and Gynecology, Hopital Jura Sud, 39000, Lons-Le-Saunier, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, University Hospital of Grenoble, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Emma Rufenacht
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Haute Comté, 25300, Pontarlier, France
| | - Emmanuel Simon
- Department of Obstetrics and Gynecology, University Hospital of Dijon, CHU Mitterand, 21000, Dijon, France
| | - Nicolas Mottet
- Pôle Mère-Femme, Department of Obstetrics and Gynecology, University Hospital of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France.
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Medel-Martinez A, Paules C, Peran M, Calvo P, Ruiz-Martinez S, Ormazabal Cundin M, Cebollada-Solanas A, Strunk M, Schoorlemmer J, Oros D, Fabre M. Placental Infection Associated with SARS-CoV-2 Wildtype Variant and Variants of Concern. Viruses 2023; 15:1918. [PMID: 37766324 PMCID: PMC10536606 DOI: 10.3390/v15091918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
The original SARS-CoV-2 lineages have been replaced by successive variants of concern (VOCs) over time. The aim of this study was to perform an assessment of the placental infection by SARS-CoV-2 according to the predominant variant at the moment of COVID-19 diagnosis. This was a prospective study of SARS-CoV-2-positive pregnant women between March 2020 and March 2022. The population was divided into pregnancies affected by COVID-19 disease during 2020 (Pre-VOC group) and pregnancies affected after December 2020 by SARS-CoV-2 variants of concern (VOC group). The presence of virus was assessed by RT-PCR, and the viral variant was determined by whole genome sequencing. A total of 104 placentas were examined, among which 54 cases belonged to the Pre-VOC group and 50 cases belonged to the VOC group. Sixteen positive placental RT-PCR tests for SARS-CoV-2 were reported. The NGS analysis confirmed the SARS-CoV-2 lineage in placenta tissue. All samples corresponded to the Pre-VOC group, whereas no placental presence of SARS-CoV-2 was detected in the VOC group (16, 29.6% vs. 0, 0.0% p = 0.000). Preterm birth (9, 16.7% vs. 2, 4%; p = 0.036) and hypertensive disorders of pregnancy (14, 25.9% vs. 3, 6%; p = 0.003) were more frequent in the Pre-VOC group than in the VOC group. Finally, the VOC group was composed of 23 unvaccinated and 27 vaccinated pregnant women; no differences were observed in the sub-analysis focused on vaccination status. In summary, SARS-CoV-2-positive placentas were observed only in pregnancies infected by SARS-CoV-2 wildtype. Thus, placental SARS-CoV-2 presence could be influenced by SARS-CoV-2 variants, infection timing, or vaccination status. According to our data, the current risk of SARS-CoV-2 placental infection after maternal COVID disease during pregnancy should be updated.
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Affiliation(s)
- Ana Medel-Martinez
- Instituto de Investigación Sanitario de Aragón (IIS Aragon), 50009 Zaragoza, Spain; (A.M.-M.); (C.P.); (M.P.); (P.C.); (S.R.-M.); (D.O.); (M.F.)
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 del IISA, 50009 Zaragoza, Spain
| | - Cristina Paules
- Instituto de Investigación Sanitario de Aragón (IIS Aragon), 50009 Zaragoza, Spain; (A.M.-M.); (C.P.); (M.P.); (P.C.); (S.R.-M.); (D.O.); (M.F.)
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 del IISA, 50009 Zaragoza, Spain
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Peran
- Instituto de Investigación Sanitario de Aragón (IIS Aragon), 50009 Zaragoza, Spain; (A.M.-M.); (C.P.); (M.P.); (P.C.); (S.R.-M.); (D.O.); (M.F.)
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 del IISA, 50009 Zaragoza, Spain
- Biochemistry Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Pilar Calvo
- Instituto de Investigación Sanitario de Aragón (IIS Aragon), 50009 Zaragoza, Spain; (A.M.-M.); (C.P.); (M.P.); (P.C.); (S.R.-M.); (D.O.); (M.F.)
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 del IISA, 50009 Zaragoza, Spain
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Sara Ruiz-Martinez
- Instituto de Investigación Sanitario de Aragón (IIS Aragon), 50009 Zaragoza, Spain; (A.M.-M.); (C.P.); (M.P.); (P.C.); (S.R.-M.); (D.O.); (M.F.)
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 del IISA, 50009 Zaragoza, Spain
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Ormazabal Cundin
- Instituto Aragonés de Ciencias de la Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), 50009 Zaragoza, Spain; (M.O.C.); (A.C.-S.); (M.S.)
| | - Alberto Cebollada-Solanas
- Instituto Aragonés de Ciencias de la Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), 50009 Zaragoza, Spain; (M.O.C.); (A.C.-S.); (M.S.)
| | - Mark Strunk
- Instituto Aragonés de Ciencias de la Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), 50009 Zaragoza, Spain; (M.O.C.); (A.C.-S.); (M.S.)
| | - Jon Schoorlemmer
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 del IISA, 50009 Zaragoza, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), 50009 Zaragoza, Spain; (M.O.C.); (A.C.-S.); (M.S.)
- ARAID Foundation, 50009 Zaragoza, Spain
| | - Daniel Oros
- Instituto de Investigación Sanitario de Aragón (IIS Aragon), 50009 Zaragoza, Spain; (A.M.-M.); (C.P.); (M.P.); (P.C.); (S.R.-M.); (D.O.); (M.F.)
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 del IISA, 50009 Zaragoza, Spain
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Fabre
- Instituto de Investigación Sanitario de Aragón (IIS Aragon), 50009 Zaragoza, Spain; (A.M.-M.); (C.P.); (M.P.); (P.C.); (S.R.-M.); (D.O.); (M.F.)
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 del IISA, 50009 Zaragoza, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Biochemistry Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
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4
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Sekulovski M, Mileva N, Chervenkov L, Peshevska-Sekulovska M, Vasilev GV, Vasilev GH, Miteva D, Tomov L, Lazova S, Gulinac M, Velikova T. Endothelial Dysfunction and Pregnant COVID-19 Patients with Thrombophilia: A Narrative Review. Biomedicines 2023; 11:2458. [PMID: 37760899 PMCID: PMC10525846 DOI: 10.3390/biomedicines11092458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Pregnancy with SARS-CoV-2 infection can raise the risk of many complications, including severe COVID-19 and maternal-fetal adverse outcomes. Additionally, endothelial damage occurs as a result of direct SARS-CoV-2 infection, as well as immune system, cardiovascular, and thrombo-inflammatory reactions. In this narrative review, we focus on endothelial dysfunction (ED) in pregnancy, associated with obstetric complications, such as preeclampsia, fetal growth retardation, gestational diabetes, etc., and SARS-CoV-2 infection in pregnant women that can cause ED itself and overlap with other pregnancy complications. We also discuss some shared mechanisms of SARS-CoV-2 pathophysiology and ED.
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Affiliation(s)
- Metodija Sekulovski
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, 1 Kozyak Str., 1407 Sofia, Bulgaria
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
| | - Niya Mileva
- Medical Faculty, Medical University of Sofia, 1 Georgi Sofiiski Str., 1431 Sofia, Bulgaria;
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria;
| | - Monika Peshevska-Sekulovska
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Department of Gastroenterology, University Hospital Lozenetz, 1407 Sofia, Bulgaria
| | - Georgi Vasilev Vasilev
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Clinic of Endocrinology and Metabolic Disorders, UMHAT “Sv. Georgi”, 4000 Plovdiv, Bulgaria
| | - Georgi Hristov Vasilev
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Laboratory of Hematopathology and Immunology, National Specialized Hospital for Active Treatment of Hematological Diseases, “Plovdivsko Pole“ Str., 6, 1756 Sofia, Bulgaria
| | - Dimitrina Miteva
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Department of Genetics, Faculty of Biology, Sofia University “St. Kliment Ohridski”, 8 Dragan Tzankov Str., 1164 Sofia, Bulgaria
| | - Latchezar Tomov
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Department of Informatics, New Bulgarian University, Montevideo 21 Str., 1618 Sofia, Bulgaria
| | - Snezhina Lazova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Pediatric Clinic, University Hospital “N. I. Pirogov,” 21 “General Eduard I. Totleben” Blvd; 1606 Sofia, Bulgaria
- Department of Healthcare, Faculty of Public Health “Prof. Tsekomir Vodenicharov, MD, DSc”, Medical University of Sofia, Bialo More 8 Str., 1527 Sofia, Bulgaria
| | - Milena Gulinac
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
- Department of General and Clinical Pathology, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4000 Plovdiv, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Kozyak 1 Str., 1407 Sofia, Bulgaria; (M.P.-S.); (G.V.V.); (G.H.V.); (D.M.); (L.T.); (S.L.); (M.G.); (T.V.)
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5
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Farisoğulları N, Denizli R, Sakcak B, Tanaçan A, Kara Ö, Şahin D. The Effect of SARS-CoV-2 İnfection on Perinatal Outcomes in Hypertensive Disorders of Pregnancy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e439-e446. [PMID: 37683655 PMCID: PMC10491470 DOI: 10.1055/s-0043-1772184] [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: 11/02/2022] [Accepted: 02/01/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To evaluate the fetal and maternal effects of the severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection in women with hypertensive disorders of pregnancy. METHODS Patients with hypertensive disorders of pregnancy and SARS-CoV-2 polymerase chain reaction (PCR) positivity (n = 55) were compared with cases with similar characteristics and PCR negativity (n = 53). The study group was further divided into two groups as severe (n = 11) and nonsevere (n = 44) coronavirus disease 2019 (COVID-19). The groups were compared in terms of clinical characteristics and perinatal outcomes. RESULTS The study and control groups were similar in terms of maternal age, parity, gestational age at diagnosis, type of hypertensive disorders, magnesium sulfate administration rate, gestational age at birth, birth weight, Apgar scores, and maternal complications. However, all cases of fetal loss (n = 6) were observed in the SARS-CoV-2 positive group (p = 0.027). From the 6 cases, there were 5 in the nonsevere group and 1 patient in the severe SARS-CoV-2 positive group. Moreover, higher rates of maternal complications, lower oxygen saturation values, and intensive care unit admissions were observed in the severe COVID-19 group. CONCLUSION Physicians should be cautious about the management of hypertensive disorders of pregnancy cases with SARS-CoV-2 positivity. Fetal loss seems to be more common in cases with SARS-CoV-2 positivity and severe COVID-19 seems to be associated with higher rates of maternal complications. Close follow-up for fetal wellbeing and active management of severe cases in terms of maternal complications seem to be favorable.
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Affiliation(s)
- Nihat Farisoğulları
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Ramazan Denizli
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Bedri Sakcak
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Atakan Tanaçan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Özgür Kara
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Dilek Şahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
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6
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Heeralall C, Ibrahim UH, Lazarus L, Gathiram P, Mackraj I. The effects of COVID-19 on placental morphology. Placenta 2023; 138:88-96. [PMID: 37235921 DOI: 10.1016/j.placenta.2023.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/10/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
The impact of the COVID-19 infection, caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during the pandemic has been considerably more severe in pregnant women than non-pregnant women. Therefore, a review detailing the morphological alterations and physiological changes associated with COVID-19 during pregnancy and the effect that these changes have on the feto-placental unit is of high priority. This knowledge is crucial for these mothers, their babies and clinicians to ensure a healthy life post-pandemic. Hence, we review the placental morphological changes due to COVID-19 to enhance the general understanding of how pregnant mothers, their placentas and unborn children may have been affected by this pandemic. Based on current literature, we deduced that COVID-19 pregnancies were oxygen deficient, which could further result in other pregnancy-related complications like preeclampsia and IUGR. Therefore, we present an up-to-date review of the COVID-19 pathophysiological implications on the placenta, covering the function of the placenta in COVID-19, the effects of this virus on the placenta, its functions and its link to other gestational complications. Furthermore, we highlight the possible effects of COVID-19 therapeutic interventions on pregnant mothers and their unborn children. Based on the literature, we strongly suggest that consistent surveillance for the mothers and infants from COVID-19 pregnancies be prioritised in the future. Though the pandemic is now in the past, its effects are long-term, necessitating the monitoring of clinical manifestations in the near future.
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Affiliation(s)
- C Heeralall
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - U H Ibrahim
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - L Lazarus
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - P Gathiram
- Discipline of Family Medicine, School of Public Health and Nursing, University of KwaZulu-Natal, Durban, South Africa
| | - I Mackraj
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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7
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Park JE, Song DH, Kim YM, Jo HC, Baek JC, Kim H, Yang J, An HJ. Impact of ACE2 and TMPRSS2 Expression in Patients With Preeclampsia. In Vivo 2023; 37:625-633. [PMID: 36881072 PMCID: PMC10026679 DOI: 10.21873/invivo.13121] [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: 01/09/2023] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM As maternal morbidity and mortality during pregnancy have increased during the COVID-19 pandemic, studies on pregnancy-related complications from SARS-CoV-2 infection are being actively conducted. Considering that pregnant women with COVID-19 may develop a preeclampsia (PE)-like syndrome, it is necessary to differentiate it from PE because true PE can result in an unfavorable perinatal outcome during a hasty delivery. MATERIALS AND METHODS We investigated the protein expression of transmembrane serine protease 2 (TMPRSS2) and angiotensin-converting enzyme 2 (ACE2) in placental samples from 42 normotensive (n=9) and PE (n=33) patients without SARS-CoV-2 infection. We isolated placental trophoblast cells from normotensive and PE patients without evidence of SARS-CoV-2 infection to determine the mRNA and protein expression levels of TMPRSS2 and ACE2. RESULTS High ACE2 cytoplasmic expression in extravillous trophoblasts (EVTs) was correlated with lower fibrin deposition (p=0.017). In comparison with high nuclear TMPRSS2 expression, low nuclearTMPRSS2 expression in endothelial cells (ECs) was positively correlated with PE (p=0.005), significantly higher systolic blood pressure (p=0.006), and higher urine protein-to-creatinine ratio (p=0.022). In contrast, high cytoplasmic TMPRSS2 expression in fibroblasts (FBs) was correlated with higher urine protein-to-creatinine ratio (p=0.018). Trophoblast cells extracted from PE placental tissue showed lower mRNA levels for both ACE2 and TMPRSS2. CONCLUSION TMPRSS2 nuclear expression in ECs and cytoplasmic expression in FBs of the placenta may be related to a trophoblast-independent PE mechanism, and TMPRSS2 could be a new biomarker to discriminate actual PE from a PE-like syndrome associated with COVID-19.
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Affiliation(s)
- Ji Eun Park
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Dae Hyun Song
- Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Yu-Min Kim
- Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyen Chul Jo
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Jong Chul Baek
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Obstetrics and Gynecology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyoeun Kim
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Juseok Yang
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hyo Jung An
- Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea;
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
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8
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Sahu S, Laishram G, Rannaware A, Choudhari SG. Impact of COVID-19 on Pregnancy and Maternal-Neonatal Outcomes: A Narrative Review. Cureus 2022; 14:e31397. [DOI: 10.7759/cureus.31397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/11/2022] [Indexed: 11/14/2022] Open
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9
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Tossetta G, Fantone S, delli Muti N, Balercia G, Ciavattini A, Giannubilo SR, Marzioni D. Preeclampsia and severe acute respiratory syndrome coronavirus 2 infection: a systematic review. J Hypertens 2022; 40:1629-1638. [PMID: 35943095 PMCID: PMC10860893 DOI: 10.1097/hjh.0000000000003213] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the coronavirus disease 2019 (COVID-19) disease that has rapidly spread worldwide, causing hundreds of thousand deaths. Normal placentation is characterized by many processes strictly regulated during pregnancy. If placentation is impaired, it can lead to gestational disorders, such as preeclampsia that is a multisystem disorder that occurs in 2-8% of pregnancies worldwide. METHODS We performed a systematic search to understand the potential involvement of SARS-CoV-2 in preeclampsia onset using the databases, PubMed and Web of Science until 31 January 2022. RESULTS SARS-CoV-2 infection not only causes damage to the respiratory system but also can infect human placenta cells impairing pivotal processes necessary for normal placenta development. The inflammatory response trigged by COVID-19 disease is very similar to that one found in preeclampsia pregnancies suggesting a possible link between SARS-CoV-2 infection and preeclampsia onset during pregnancy. CONCLUSION Some studies showed that pregnancies affected by COVID-19 had higher incidence of preeclampsia compared with SARS-CoV-2-negative ones. However, increased blood pressure found in COVID-19 pregnancies does not allow to associate COVID-19 to preeclampsia as hypertension is a common factor to both conditions. At present, no diagnostic tools are available to discriminate real preeclampsia from preeclampsia-like syndrome in patients with SARS-CoV-2 infection. Thus, new specific diagnostic tools are necessary to assure an appropriate diagnosis of preeclampsia in these patients, especially in case of severe COVID-19 disease.
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Affiliation(s)
- Giovanni Tossetta
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Umberto I Hospital
- Clinic of Obstetrics and Gynaecology, Department of Clinical Sciences, Università Politecnica delle Marche, Salesi Hospital, Azienda Ospedaliero Universitaria
| | - Sonia Fantone
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Umberto I Hospital
| | - Nicola delli Muti
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Umberto I Hospital, Ancona, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Umberto I Hospital, Ancona, Italy
| | - Andrea Ciavattini
- Clinic of Obstetrics and Gynaecology, Department of Clinical Sciences, Università Politecnica delle Marche, Salesi Hospital, Azienda Ospedaliero Universitaria
| | - Stefano Raffaele Giannubilo
- Clinic of Obstetrics and Gynaecology, Department of Clinical Sciences, Università Politecnica delle Marche, Salesi Hospital, Azienda Ospedaliero Universitaria
| | - Daniela Marzioni
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Umberto I Hospital
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10
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Samara A, Khalil A, Brien PO, Herlenius E. The effect of the Delta SARS-CoV-2 variant in maternal infection and pregnancy. iScience 2022; 25:104295. [PMID: 35492217 PMCID: PMC9040522 DOI: 10.1016/j.isci.2022.104295] [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] [Indexed: 12/29/2022] Open
Abstract
A greater proportion of pregnant women with COVID-19 have mild disease compared with their non-pregnant counterparts. Paradoxically, however, they are at higher risk of developing severe disease, requiring respiratory support and admission to intensive care. The delta SARS-Cov-2 variant is associated with increased risk of hospitalization and morbidity in unvaccinated pregnant populations. However, it is not known whether the worse pregnancy outcomes associated with the delta variant are due to a direct effect of the virus on the pregnancy, or whether this effect is mediated through more severe maternal infection. Here, we synthesize studies of COVID-19 pregnancies, focusing on the different routes of SARS-CoV-2 infection of lung and placenta, and the mechanisms of syncytial formation for each SARS-CoV-2 variant. To delineate COVID-19 complications in pregnant women, future studies should explore whether the delta variant causes greater placental infection compared to other variants and contributes to increased syncytial formation.
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Affiliation(s)
- Athina Samara
- Division of Clinical Paediatrics, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Asma Khalil
- The Royal College of Obstetricians and Gynaecologists, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK.,Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - Patrick O' Brien
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - Eric Herlenius
- Division of Clinical Paediatrics, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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11
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Reynolds RM, Stock SJ, Denison F, Maybin JA, Critchley HO. Editorial on pregnancy and the SARS-CoV-2 pandemic. Physiol Rev 2022; 102:1385-1391. [PMID: 35343829 PMCID: PMC9076407 DOI: 10.1152/physrev.00003.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rebecca M Reynolds
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona Denison
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacqueline A Maybin
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Hilary Od Critchley
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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