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Packer CH, Prabhu M. COVID-19 in Pregnancy: An Update for Clinicians. Clin Obstet Gynecol 2024; 67:565-575. [PMID: 38967474 DOI: 10.1097/grf.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
In this review, we will discuss the risks of COVID-19 on maternal, obstetric, and neonatal outcomes. We will also review the safety of COVID-19 vaccination in pregnancy, as well as review the management of COVID-19 in pregnancy.
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Affiliation(s)
- Claire H Packer
- Department of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Hirschel J, Barcos-Munoz F, Chalard F, Chiodini F, Epiney M, Fluss J, Rougemont AL. Perinatal arterial ischemic stroke: how informative is the placenta? Virchows Arch 2024; 484:815-825. [PMID: 38502326 PMCID: PMC11106178 DOI: 10.1007/s00428-024-03780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
Neuroplacentology is an expanding field of interest that addresses the placental influence on fetal and neonatal brain lesions and on further neurodevelopment. The objective of this study was to clarify the link between placental pathology and perinatal arterial ischemic stroke (PAIS). Prior publications have reported different types of perinatal stroke with diverse methodologies precluding firm conclusions. We report here the histological placental findings in a series of 16 neonates with radiologically confirmed PAIS. Findings were grouped into 3 categories of lesions: (1) inflammation, (2) placental and fetal hypoxic lesions, and (3) placentas with a high birthweight/placenta weight ratio. Matched control placentas were compared to the pathological placentas when feasible. The eight term singleton placentas were compared to a series of 20 placentas from a highly controlled amniotic membrane donation program; in three twin pregnancies, the placental portions from the affected twin and unaffected co-twin were compared. Slightly more than half (9/16, 56%) had histopathological features belonging to more than one category, a feature shared by the singleton control placentas (13/20, 65%). More severe and extensive lesions were however observed in the pathological placentas. One case occurring in the context of SARS-CoV-2 placentitis further expands the spectrum of COVID-related perinatal disease. Our study supports the assumption that PAIS can result from various combinations and interplay of maternal and fetal factors and confirms the value of placenta examination. Yet, placental findings must be interpreted with caution given their prevalence in well-designed controls.
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Affiliation(s)
- Jessica Hirschel
- Division of Neonatal and Intensive Care, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Francisca Barcos-Munoz
- Division of Neonatal and Intensive Care, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - François Chalard
- Unit of Pediatric Radiology, Department of Radiology, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Florence Chiodini
- Therapeutic Tissue Biobank, University Hospitals of Geneva, Geneva, Switzerland
| | - Manuella Epiney
- Obstetrics Unit Department of Obstetrics and Gynecology, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Joel Fluss
- Pediatric Neurology Unit, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne-Laure Rougemont
- Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Merriel A, Fitzgerald B, O'Donoghue K. SARS-CoV-2-Placental effects and association with stillbirth. BJOG 2024; 131:385-400. [PMID: 37984971 DOI: 10.1111/1471-0528.17698] [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: 06/15/2023] [Revised: 10/02/2023] [Accepted: 10/14/2023] [Indexed: 11/22/2023]
Abstract
SARS-CoV-2 has had a significant impact on pregnancy outcomes due to the effects of the virus and the altered healthcare environment. Stillbirth has been relatively hidden during the COVID-19 pandemic, but a clear link between SARS-CoV-2 and poor fetal outcome emerged in the Alpha and Delta waves. A small minority of women/birthing people who contracted COVID-19 developed SARS-CoV-2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases of delivery just before imminent fetal demise and we shall discuss how some cases are sub-clinical. What is surprising, is that SARS-CoV-2 placentitis is often not associated with severe maternal COVID-19 infection and this makes it difficult to predict. The worst outcomes seem to be with diffuse placental disease which occurs within 21 days of COVID-19 diagnosis. Poor outcomes are often pre-dated by reduced fetal movements but are not associated with ultrasound changes. In some cases, there has also been maternal thrombocytopenia, or coagulation abnormalities, which may provide a clue as to which pregnancies are at risk of fetal demise if a further variant of concern is to emerge. In future, multidisciplinary collaboration and cross-boundary working must be prioritised, to identify quickly such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. While we wait to see if COVID-19 brings a future variant of concern, we must focus on appropriate future management of women who have had SARS-CoV-2 placentitis. As a placental condition with an infectious aetiology, SARS-CoV-placentitis is unlikely to recur in a subsequent pregnancy and thus a measured approach to subsequent pregnancy management is needed.
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Affiliation(s)
- Abi Merriel
- Centre for Women's Health Research, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Liverpool Women's Hospital, Liverpool, UK
| | | | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
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Mughis H, Lye P, Matthews SG, Bloise E. Hypoxia modifies levels of the SARS-CoV-2 cell entry proteins, angiotensin-converting enzyme 2, and furin in fetal human brain endothelial cells. Am J Obstet Gynecol MFM 2023; 5:101126. [PMID: 37562534 DOI: 10.1016/j.ajogmf.2023.101126] [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: 05/31/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND It is not known whether human fetal brain endothelial cells that form the blood-brain barrier express angiotensin-converting enzyme 2, transmembrane serine protease 2, and furin, which are SARS-CoV-2 cell entry proteins. Moreover, it is unclear whether hypoxia, commonly observed during severe maternal COVID-19, can modify their level of expression. We hypothesized that human fetal brain endothelial cells isolated from early- and midpregnancy brain microvessels express angiotensin-converting enzyme 2, transmembrane serine protease 2, and furin. Furthermore, we hypothesized that hypoxia modifies their expression levels in a gestational age- and time-of-exposure-dependent manner. OBJECTIVE This study aimed to investigate whether early- and midpregnancy human fetal brain endothelial cells express angiotensin-converting enzyme 2, transmembrane serine protease 2, and furin SARS-CoV-2-associated cell entry proteins and to determine the effects of hypoxia on angiotensin-converting enzyme 2, transmembrane serine protease 2, and furin expression levels in human fetal brain endothelial cells. STUDY DESIGN This was a prospective study where human fetal brain endothelial cells isolated from early-pregnancy (12.4±0.7 weeks of gestation) and midpregnancy (17.9±0.5 weeks of gestation) fetal brain microvessels (6 per group) were exposed to different oxygen tensions (20%, 5%, and 1% oxygen) for 6, 24, and 48 hours. Angiotensin-converting enzyme 2, transmembrane serine protease 2, and furin messenger RNA and protein levels and localization were assessed using quantitative polymerase chain reaction, Western blot testing, and immunofluorescence. RESULTS Angiotensin-converting enzyme 2, transmembrane serine protease 2, and furin co-localize with the endothelial cell marker von Willebrand factor in human fetal brain endothelial cells isolated from early pregnancy and midpregnancy. In early pregnancy, TMPRSS2 messenger RNA expression was decreased by 5% oxygen compared with 20% oxygen after 6 hours of exposure (P<.05). In midpregnancy, 5% oxygen down-regulated ACE2 messenger RNA compared with 20% oxygen after 24 hours (P<.05). Furin messenger RNA expression was decreased under 5% and 1% oxygen compared with 20% oxygen (P<.05) after 24 hours. In midpregnancy, angiotensin-converting enzyme 2 protein levels were decreased under 5% and 1% oxygen (P<.001) after 24 hours. In contrast, furin protein levels were increased under 1% oxygen compared with 20% oxygen after 24 hours (P<.05). At 48 hours, 1% oxygen increased angiotensin-converting enzyme 2 protein levels compared with 20% oxygen (P<.01). CONCLUSION Hypoxia modifies the expression of selected SARS-CoV-2 cell entry proteins in human fetal brain endothelial cells in a gestational age- and time-of-exposure-dependent manner. As severe COVID-19 may lead to maternal hypoxia, an altered expression of these proteins in the developing human blood-brain barrier could potentially lead to altered SARS-CoV-2 brain invasion and neurologic sequelae in neonates born to pregnancies complicated by SARS-CoV-2 infection.
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Affiliation(s)
- Hafsah Mughis
- Department of Physiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada (Mses Mughis and Lye and Dr Matthews)
| | - Phetcharawan Lye
- Department of Physiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada (Mses Mughis and Lye and Dr Matthews)
| | - Stephen G Matthews
- Department of Physiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada (Mses Mughis and Lye and Dr Matthews); Lunenfeld-Tanenbaum Research Institute, Mount Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada (Dr Matthews)
| | - Enrrico Bloise
- Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, Brazil (Dr Bloise).
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Favre G, Maisonneuve E, Pomar L, Daire C, Monod C, Martinez de Tejada B, Quibel T, Todesco-Bernasconi M, Sentilhes L, Blume C, Papadia A, Sturm S, Bassler D, Grawe C, Radan AP, Rossier MC, Mathis J, Capoccia-Brugger R, Lepigeon K, Gerbier E, Addor MC, Winterfeld U, Baud D, Panchaud A. Risk of congenital malformation after first trimester mRNA COVID-19 vaccine exposure in pregnancy: the COVI-PREG prospective cohort. Clin Microbiol Infect 2023; 29:1306-1312. [PMID: 37343619 PMCID: PMC10279463 DOI: 10.1016/j.cmi.2023.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES This study aimed to evaluate the risk of congenital malformation among pregnant women exposed to the mRNA COVID-19 vaccines during the first trimester of pregnancy, which is a developmental period where the foetus is at risk of teratogenicity. METHODS Pregnant women were prospectively enrolled from March 2021 to March 2022, at the time of COVID-19 vaccination. Pregnant women exposed to at least one dose of mRNA COVID-19 vaccine from conception to 11 weeks of gestations and 6 days were compared with pregnant women exposed to the vaccine from 12 weeks to the end of pregnancy. The primary outcome was a confirmed congenital malformation at birth. RESULTS A total of 1450 pregnant women were enrolled including 124 in the first trimester and 1326 in the second and third trimester. The overall proportion of congenital malformation was 0.81% (n = 1/124; 95% CI: 0.02-4.41) and 0.83% (n = 11/1326; 95% CI: 0.41-1.48) among pregnant exposed to the COVID-19 vaccine during the first and second/third trimester, respectively. First trimester exposure was not associated with a higher risk of congenital malformation with a relative risk of 0.89 (95% CI: 0.12-6.80) with no significant changes after adjustment through exploratory analysis. CONCLUSIONS Pregnant women exposed to mRNA COVID-19 vaccine before 12 weeks of gestation did not have an increased risk of congenital malformation compared with women exposed outside the teratogenic window. Because vaccination is safe and effective, emphasis must be placed on promoting vaccination during pregnancy.
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Affiliation(s)
- Guillaume Favre
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Emeline Maisonneuve
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Léo Pomar
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Charlotte Daire
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Cécile Monod
- Department of Obstetrics, Basel, University Hospital, Basel, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Division, Department of Pediatrics, Gynecology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Thibaud Quibel
- Department of Obstetrics, Maternité Poissy Saint Germain, Poissy, France
| | | | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Carolin Blume
- Kantonsspital Graubünden, Frauenklinik Fontana, Chur, Switzerland
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Dirk Bassler
- Neonatal Department, University Hospital Zürich, Zürich, Switzerland
| | - Claudia Grawe
- Department of Obstetrics, Gynecology Stadtspital Triemli Zürich, Zürich, Switzerland
| | - Anda Petronela Radan
- Department of Obstetrics and Feto-maternal Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Marie-Claude Rossier
- Department of Obstetrics and Gynecology, Hospital Riviera Chablais, Rennaz, Switzerland
| | - Jérôme Mathis
- Department of Obstetrics and Gynecology, Centre Hospitalier Bienne, Bienne, Switzerland
| | | | - Karine Lepigeon
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Eva Gerbier
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Marie Claude Addor
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Clinical Pharmacology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Doratt BM, Sureshchandra S, True H, Rincon M, Marshall NE, Messaoudi I. Mild/asymptomatic COVID-19 in unvaccinated pregnant mothers impairs neonatal immune responses. JCI Insight 2023; 8:e172658. [PMID: 37698937 PMCID: PMC10629812 DOI: 10.1172/jci.insight.172658] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Maternal SARS-CoV-2 infection triggers placental inflammation and alters cord blood immune cell composition. However, most studies focus on outcomes of severe maternal infection. Therefore, we analyzed cord blood and chorionic villi from newborns of unvaccinated mothers who experienced mild/asymptomatic SARS-CoV-2 infection during pregnancy. We investigated immune cell rewiring using flow cytometry, single-cell RNA sequencing, and functional readouts using ex vivo stimulation with TLR agonists and pathogens. Maternal infection was associated with increased frequency of memory T and B cells and nonclassical monocytes in cord blood. Ex vivo T and B cell responses to stimulation were attenuated, suggesting a tolerogenic state. Maladaptive responses were also observed in cord blood monocytes, where antiviral responses were dampened but responses to bacterial TLRs were increased. Maternal infection was also associated with expansion and activation of placental Hofbauer cells, secreting elevated levels of myeloid cell-recruiting chemokines. Moreover, we reported increased activation of maternally derived monocytes/macrophages in the fetal placenta that were transcriptionally primed for antiviral responses. Our data indicate that even in the absence of vertical transmission or symptoms in the neonate, mild/asymptomatic maternal COVID-19 altered the transcriptional and functional state in fetal immune cells in circulation and in the placenta.
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Affiliation(s)
- Brianna M. Doratt
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, USA
| | - Suhas Sureshchandra
- Department of Physiology and Biophysics, School of Medicine, and
- Institute for Immunology, University of California, Irvine, California, USA
| | - Heather True
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, USA
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Monica Rincon
- Maternal-Fetal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Nicole E. Marshall
- Maternal-Fetal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Ilhem Messaoudi
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, Kentucky, USA
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Recaioglu H, Kolk SM. Developing brain under renewed attack: viral infection during pregnancy. Front Neurosci 2023; 17:1119943. [PMID: 37700750 PMCID: PMC10493316 DOI: 10.3389/fnins.2023.1119943] [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: 12/09/2022] [Accepted: 04/26/2023] [Indexed: 09/14/2023] Open
Abstract
Living in a globalized world, viral infections such as CHIKV, SARS-COV-2, and ZIKV have become inevitable to also infect the most vulnerable groups in our society. That poses a danger to these populations including pregnant women since the developing brain is sensitive to maternal stressors including viral infections. Upon maternal infection, the viruses can gain access to the fetus via the maternofetal barrier and even to the fetal brain during which factors such as viral receptor expression, time of infection, and the balance between antiviral immune responses and pro-viral mechanisms contribute to mother-to-fetus transmission and fetal infection. Both the direct pro-viral mechanisms and the resulting dysregulated immune response can cause multi-level impairment in the maternofetal and brain barriers and the developing brain itself leading to dysfunction or even loss of several cell populations. Thus, maternal viral infections can disturb brain development and even predispose to neurodevelopmental disorders. In this review, we discuss the potential contribution of maternal viral infections of three relevant relative recent players in the field: Zika, Chikungunya, and Severe Acute Respiratory Syndrome Coronavirus-2, to the impairment of brain development throughout the entire route.
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Affiliation(s)
| | - Sharon M. Kolk
- Faculty of Science, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
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Bernad ES, Duica F, Antoniadis P, Moza A, Lungeanu D, Craina M, Bernad BC, Maghet E, Vasilache IA, Maghiari AL, Arnautu DA, Iacob D. Maternal Fever and Reduced Fetal Movement as Predictive Risk Factors for Adverse Neonatal Outcome in Cases of Congenital SARS-CoV-2 Infection: A Meta-Analysis of Individual Participant Data from Case Reports and Case Series. Viruses 2023; 15:1615. [PMID: 37515301 PMCID: PMC10384546 DOI: 10.3390/v15071615] [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: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES To determine risk factors for primary and secondary adverse neonatal outcomes in newborns with congenital SARS-CoV-2 infection. DATA SOURCES PubMed/MEDLINE and Google Scholar from January 2020 to January 2022. STUDY ELIGIBILITY CRITERIA newborns delivered after 24 weeks of gestation with confirmed/possible congenital SARS-CoV-2 infection, according to standard classification criteria. METHODS Execution of the IPD analyses followed the PRISMA-IPD statement. Univariate non-parametric tests compared numerical data distributions. Fisher's exact or Chi-square test determined categorical variables' statistical significance. Multivariate logistic regression revealed risk factors for adverse neonatal outcome. RESULTS Maternal fever was associated with symptomatic congenital infection (OR: 4.55, 95% CI: 1.33-15.57). Two-thirds of women that reported decreased fetal movements were diagnosed with IUFD (p-value = 0.001). Reduced fetal movement increased the risk of intrauterine fetal death by 7.84 times (p-value = 0.016, 95% CI: 2.23-27.5). The risk of stillbirth decreased with gestational age at the time of maternal infection (p-value < 0.05, OR: 0.87, 95% CI: 0.79-0.97). CONCLUSIONS Maternal fever and perception of reduced fetal movement may be predictive risk factors for adverse pregnancy outcome in cases with congenital SARS-CoV-2 infection.
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Affiliation(s)
- Elena S Bernad
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynecology, "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Florentina Duica
- Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
- Alessandrescu-Rusescu National Institute for Mother and Child Health, Fetal Medicine Excellence Research Center, 020395 Bucharest, Romania
| | - Panagiotis Antoniadis
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Southern Denmark, 5230 Odense, Denmark
| | - Andreea Moza
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynecology, "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Functional Sciences, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Craina
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynecology, "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Brenda C Bernad
- Department of Neuroscience, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Neuropsychology and Behavioral Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Edida Maghet
- 1st Department, Faculty of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy, 300070 Timisoara, Romania
| | - Ingrid-Andrada Vasilache
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Laura Maghiari
- 1st Department, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Diana-Aurora Arnautu
- Department of Cardiology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Daniela Iacob
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Schwartz DA, Ha S, Dashraath P, Baud D, Pittman PR, Adams Waldorf K. Mpox Virus in Pregnancy, the Placenta, and Newborn. Arch Pathol Lab Med 2023; 147:746-757. [PMID: 36857117 DOI: 10.5858/arpa.2022-0520-sa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
CONTEXT.— Before its eradication, the smallpox virus was a significant cause of poor obstetric outcomes, including maternal and fetal morbidity and mortality. The mpox (monkeypox) virus is now the most pathogenic member of the Orthopoxvirus genus infecting humans. The 2022 global mpox outbreak has focused attention on its potential effects during pregnancy. OBJECTIVE.— To understand the comparative effects of different poxvirus infections on pregnancy, including mpox virus, variola virus, vaccinia virus, and cowpox virus. The impact on the pregnant individual, fetus, and placenta will be examined, with particular attention to the occurrence of intrauterine vertical transmission and congenital infection. DATA SOURCES.— The data are obtained from the authors' cases and from various published sources, including early historical information and contemporary publications. CONCLUSIONS.— Smallpox caused maternal and perinatal death, with numerous cases reported of intrauterine transmission. In endemic African countries, mpox has also affected pregnant individuals, with up to a 75% perinatal case fatality rate. Since the start of the 2022 mpox outbreak, increasing numbers of pregnant women have been infected with the virus. A detailed description is given of the congenital mpox syndrome in a stillborn fetus, resulting from maternal-fetal transmission and placental infection, and the potential mechanisms of intrauterine infection are discussed. Other poxviruses, notably vaccinia virus and, in 1 case, cowpox virus, can also cause perinatal infection. Based on the historical evidence of poxvirus infections, mpox remains a threat to the pregnant population, and it can be expected that additional cases will occur in the future.
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Affiliation(s)
- David A Schwartz
- From Perinatal Pathology Consulting, Atlanta, Georgia (Schwartz)
| | - Sandy Ha
- The Department of Obstetrics and Gynecology, University of Washington, Seattle (Ha)
| | - Pradip Dashraath
- The Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Dashraath)
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland (Baud)
| | - Phillip R Pittman
- The Department of Clinical Research, US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland (Pittman)
| | - Kristina Adams Waldorf
- The Departments of Obstetrics and Gynecology and Global Health, University of Washington School of Medicine, Seattle (Adams Waldorf)
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Doratt BM, Sureshchandra S, True H, Rincon M, Marshall N, Messaoudi I. Mild/Asymptomatic Maternal SARS-CoV-2 Infection Leads to Immune Paralysis in Fetal Circulation and Immune Dysregulation in Fetal-Placental Tissues. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.10.540233. [PMID: 37214938 PMCID: PMC10197637 DOI: 10.1101/2023.05.10.540233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Few studies have addressed the impact of maternal mild/asymptomatic SARS-CoV-2 infection on the developing neonatal immune system. In this study, we analyzed umbilical cord blood and placental chorionic villi from newborns of unvaccinated mothers with mild/asymptomatic SARSCoV-2 infection during pregnancy using flow cytometry, single-cell transcriptomics, and functional assays. Despite the lack of vertical transmission, levels of inflammatory mediators were altered in cord blood. Maternal infection was also associated with increased memory T, B cells, and non-classical monocytes as well as increased activation. However, ex vivo responses to stimulation were attenuated. Finally, within the placental villi, we report an expansion of fetal Hofbauer cells and infiltrating maternal macrophages and rewiring towards a heightened inflammatory state. In contrast to cord blood monocytes, placental myeloid cells were primed for heightened antiviral responses. Taken together, this study highlights dysregulated fetal immune cell responses in response to mild maternal SARS-CoV-2 infection during pregnancy.
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Affiliation(s)
- Brianna M. Doratt
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington KY 40536
| | - Suhas Sureshchandra
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine CA 92697
- Institute for Immunology, University of California, Irvine CA 92697
| | - Heather True
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington KY 40536
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington KY 40536
| | - Monica Rincon
- Maternal-Fetal Medicine, Oregon Health and Science University, Portland OR 97239
| | - Nicole Marshall
- Maternal-Fetal Medicine, Oregon Health and Science University, Portland OR 97239
| | - Ilhem Messaoudi
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington KY 40536
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11
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Claudet A, De Luca D, Mosnino E, Mattern J, Picone O, Sibiude J, Wafo E, Tsatsaris V, Giral E, Grefenstette I, Carrara J, Badr DA, Saint-Frison MH, Prevot S, Benachi A, Vivanti AJ. Impact of SARS-CoV-2 Infection on Unvaccinated Pregnant Women: Non-Reassuring Fetal Heart Rate Tracing Because of Placentitis. Viruses 2023; 15:v15051069. [PMID: 37243156 DOI: 10.3390/v15051069] [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: 02/12/2023] [Revised: 04/14/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
In 2020, a new coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China. SARS-CoV-2 infection has been shown to be highly morbid in pregnant women, being a risk factor for several obstetric conditions leading to increased maternal and neonatal mortality. A few studies since 2020 have shown SARS-CoV-2 maternal-fetal transmission and noted placental abnormalities grouped under the term placentitis. We hypothesized that these placental lesions could be responsible for abnormalities in placental exchange and therefore abnormalities in cardiotocographic monitoring, leading to premature fetal extraction. The objective is to identify the clinical, biochemical, and histological determinants associated with the occurrence of non-reassuring fetal heart rate (NRFHR) outside labor in fetuses of SARS-CoV-2-infected mothers. We conducted a retrospective multicenter case series of the natural history of maternal SARS-CoV-2 infections resulting in fetal delivery outside labor due to NRFHR. Collaboration was sought with the maternity hospitals in the CEGORIF, the APHP and Brussels hospitals. The investigators were contacted by e-mail on three successive occasions over a period of one year. Data from 17 mothers and 17 fetuses were analyzed. Most women had a mild SARS-CoV-2 infection; only two women presented severe infection. No woman was vaccinated. We found a substantial proportion of maternal coagulopathy at birth: elevation of APTT ratio (62%), thrombocytopenia (41%) and liver cytolysis (58.3%). Iatrogenic prematurity was noted in 15 of 17 fetuses, and 100% were born by cesarean delivery due to emergency criteria. One male neonate died on the day of birth due to peripartum asphyxia. Three cases of maternal-fetal transmission were recorded following WHO criteria. Placental analysis in 15 cases revealed eight cases of SARS-CoV-2 placentitis, causing placental insufficiency. In total, 100% of the placentas analyzed showed at least one lesion suggestive of placentitis. SARS-CoV-2 maternal infection during pregnancy is likely to generate neonatal morbidity in relation to placental damage resulting in placental insufficiency. This morbidity may be the consequence of induced prematurity as well as acidosis in the most severe situations. Placental damage occurred in unvaccinated women and in women with no identified risk factor, in contrast to severe maternal clinical forms.
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Affiliation(s)
- Alexandra Claudet
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Elie Mosnino
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Jérémie Mattern
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Olivier Picone
- Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris Nord Val de Seine University, APHP, 75000 Paris, France
- Inserm IAME 1137, 75000 Paris, France
- GRIG: Groupe de Recherche sur les Infections en cours de Grossesse, 75000 Paris, France
| | - Jeanne Sibiude
- Division of Obstetrics and Gynecology, "Louis Mourier" Hospital, Paris Nord Val de Seine University, APHP, 75000 Paris, France
- Inserm IAME 1137, 75000 Paris, France
| | - Estelle Wafo
- Division of Obstetrics and Gynecology, "Marne La Vallée" Hospital, 77600 Jossigny, France
| | - Vassilis Tsatsaris
- Division of Obstetrics and Gynecology, "Port Royal" Hospital, Paris Centre University Hospitals, APHP, 75000 Paris, France
| | - Emilie Giral
- Division of Obstetrics and Gynecology, "André Grégoire" Hospital, 93100 Montreuil, France
| | - Irène Grefenstette
- Division of Obstetrics and Gynecology, "Centre Hospitalier des Quatre Villes", 92064 Saint Cloud, France
| | - Julie Carrara
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Dominique A Badr
- Division of Obstetrics and Gynecology, "University Hospital Brugmann", Université Libre de Bruxelles, 1070 Brussels, Belgium
| | | | - Sophie Prevot
- Division of Pathology, "Bicetre" Hospital, Paris Saclay University Hospitals, APHP, 94270 Le Kremlin-Bicêtre, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, 75000 Paris, France
- GRIG: Groupe de Recherche sur les Infections en cours de Grossesse, 75000 Paris, France
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12
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Tosto V, Meyyazhagan A, Alqasem M, Tsibizova V, Di Renzo GC. SARS-CoV-2 Footprints in the Placenta: What We Know after Three Years of the Pandemic. J Pers Med 2023; 13:jpm13040699. [PMID: 37109085 PMCID: PMC10142804 DOI: 10.3390/jpm13040699] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
As the COVID-19 pandemic continues into its third year, there is accumulating evidence on the consequences of maternal infection. Emerging data indicate increased obstetrics risks, including maternal complications, preterm births, impaired intrauterine fetal growth, hypertensive disorders, stillbirth, gestational diabetes, and a risk of developmental defects in neonates. Overall, controversial concerns still exist regarding the potential for vertical transmission. Histopathological examination of the placenta can represent a useful instrument for investigation and can contribute significant information regarding the possible immunohistopathological mechanisms involved in developing unfavorable perinatal outcomes. Based on current evidence, SARS-CoV-2 infection can affect placental tissue by inducing several specific changes. The level of placental involvement is considered one of the determining factors for unfavorable outcomes during pregnancy due to inflammation and vascular injuries contributing to complex cascade immunological and biological events; however, available evidence does not indicate a strong and absolute correlation between maternal infection, placental lesions, and obstetric outcomes. As existing studies are still limited, we further explore the placenta at three different levels, using histology, immunohistochemistry, and molecular genetics to understand the epidemiological and virological changes observed in the ongoing pandemic.
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Affiliation(s)
- Valentina Tosto
- Centre of Perinatal and Reproductive Medicine, University of Perugia, 06121 Perugia, Italy
| | - Arun Meyyazhagan
- Centre of Perinatal and Reproductive Medicine, University of Perugia, 06121 Perugia, Italy
- Perinatology Research Branch, Wayne State University, Detroit, MI 48202, USA
- Department of Life Sciences, CHRIST (Deemed to be University), Bengaluru 560029, India
| | - Malek Alqasem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Al-Karak 61710, Jordan
| | | | - Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, University of Perugia, 06121 Perugia, Italy
- PREIS International School, 50122 Firenze, Italy
- Department of Obstetrics and Gynecology, IM Sechenov First State University, 19c1, Moscow 119991, Russia
- Almazov National Medical Research Centre, St Petersburg 197341, Russia
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13
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Maternal and perinatal outcomes following pre-Delta, Delta, and Omicron SARS-CoV-2 variants infection among unvaccinated pregnant women in France and Switzerland: a prospective cohort study using the COVI-PREG registry. THE LANCET REGIONAL HEALTH. EUROPE 2023; 26:100569. [PMID: 36628358 PMCID: PMC9815480 DOI: 10.1016/j.lanepe.2022.100569] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023]
Abstract
Background SARS-CoV-2 positive pregnant women are at higher risk of adverse outcomes, but little evidence is available on how variants impact that risk. We aim to evaluate maternal and perinatal outcomes among unvaccinated pregnant women that tested positive for SARS-CoV-2, stratified by pre-Delta, Delta, and Omicron periods. Methods This prospective study enrolled women from March 2020 to September 2022. Exposure to the different SARS-CoV-2 variants was defined by their periods of predominance. The primary outcome was severe maternal adverse outcome defined as either intensive care unit admission, acute respiratory distress syndrome, advanced oxygen supplementation, or maternal death. The secondary outcomes were preterm birth and other perinatal outcomes. Findings Overall, 1402, 262, and 391 SARS-CoV-2 positive pregnant women were enrolled during the pre-Delta, Delta, and Omicron periods respectively. Severe maternal adverse outcome was reported in 3.4% (n = 947/1402; 95% confidence intervals (95%CI) 2.5-4.5), 6.5% (n = 7/262; 95%CI 3.8-10.2), and 1.0% (n = 4/391; 95%CI 0.3-2.6) of women during the pre-Delta, Delta, and Omicron periods. The risk of severe maternal adverse outcome was higher during the Delta vs pre-Delta period (adjusted risk ratio (aRR) = 1.8; 95%CI 1.1-3.2) and lower during the Omicron vs pre-Delta period (aRR = 0.3; 95%CI, 0.1-0.8). The risks of hospitalization for COVID-19 were 12.6% (n = 176/1402; 95%CI 10.9-14.4), 17.2% (n = 45/262; 95%CI 12.8-22.3), and 12.5% (n = 49/391; 95%CI 9.4-16.2), during the pre-Delta, Delta, and Omicron period, respectively. Pregnancy complications occurred after SARS-CoV-2 exposure in 30.0% (n = 363/1212; 95%CI 27.4-32.6), 35.2% (n = 83/236; 95%CI 29.1-41.6), and 30.3% (n = 105/347; 95%CI 25.5-35.4) of patients during the pre-Delta, Delta, and Omicron periods, respectively. Stillbirths were reported in 0.5% (n = 6/1159; 95%CI 0.2-1.1), 2.8% (n = 6/210; 95%CI 1.0-6.0), and 0.9% (n = 2/213; 95%CI 0.1-3.4) or patients during the pre-Delta, Delta, and Omicron periods respectively. Interpretation The Delta period was associated with a higher risk of severe maternal adverse outcome and the Omicron period with a lower risk of severe adverse outcome compared to pre-Delta era. The reported risk of hospitalization was high during the Omicron period and should not be trivialized. Funding Swiss Federal Office of Public Health, Fondation CHUV.
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14
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Pregnancy Outcomes in SARS-CoV-2-Positive Patients: A 20-Month Retrospective Analysis of Delivery Cases. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020341. [PMID: 36837541 PMCID: PMC9968024 DOI: 10.3390/medicina59020341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023]
Abstract
Background and Objectives: The SARS-CoV-2 infection brings supplemental risks for pregnant women. Due to controversial hesitancy, their vaccination rate was lower in 2021 compared to the general population. In addition, access to maternal care was reduced during the pandemic. We conducted a retrospective cross-sectional analysis of the health records data over 20 months (1 April 2020 to 20 November 2021) aiming to explore the outcomes in SARS-CoV-2-positive cases referred for delivery to a tertiary public hospital in Western Romania. Materials and Methods: Women with SARS-CoV-2 infection diagnosed for the first time at the moment of birth who delivered singletons after 24 weeks of gestation, and had a clear immunization status were included in the analysis. Results: Out of the 97 patients included in the study, 35 (36%) had undergone ARN-based vaccination. Five cases of maternal death were recorded (all unvaccinated). Our retrospective exploratory analysis showed that the presence of COVID-19 symptoms in the SARS-CoV-2-positive patients made a significant impact on the delivery hospitalization, with a median hospital stay increase from 5 to 9 days (Mann-Whitney test, p = 0.014): longer hospitalization was recorded in the symptomatic cases irrespective of their vaccination status. No other adverse outcomes, such as gestational age at delivery, C-section rate, 5 min Apgar index, or birth weight were associated with the presence of symptoms. Conclusions: Our clinic maintained safe maternal care for the COVID-19 patients during the analyzed period. Vaccination of the expectant women was beneficial in SARS-CoV-2-positive patients by lowering the risk of COVID-19 symptoms, with subsequent implications on the newborns' health and maternal attachment.
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15
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The Histopathological "Placentitis Triad" Is Specific for SARS-CoV-2 Infection, and Its Acute Presentation Can Be Associated with Poor Fetal Outcome. Life (Basel) 2023; 13:life13020479. [PMID: 36836836 PMCID: PMC9963180 DOI: 10.3390/life13020479] [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] [Received: 12/21/2022] [Revised: 01/06/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
(1) Background: Placental histological lesions reported in relation with SARS-CoV-2 infection are various, with potential consequences such as fetal growth retardation, prematurity or stillbirth/neonatal death. We report here on a placental pathological association which could be specific for SARS-CoV-2 infection and associated with poor fetal outcome; (2) Methods: We collected all the placental pathological examinations performed in Brest University Hospital (France) since the beginning of COVID-19 pandemic with a known maternal SARS-CoV-2 infection and a poor pregnancy outcome. In these cases, we described the pathological lesions and we searched for these lesions in a large series of placentas collected and examined in the same institution before the SARS-CoV-2 pandemic; (3) Results: Three cases with severe fetal outcome (tardive abortion, prematurity, neonatal death), from the first to the third trimesters of pregnancy, were included. The three cases showed features of massive and acute "placentitis triad" consisting in massive perivillous fibrin deposition, sub-acute intervillositis and trophoblastic necrosis. This association was not encountered in any of 8857 placentas analyzed during the period between 2002 and 2012 in our institution; (4) Conclusions: The "placentitis triad" appears to be specific for SARS-CoV-2 infection and, in case of massive and acute presentation, could result in poor fetal outcome.
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16
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Outcome of Newborns with Confirmed or Possible SARS-CoV-2 Vertical Infection-A Scoping Review. Diagnostics (Basel) 2023; 13:diagnostics13020245. [PMID: 36673058 PMCID: PMC9858608 DOI: 10.3390/diagnostics13020245] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Severe acute respiratory syndrome virus 2 (SARS-CoV-2), the virus that causes 2019 coronavirus disease (COVID-19), has been isolated from various tissues and body fluids, including the placenta, amniotic fluid, and umbilical cord of newborns. In the last few years, much scientific effort has been directed toward studying SARS-CoV-2, focusing on the different features of the virus, such as its structure and mechanisms of action. Moreover, much focus has been on developing accurate diagnostic tools and various drugs or vaccines to treat COVID-19. However, the available evidence is still scarce and consistent criteria should be used for diagnosing vertical transmission. Applying the PRISMA ScR guidelines, we conducted a scoping review with the primary objective of identifying the types, and examining the range, of available evidence of vertical transmission of SARS-CoV-2 from mother to newborn. We also aimed to clarify the key concepts and criteria for diagnosis of SARS-CoV-2 vertical infection in neonates and summarize the existing evidence and advance the awareness of SARS-CoV-2 vertical infection in pregnancy. Most studies we identified were case reports or case series (about 30% of poor quality and inconsistent reporting of the findings). Summarizing the existing classification criteria, we propose an algorithm for consistent diagnosis. Registration: INPLASY2022120093.
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17
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Carvajal J, Casanello P, Toso A, Farías M, Carrasco-Negue K, Araujo K, Valero P, Fuenzalida J, Solari C, Sobrevia L. Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166582. [PMID: 36273675 PMCID: PMC9581789 DOI: 10.1016/j.bbadis.2022.166582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022]
Abstract
The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.
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Affiliation(s)
- Jorge Carvajal
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Paola Casanello
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands
| | - Alberto Toso
- Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Marcelo Farías
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Karina Carrasco-Negue
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Kenny Araujo
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Paola Valero
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile
| | - Javiera Fuenzalida
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Caterina Solari
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Luis Sobrevia
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland, Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston 4029, Queensland, Australia; Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.
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18
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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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Antonella V, De Nola R, Battaglia S, Di Mussi R, Cazzato G, Resta L, Chironna M, Loconsole D, Vinci L, Chiarello G, Marucci M, Cicinelli E. Adverse Maternal Outcomes in Pregnant Women Affected by Severe-Critical COVID-19 Illness: Correlation with Vaccination Status in the Time of Different Viral Strains' Dominancy. Vaccines (Basel) 2022; 10:vaccines10122061. [PMID: 36560471 PMCID: PMC9783263 DOI: 10.3390/vaccines10122061] [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] [Received: 10/03/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
This is a monocentric and cross-sectional study conducted at the COVID-19 Division of the Obstetrical and Gynecological Unit and Intensive Care Units (ICUs) of Policlinico di Bari, in Bari, Italy, between September 2020 and April 2022. This study aimed to identify the prevalence of severe-critical COVID-19 illness requiring access to the Intensive Care Unit (ICU) among 287 pregnant patients, and possible correlations between the SARS-CoV-2 variants, the specific pandemic wave (dominated by wild, Alpha, Delta, and Omicron strains), and severe-critical adverse maternal outcomes. The prevalence of severe-critical COVID-19 illness was 2.8% (8/287), reaching 4.9% (8/163) excluding the 4th wave (Omicron dominant). The Delta variant determined the highest risk ratio and odds for access to the ICU due to severe-critical COVID-19-related symptoms compared to the other variants (wild, Alpha, Omicron). During the third wave (Delta), the ICU cases underwent a higher rate of hyperimmune plasma infusion (75%), antibiotic therapy (75%), and remdesivir (33%); all of the patients were intubated. During the Omicron wave, the patients were asymptomatic or with few symptoms: most of them (70%) were vaccinated with a median of two doses. The maternal outcome worsened in the case of Alpha and, especially, Delta variants for severe-critical COVID-19-related symptoms and ICU access.
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Affiliation(s)
- Vimercati Antonella
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Rosalba De Nola
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
- Correspondence:
| | - Stefano Battaglia
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Rossella Di Mussi
- Department of Emergency and Organ Transplantation, Anaesthesia and Resuscitation Division, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplant, Pathology Division, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Leonardo Resta
- Department of Emergency and Organ Transplant, Pathology Division, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Maria Chironna
- Department of Interdisciplinary Medicine (Laboratory of Molecular Epidemiology and Public Health), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Daniela Loconsole
- Department of Interdisciplinary Medicine (Laboratory of Molecular Epidemiology and Public Health), University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Lorenzo Vinci
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giulia Chiarello
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Massimo Marucci
- Department of Emergency and Organ Transplantation, Anaesthesia and Resuscitation Division, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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20
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Favre G, Gerbier E, Maisonneuve E, Pomar L, Winterfeld U, Lepigeon K, Bloemenkamp KWM, de Bruin O, Eimir H, Nordeng H, Siiskonen SJ, Sturkenboom MCJM, Baud D, Panchaud A. COVID-19-related medicine utilization study in pregnancy: The COVI-PREG cohort. Br J Clin Pharmacol 2022; 89:1560-1574. [PMID: 36417423 DOI: 10.1111/bcp.15611] [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: 07/12/2022] [Revised: 09/23/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022] Open
Abstract
AIM The objective of this study was to describe the use of COVID-19-related medicines during pregnancy and their evolution between the early/late periods of the pandemic. METHODS Pregnant women who tested positive for SARS-CoV-2 from March 2020 to July 2021 were included using the COVI-PREG registry. Exposure to the following COVID-19-related medicines was recorded: antibiotics, antivirals, hydroxychloroquine, corticosteroids, anti-interleukin-6 and immunoglobulins. We described the prevalence of medicines used, by trimester of pregnancy, maternal COVID-19 severity level and early/late period of the pandemic (before and after 1 July 2020). FINDINGS We included 1964 pregnant patients who tested positive for SARS-CoV-2. Overall, 10.4% (205/1964) received at least one COVID-19-related medicine including antibiotics (8.6%; 169/1694), corticosteroids (3.2%; 62/1964), antivirals (2.0%; 39/1964), hydroxychloroquine (1.4%; 27/1964) and anti-interleukin-6 (0.3%; 5/1964). The use of at least one COVID-19-related medicine was 3.1% (12/381) in asymptomatic individuals, 4.2% (52/1233) in outpatients, 19.7% (46/233) in inpatients without oxygen, 72.1% (44/61) in those requiring standard oxygen, 95.7% (22/23) in those requiring high flow oxygen, 96.2% (25/26) in patients who required intubation and 57.1% (4/7) among patients who died. The proportion who received medicines to treat COVID-19 was higher before than after July 2020 (16.7% vs. 7.7%). Antibiotics, antivirals and hydroxychloroquine had lower rates of use during the late period. CONCLUSION Medicine use in pregnancy increased with disease severity. The trend towards increased use of corticosteroids seems to be aligned with changing guidelines. Evidence is still needed regarding the effectiveness and safety of COVID-19-related medicines in pregnancy.
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Affiliation(s)
- Guillaume Favre
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Eva Gerbier
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Emeline Maisonneuve
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Léo Pomar
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland.,School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Clinical pharmacology service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Karine Lepigeon
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands
| | - Odette de Bruin
- Department of Obstetrics, WKZ Birth Centre, Division Woman and Baby, UMC Utrecht, Utrecht, the Netherlands.,Julius Global Health, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hurley Eimir
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Satu J Siiskonen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department "Femme-Mère-Enfant", University Hospital, Lausanne, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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21
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Mental health in pregnant individuals during the COVID-19 pandemic based on a Swiss online survey. Sci Rep 2022; 12:18448. [PMID: 36323687 PMCID: PMC9628478 DOI: 10.1038/s41598-022-21881-2] [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: 02/24/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of our study was to evaluate the mental health of pregnant individuals during the early COVID-19 pandemic and the potential factors associated. A Swiss online survey was proposed to individuals who gave birth during the pandemic period from March 2020. The Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7 questions (GAD-7), and Impact Event Scale-Revised (IES-R) were evaluated and used to defined mental health impairment as a composite outcome. From October, 2020 to February, 2021, 736 participants responded. The anxiety GAD-7 score was moderate in 9.6% and severe in 2.0%. The EPDS was moderate in 21.5% and severe in 32.9%. The IES-R was moderate in 10.3% and severe in 3.9%. Mental health impairment was reported in 37.0%. The association between the risk of mental health impairment and foreign nationality was significant (OR = 1.48; 95%CI [1.06-2.05]) as well as fetal and pregnancy worries because of coronavirus (OR = 1.46; 95% CI [1.08-1.98]) and 1.65; 95% CI [1.22-2.24]). Adjusted ORs were significant for foreign nationality (aOR = 1.51; 95%CI [1.07-2.13]) and pregnancy worries because of coronavirus (aOR = 1.62; 95%CI [1.10-2.40]). Pregnant people and especially foreign national have a high risk of mental health impairment during the pandemic.
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22
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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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23
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Germano C, Messina A, Tavella E, Vitale R, Avellis V, Barboni M, Attini R, Revelli A, Zola P, Manzoni P, Masturzo B. Fetal Brain Damage during Maternal COVID-19: Emerging Hypothesis, Mechanism, and Possible Mitigation through Maternal-Targeted Nutritional Supplementation. Nutrients 2022; 14:nu14163303. [PMID: 36014809 PMCID: PMC9414753 DOI: 10.3390/nu14163303] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
The recent outbreak of the novel Coronavirus (SARS-CoV-2 or CoV-2) pandemic in 2019 and the risk of CoV-2 infection during pregnancy led the scientific community to investigate the potential negative effects of Coronavirus infection on pregnancy outcomes and fetal development. In particular, as CoV-2 neurotropism has been demonstrated in adults, recent studies suggested a possible risk of fetal brain damage and fetal brain development impairment, with consequent psychiatric manifestations in offspring of mothers affected by COronaVIrus Disease (COVID) during pregnancy. Through the understanding of CoV-2’s pathogenesis and the pathways responsible for cell damage, along with the available data about neurotropic virus attitudes, different strategies have been suggested to lower the risk of neurologic disease in newborns. In this regard, the role of nutrition in mitigating fetal damages related to oxidative stress and the inflammatory environment during viral infection has been investigated, and arginine, n3PUFA, vitamins B1 and B9, choline, and flavonoids were found to be promising in and out of pregnancy. The aim of this review is to provide an overview of the current knowledge on the mechanism of fetal brain damage and the impact of nutrition in reducing inflammation related to worse neurological outcomes in the context of CoV-2 infections during pregnancy.
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Affiliation(s)
- Chiara Germano
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Correspondence:
| | - Alessandro Messina
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Elena Tavella
- Sant’Anna Hospital, Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Raffaele Vitale
- Sant’Anna Hospital, Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Vincenzo Avellis
- Sant’Anna Hospital, Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
| | - Martina Barboni
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Rossella Attini
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Alberto Revelli
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Paolo Zola
- Sant’Anna Hospital, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Paolo Manzoni
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
| | - Bianca Masturzo
- Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy
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24
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From Fetal to Neonatal Neuroimaging in TORCH Infections: A Pictorial Review. CHILDREN 2022; 9:children9081210. [PMID: 36010101 PMCID: PMC9406729 DOI: 10.3390/children9081210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.
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25
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Kobata K, Yutaka N, Ogasawara H, Mima A, Suzuki K, Hazama R, Goldman RD, Nabetani M. Case Report: A Very Low Birth Weight Female Infant With Congenital Bilateral Periventricular Leukomalacia, Born to a Mother With Coronavirus Disease 2019. Front Pediatr 2022; 10:887132. [PMID: 35615636 PMCID: PMC9124962 DOI: 10.3389/fped.2022.887132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
A 26-year-old primipara woman with COVID-19 performed an emergency Cesarean section due to further hypoxemia at 28 weeks 5/7 days gestation. The female neonate was born weighing 1,347 gram with an Apgar score of four at 1 min, three at 5 min, and eight at 10 min. RT-PCR from nasopharyngeal swabs for COVID-19 were performed at birth, 24 h, and 48 h after birth, all of which were negative. On head ultrasound bilateral cystic lesions were found in the anterior horn of the lateral ventricles at birth. A brain magnetic resonance imaging (MRI) test at 56 days of life (corrected 36 weeks and 6/7 days) revealed cystic lesions with T1 low signal, T2 high signal, and T2 Flair high signal around the anterior horn of the lateral ventricle and We diagnose it as Grade 2 periventricular leukomalacia (PVL). She was discharged on day 64 of life, with no abnormality on exam. While the majority of neonates born to women with COVID-19 during pregnancy have favorable outcome, we report a case of a neonate with Grade 2 periventricular leukomalacia and this should prompt clinicians to monitor fetal cerebral function and structure shortly after birth.
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Affiliation(s)
- Keisuke Kobata
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Nanae Yutaka
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | | | - Aya Mima
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Kaho Suzuki
- Department of Obstetrics and Gynecology, Yodogawa Christian Hospital, Osaka, Japan
| | - Ryoichi Hazama
- Department of Obstetrics and Gynecology, Yodogawa Christian Hospital, Osaka, Japan
| | - Ran D Goldman
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Makoto Nabetani
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
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