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Bui MT, Nguyen Le CA, Duong KL, Hoang VT, Nguyen TK. Transplacental Transmission of SARS-CoV-2: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1517. [PMID: 39336558 PMCID: PMC11434576 DOI: 10.3390/medicina60091517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/12/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: The study aims to explore the potential for transplacental transmission of SARS-CoV-2, focusing on its pathophysiology, placental defense mechanisms, and the clinical implications for maternal and neonatal health. Materials and Methods: A comprehensive review of the current literature was conducted, analyzing studies on SARS-CoV-2 infection in pregnancy, the expression of key viral receptors (ACE2 and TMPRSS2) in placental cells, and the immune responses involved in placental defense. The review also examined the clinical outcomes related to maternal and neonatal health, including adverse pregnancy outcomes and neonatal infection. Results: The expression of ACE2 and TMPRSS2 in the placenta supports the biological plausibility of SARS-CoV-2 transplacental transmission. Histopathological findings from the infected placentas reveal inflammation, vascular changes, and the evidence of viral particles in placental tissues. Clinical reports indicate an increased risk of preterm birth, intrauterine growth restriction, and neonatal infection in pregnancies affected by COVID-19. However, the frequency and mechanisms of vertical transmission remain variable across studies, highlighting the need for standardized research protocols. Conclusions: SARS-CoV-2 can potentially infect placental cells, leading to adverse pregnancy outcomes and neonatal infection. While evidence of transplacental transmission has been documented, the risk and mechanisms are not fully understood. Ongoing research is essential to clarify these aspects and inform obstetric care practices to improve maternal and neonatal outcomes during the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | - Trung Kien Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh 410000, Vietnam; (M.T.B.); (C.A.N.L.); (K.L.D.); (V.T.H.)
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Borowczak J, Gąsiorek-Kwiatkowska A, Szczerbowski K, Maniewski M, Zdrenka M, Szadurska-Noga M, Gostomczyk K, Rutkiewicz P, Olejnik K, Cnota W, Karpów-Greiner M, Knypiński W, Sekielska-Domanowska M, Ludwikowski G, Dubiel M, Szylberg Ł, Bodnar M. SARS-CoV-2 Infection during Delivery Causes Histopathological Changes in the Placenta. Diseases 2024; 12:142. [PMID: 39057113 PMCID: PMC11276080 DOI: 10.3390/diseases12070142] [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: 05/29/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND SARS-CoV-2 can damage human placentas, leading to pregnancy complications, such as preeclampsia and premature birth. This study investigates the histopathological changes found in COVID-19-affected placentas. MATERIALS AND METHODS This study included 23 placentas from patients with active COVID-19 during delivery and 22 samples from patients without COVID-19 infection in their medical history. The samples underwent histopathological examination for pathology, such as trophoblast necrosis, signs of vessel damage, or fetal vascular malperfusion. RESULTS Newborns from the research group have lower weights and Apgar scores than healthy newborns. In the COVID-19 group, calcifications and collapsed intervillous space were more frequent, and inflammation was more severe than in the healthy group. At the same time, the placenta of SARS-CoV-2-positive patients showed signs of accelerated vascular maturation. Trophoblast necrosis was found only in the placentas of the research group. The expression of CD68+ was elevated in the COVID-19 cohort, suggesting that macrophages constituted a significant part of the inflammatory infiltrate. The increase in lymphocyte B markers was associated with placental infarctions, while high levels of CD3+, specific for cytotoxic T lymphocytes, correlated with vascular injury. CONCLUSIONS SARS-CoV-2 is associated with pathological changes in the placenta, including trophoblast necrosis, calcification, and accelerated villous maturation. Those changes appear to be driven by T cells and macrophages, whose increased expression reflects ongoing histiocytic intervillositis in the placenta.
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Affiliation(s)
- Jędrzej Borowczak
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
| | - Agnieszka Gąsiorek-Kwiatkowska
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Krzysztof Szczerbowski
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
| | - Mateusz Maniewski
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
- Doctoral School of Medical and Health Sciences, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
| | - Marek Zdrenka
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
| | - Marta Szadurska-Noga
- Department of Pathomorphology and Forensic Medicine, Faculty of Medical Sciences, University of Warmia and Mazury, 10-561 Olsztyn, Poland;
| | - Karol Gostomczyk
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Paula Rutkiewicz
- Chair of Pathology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland (K.O.)
| | - Katarzyna Olejnik
- Chair of Pathology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland (K.O.)
| | - Wojciech Cnota
- Chair and Department of Gynaecology and Obstetrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, 41-703 Ruda Śląska, Poland
| | - Magdalena Karpów-Greiner
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Wojciech Knypiński
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Marta Sekielska-Domanowska
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Grzegorz Ludwikowski
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Mariusz Dubiel
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
| | - Łukasz Szylberg
- Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland (K.G.)
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
- Chair of Pathology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland (K.O.)
| | - Magdalena Bodnar
- Department of Obstetrics, Gynaecology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-168 Bydgoszcz, Poland (M.K.-G.); (W.K.); (M.S.-D.); (M.D.)
- Chair of Pathology, Jan Biziel University Hospital No. 2, 85-168 Bydgoszcz, Poland (K.O.)
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Rocha de Souza L, Ramos Amorim MM, Souza AS, Carvalho Pinto de Melo B, Tiné Cantilino C, de Oliveira Saunders MA, Jucá de Petribú M, Soares Lúcio L, Rodrigues Marinho J, de Oliveira Correia MEV, Katz L. Association between maternal and perinatal outcomes and histological changes in the placenta of patients with Covid-19: A cohort study. Medicine (Baltimore) 2024; 103:e38171. [PMID: 38788031 PMCID: PMC11124646 DOI: 10.1097/md.0000000000038171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
Although studies evaluated placental involvement in Covid-19 patients, few have assessed its association with clinical repercussions. The study aimed to determine the association between the clinical status and maternal and perinatal outcomes of patients with Covid-19 at delivery and changes in placental histology. It is so far the largest cohort evaluating placentas of patients infected by the SARS-CoV-2. A secondary analysis was conducted of a database from which a cohort of 226 patients, who tested real-time polymerase chain reaction-positive for Covid-19 at delivery and whose placentas were collected and submitted to pathology, was selected for inclusion. One or more types of histological changes were detected in 44.7% of the 226 placentas evaluated. The most common abnormalities were maternal vascular malperfusion (38%), evidence of inflammation/infection (9.3%), fetal vascular malperfusion (0.8%), fibrinoid changes and intervillous thrombi (0.4%). Oxygen use (P = .01) and need for admission to an intensive care unit (ICU) (P = .04) were less common in patients with placental findings, and hospital stay was shorter in these patients (P = .04). There were more fetal deaths among patients with evidence of inflammation/infection (P = .02). Fetal death, albeit uncommon, is associated with findings of inflammation/infection. Oxygen use and need for admission to an ICU were less common among patients with placental findings, probably due to the pregnancy being interrupted early. None of the other findings was associated with maternal clinical status or with adverse perinatal outcome.
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Affiliation(s)
- Luiza Rocha de Souza
- Master’s Program of Comprehensive Health at IMIP, Recife, Brazil
- High Risk Pregnancy Unit at IMIP, Recife, Brazil
| | | | - Alex Sandro Souza
- Professor of the Postgraduate Program at IMIP, Recife, Brazil
- Department of Fetal Medicine at IMIP, Recife, Brazil
| | - Brena Carvalho Pinto de Melo
- High Risk Pregnancy Unit at IMIP, Recife, Brazil
- Simulation Center at Faculdade Pernambucana de Saúde (Csim), Recife, Brazil
| | | | | | | | | | | | | | - Leila Katz
- Professor of the Postgraduate Program at IMIP, Recife, Brazil
- Obstetric Intensive Care Unit at IMIP, Recife, Brazil
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Zanin V, Driul L, Zoletto S, Restaino S, Tulisso A, Bulfoni M, Orsaria M. Intrauterine fetal death in a COVID positive pregnant woman. Minerva Obstet Gynecol 2024; 76:205-210. [PMID: 36255162 DOI: 10.23736/s2724-606x.22.05149-1] [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: 06/16/2023]
Abstract
SARS-CoV-2 disease mechanisms are not yet fully understood, especially in cases affecting pregnant women. In fact, although they suffer from the same symptoms as non-pregnant women, they are more susceptible to-adverse outcomes of COVID-19 as well as pregnancy complications leading to stillbirth, premature rupture of membrane, or intrauterine fetal demise (IUFD). The consequences on pregnancy are not clearly correlated with the severity of the infection. We present a case of fetal death in a 30-year-old woman with a confirmed SARS-CoV-2 infection without any other significant clinical or obstetric disorders. A histopathological examination of the placenta indicated massive and diffuse intervillar fibrinoid deposits associated with chronic histiocytic intervillositis that can be associated with SARS-CoV-2 placentitis. Given the high rates of SARS-CoV-2 infections in pregnancy, it is important to understand the factors that determine negative pregnancy outcomes, regardless of the severity of the patient's symptoms.
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Affiliation(s)
- Valentina Zanin
- Department of Medicine, University of Udine, Udine, Italy -
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy -
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Silvia Zoletto
- Department of Medicine, University of Udine, Udine, Italy
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Stefano Restaino
- Department of Medicine, University of Udine, Udine, Italy
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Angelica Tulisso
- Department of Medicine, University of Udine, Udine, Italy
- Department of Pathological Anatomy, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Michela Bulfoni
- Department of Medicine, University of Udine, Udine, Italy
- Department of Pathological Anatomy, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Maria Orsaria
- Department of Medicine, University of Udine, Udine, Italy
- Department of Pathological Anatomy, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
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Kılçar M, Turgut ÜK, Bozkurt KK, Bayhan G. Effects of permanent placental injury due to severe acute respiratory syndrome coronavirus 2 infection during pregnancy on the feto-placental circulation: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230827. [PMID: 38422318 PMCID: PMC10903274 DOI: 10.1590/1806-9282.20230827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/24/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of permanent placental injury due to a severe acute respiratory syndrome coronavirus 2 infection during pregnancy on feto-placental circulation. METHODS In this cross-sectional study, 83 pregnant women with planned deliveries were divided into two groups according to their severe acute respiratory syndrome coronavirus 2 infection statuses during pregnancy. Their demographic parameters, obstetric histories, and prenatal risks were evaluated. A prenatal fetal Doppler ultrasound examination was performed for all participants, and umbilical artery and middle cerebral artery Doppler parameters were obtained. Postpartum placentas were examined for pathological findings under appropriate conditions. All placentas were evaluated according to the Amsterdam consensus criteria. Mann-Whitney U test, Student's t-test, and chi-square test were used for comparisons. RESULTS Demographic parameters were statistically similar, except that they were borderline significant for gestational weeks at delivery (p=0.044). In the pathological examination of the placenta, regardless of the trimester of exposure to viral infection, perivillous fibrin deposition and villus dystrophic calcification were more common in group 2 (p=0.016 and p=0.048, respectively) than in group 1. In the prenatal Doppler examination between the groups, no statistically significant difference was found for all of the umbilical artery pulsatile index, middle cerebral artery pulsatile index, and cerebro-placental ratio values. CONCLUSION Severe acute respiratory syndrome coronavirus 2 infection during pregnancy causes an increase in perivillous fibrin deposition and villus dystrophic calcification in the placenta. Placental injury caused by the severe acute respiratory syndrome coronavirus 2 virus does not affect fetal Doppler parameters.
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Affiliation(s)
- Mihriban Kılçar
- Süleyman Demirel University, Faculty of Medicine, Department of Obstetrics and Gynecology - Isparta, Turkey
| | - Ümran Kılınçdemir Turgut
- Süleyman Demirel University, Faculty of Medicine, Department of Obstetrics and Gynecology - Isparta, Turkey
| | - Kemal Kürşat Bozkurt
- Süleyman Demirel University, Faculty of Medicine, Department of Pathology - Isparta, Turkey
| | - Gökhan Bayhan
- Süleyman Demirel University, Faculty of Medicine, Department of Obstetrics and Gynecology - Isparta, Turkey
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Ryan EE, Brar N, Allard G, Wang A, Winn VD, Folkins A, Yang EJ, Tan S, Hazard FK, Howitt BE. Clinical Features of SARS-CoV-2 Infection During Pregnancy and Associated Placental Pathologies. Int J Gynecol Pathol 2024; 43:15-24. [PMID: 36811832 DOI: 10.1097/pgp.0000000000000948] [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: 02/24/2023]
Abstract
SUMMARY We reviewed the clinicopathologic findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-exposed placentas at our institution. We identified patients diagnosed with SARS-CoV-2 during pregnancy (March-October 2020). Clinical data included gestational age at diagnosis and delivery and maternal symptoms. Hematoxylin and eosin slides were reviewed for maternal vascular malperfusion, fetal vascular malperfusion, chronic villitis, amniotic fluid infection, intervillous thrombi, fibrin deposition, and infarction. Immunohistochemistry (IHC) for coronavirus spike protein and RNA in situ hybridization (ISH) for SARS-CoV-2 was performed on a subset of blocks. A review of placentas from age-matched patients received March-October 2019 was conducted as a comparison cohort. A total of 151 patients were identified. Placentas in the 2 groups were similar in weight for gestational age and had similar rates of maternal vascular malperfusion, fetal vascular malperfusion, amniotic fluid infection, intervillous thrombi, fibrin deposition, and infarction. Chronic villitis was the only significantly different pathologic finding between cases and controls (29% of cases showed chronic villitis vs. 8% of controls, P <0.001). Overall, 146/151 (96.7%) cases were negative for IHC and 129/133 (97%) cases were negative for RNA ISH. There were 4 cases that stained positively for IHC/ISH, 2 of which showed massive perivillous fibrin deposition, inflammation, and decidual arteriopathy. Coronavirus disease 2019 (COVID-19)-positive patients were more likely to self-identify as Hispanic and more likely to have public health insurance. Our data suggests SARS-CoV-2 exposed placentas that stain positively for SARS-CoV-2 show abnormal fibrin deposition, inflammatory changes, and decidual arteriopathy. The group of patients with clinical COVID-19 are more likely to show chronic villitis. IHC and ISH evidence of viral infection is rare.
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Gostomczyk K, Borowczak J, Siekielska-Domanowska M, Szczerbowski K, Maniewski M, Dubiel M, Szylberg Ł, Bodnar M. Mechanisms of SARS-CoV-2 Placental Transmission. Arch Immunol Ther Exp (Warsz) 2024; 72:aite-2024-0001. [PMID: 38299561 DOI: 10.2478/aite-2024-0001] [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: 06/30/2023] [Accepted: 09/07/2023] [Indexed: 02/02/2024]
Abstract
The widespread occurrence of SARS-CoV-2 infections and the diverse range of symptoms have placed significant strain on healthcare systems worldwide. Pregnancy has also been affected by COVID-19, with an increased risk of complications and unfavorable outcomes for expectant mothers. Multiple studies indicate that SARS-CoV-2 can infiltrate the placenta, breach its protective barrier, and infect the fetus. Although the precise mechanisms of intrauterine transmission remain unclear, factors such as perinatal infection, macrophages, sexual intercourse, and the virus' interaction with host angiotensin-converting enzyme 2 (ACE2) and neuropilin-1 (NRP-1) proteins appear to play a role in this process. The integrity of the placental barrier fluctuates throughout pregnancy and appears to influence the likelihood of fetal transmission. The expression of placental cell receptors, like ACE2, changes during pregnancy and in response to placental damage. However, due to the consistent presence of others, such as NRP-1, SARS-CoV-2 may potentially enter the fetus at different stages of pregnancy. NRP-1 is also found in macrophages, implicating maternal macrophages and Hofbauer cells as potential routes for viral transmission. Our current understanding of SARS-CoV-2's vertical transmission pathways remains limited. Some researchers question the ACE2-associated transmission model due to the relatively low expression of ACE2 in the placenta. Existing studies investigating perinatal transmission and the impact of sexual intercourse have either involved small sample sizes or lacked statistical significance. This review aims to explore the current state of knowledge regarding the potential mechanisms of COVID-19 vertical transmission, identifying areas where further research is needed to fill the gaps in our understanding.
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Affiliation(s)
- Karol Gostomczyk
- Department of Obstetrics, Gynaecology and Oncology, Chair of Pathomorphology and Clinical Placentology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Department of Tumor Pathology and Pathomorphology, Oncology Centre - Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Jędrzej Borowczak
- Department of Obstetrics, Gynaecology and Oncology, Chair of Pathomorphology and Clinical Placentology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Marta Siekielska-Domanowska
- Department of Obstetrics, Gynaecology and Oncology, Chair of Pathomorphology and Clinical Placentology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Krzysztof Szczerbowski
- Department of Obstetrics, Gynaecology and Oncology, Chair of Pathomorphology and Clinical Placentology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Mateusz Maniewski
- Department of Obstetrics, Gynaecology and Oncology, Chair of Pathomorphology and Clinical Placentology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Mariusz Dubiel
- Department of Obstetrics, Gynaecology and Oncology, Chair of Pathomorphology and Clinical Placentology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Łukasz Szylberg
- Department of Obstetrics, Gynaecology and Oncology, Chair of Pathomorphology and Clinical Placentology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Department of Tumor Pathology and Pathomorphology, Oncology Centre - Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
- Chair of Pathology, Dr. Jan Biziel Memorial University Hospital No. 2, Bydgoszcz, Poland
| | - Magdalena Bodnar
- Department of Obstetrics, Gynaecology and Oncology, Chair of Pathomorphology and Clinical Placentology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Chair of Pathology, Dr. Jan Biziel Memorial University Hospital No. 2, Bydgoszcz, Poland
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Lira V, Beltrami L, Cirimbelli F, Garbelli L, Merlo C, Prandelli EA, Sanfilippo M, Peli NE. Midwifery care for a COVID-19 cohort of women in Northern Italy: two years of pandemic. Minerva Obstet Gynecol 2023; 75:544-552. [PMID: 37326356 DOI: 10.23736/s2724-606x.23.05328-9] [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: 06/17/2023]
Abstract
BACKGROUND The rapid development of the COVID-19 pandemic has altered the context of healthcare around the world. SARS-CoV-2 positive pregnant and postnatal women, being at greater risk of complications, require continuous midwifery surveillance as well as specialized medical care. Scientific literature lacks studies related to midwifery care models in hospital settings during the pandemic. The aim of this work is to describe hospitalizations in an obstetric-gynecological COVID care unit and to provide a descriptive analysis of the organizational and care model adopted. METHODS A cohort retrospective descriptive study was carried out. The sample was stratified by COVID-related care complexity and by obstetric risk. The sample recruited pregnant women, postnatal women, and gynecological patients with confirmed SARS-CoV-2 infection admitted to the obstetric-gynecological COVID unit of a birth center in Northern Italy, from March 16, 2020, to March 16, 2022. RESULTS A number of 1037 women were hospitalized, and of these, 551 were SARS-CoV-2 positive women. The 551 SARS-CoV-2 positive women included 362 pregnant women, 132 postnatal women, 9 gynecological patients with medical diagnosis while 17 with a surgical path, and 31 women undergoing voluntary interruption of pregnancy. The final sample included 536 women. 68.6% of women requested a low care complexity, 22.8% a medium one, and 8.6% a high care complexity. Among the obstetric women population, the majority (70.6%) showed a high obstetric risk. CONCLUSIONS The COVID-19 cohort of women required different levels of care with various care complexity and levels of obstetric risk. The model adopted allowed the acquisition of new technical and professional skills as well as the sharing of responsibilities and competences according to the care model of the Buddy System. Future studies could investigate COVID-related care models adopted internationally, but also deepen the technical and professional skills developed by midwives during the pandemic in order to enrich, improve and support midwifery profession.
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Affiliation(s)
- Viviana Lira
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Laura Beltrami
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Francesca Cirimbelli
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Laura Garbelli
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy -
| | - Camilla Merlo
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Elena A Prandelli
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Massimiliano Sanfilippo
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Nives E Peli
- Department of Obstetrics and Gynaecology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
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Debelenko L. SARS-CoV-2 Infection in Late Pregnancy and Childbirth from the Perspective of Perinatal Pathology. J Dev Biol 2023; 11:42. [PMID: 37987372 PMCID: PMC10660738 DOI: 10.3390/jdb11040042] [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: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023] Open
Abstract
This review focuses on SARS-CoV-2 infection in placental and fetal tissues. Viremia is rare in infected pregnant women, and the virus is seldom amplified from placental tissues. Definite and probable placental infection requires the demonstration of viral RNA or proteins using in situ hybridization (ISH) and immunohistochemistry (IHC). Small subsets (1.0-7.9%, median 2.8%) of placentas of SARS-CoV-2-positive women showed definite infection accompanied by a characteristic histopathology named SARS-CoV-2 placentitis (SP). The conventionally accepted histopathological criteria for SP include the triad of intervillositis, perivillous fibrin deposition, and trophoblast necrosis. SP was shown to be independent of the clinical severity of the infection, but associated with stillbirth in cases where destructive lesions affecting more than 75% of the placental tissue resulted in placental insufficiency and severe fetal hypoxic-ischemic injury. An association between maternal thrombophilia and SP was shown in a subset of cases, suggesting a synergy of the infection and deficient coagulation cascade as one of the mechanisms of the pathologic accumulation of fibrin in affected placentas. The virus was amplified from fetal tissues in approximately 40% of SP cases, but definite fetal involvement demonstrated using ISH or IHC is exceptionally rare. The placental pathology in SARS-CoV-2-positive women also includes chronic lesions associated with placental malperfusion in the absence of definite or probable placental infection. The direct viral causation of the vascular malperfusion of the placenta in COVID-19 is debatable, and common predispositions (hypertension, diabetes, and obesity) may play a role.
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Affiliation(s)
- Larisa Debelenko
- Department of Pathology and Cell Biology, Columbia University-Irving Medical Center, New York, NY 10032, USA
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Patiño Escarcina JE, da Silva AKCV, Medeiros MODA, Fernandes SSS, Agareno LA, Garboggini LA, Gouveia MDS, Duarte VC, Morbeck DL, Moreira LMO. Histological Alterations in Placentas of Pregnant Women with SARS-CoV-2 Infection: A Single-Center Case Series. Pathogens 2023; 12:1197. [PMID: 37887713 PMCID: PMC10610047 DOI: 10.3390/pathogens12101197] [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: 08/01/2023] [Revised: 09/02/2023] [Accepted: 09/13/2023] [Indexed: 10/28/2023] Open
Abstract
This study aimed to investigate the histopathological changes associated with SARS-CoV-2 infection in placentas. A case series of anatomopathological analysis was conducted on the placentas of pregnant women with SARS-CoV-2 who delivered between March and December 2020 at Santo Amaro Hospital (HSA) in Salvador, Brazil. Out of the 29 placentas examined, the median weight was 423.0 (IQR: 385.0-521.0) g. Among them, 58.3% (n = 14) had inadequate weight relative to the newborn's weight. The histopathological findings revealed that 86.2% (n = 25) of the placentas had poorly defined lobes, and the fetal and maternal surface color was normal in 89.7% (n = 26) and 93.1% (n = 27), respectively. Additionally, 51.7% (n = 15) of the umbilical cords displayed hypercoiling. The most frequent microscopic finding was infarction, present in 35.3% (n = 6) of the cases, followed by 11.8% (n = 2) for each of chorioamnionitis, chronic villitis, focal perivillositis, and laminar necrosis. Analysis of the umbilical cords identified 23.5% (n = 4) cases of intervillous thrombosis, while amnion analysis showed 13.8% (n = 4) cases of squamous metaplasia. Extraplacental membrane examination revealed fibrin deposition in 93.1% (n = 27) of the cases, necrosis in 62.0% (n = 18), calcifications in 51.7% (n = 15), cysts in 37.9% (n = 11), neutrophilic exudate in 17.2% (n = 5), thrombosis in 13.7% (n = 4), and delayed placental maturation in 6.9% (n = 2). All analyzed placentas exhibited histopathological changes, primarily vascular and inflammatory, which indicate SARS-CoV-2 infection in term pregnancies. These alterations could be associated with impaired placental function, fetal growth restriction, preeclampsia, and prematurity. However, further prospective studies are required to validate the type, prevalence, and prognosis of each of these changes.
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Affiliation(s)
- Jesus Enrique Patiño Escarcina
- José Silveira Foundation, Center for Research, Learning and Innovation, Salvador 40210-320, BA, Brazil; (A.K.C.V.d.S.); (L.A.A.); (D.L.M.); (L.M.O.M.)
- Collective Health Institute, Universidade Federal da Bahia, Salvador 40110-040, BA, Brazil
| | - Ana Keila Carvalho Vieira da Silva
- José Silveira Foundation, Center for Research, Learning and Innovation, Salvador 40210-320, BA, Brazil; (A.K.C.V.d.S.); (L.A.A.); (D.L.M.); (L.M.O.M.)
| | | | | | - Luiza Andrade Agareno
- José Silveira Foundation, Center for Research, Learning and Innovation, Salvador 40210-320, BA, Brazil; (A.K.C.V.d.S.); (L.A.A.); (D.L.M.); (L.M.O.M.)
| | | | - Marcela de Sá Gouveia
- Climério de Oliveira Maternity, Salvador 40055-150, BA, Brazil; (L.A.G.); (M.d.S.G.); (V.C.D.)
| | - Vanessa Campos Duarte
- Climério de Oliveira Maternity, Salvador 40055-150, BA, Brazil; (L.A.G.); (M.d.S.G.); (V.C.D.)
| | - Diogo Lago Morbeck
- José Silveira Foundation, Center for Research, Learning and Innovation, Salvador 40210-320, BA, Brazil; (A.K.C.V.d.S.); (L.A.A.); (D.L.M.); (L.M.O.M.)
| | - Lícia Maria Oliveira Moreira
- José Silveira Foundation, Center for Research, Learning and Innovation, Salvador 40210-320, BA, Brazil; (A.K.C.V.d.S.); (L.A.A.); (D.L.M.); (L.M.O.M.)
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11
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Xin X, Yao W, Zhang Z, Yang X, Li S, Zhu Y, Zhang C, Zhang L, Huang H, Dong T, Dong H, Feng L, Wang S. Immune and cytokine alterations and RNA-sequencing analysis in gestational tissues from pregnant women after recovery from COVID-19. BMC Infect Dis 2023; 23:620. [PMID: 37735363 PMCID: PMC10512579 DOI: 10.1186/s12879-023-08607-z] [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: 11/14/2022] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND COVID-19 is a global pandemic. Understanding the immune responses in pregnant women recovering from COVID-19 may suggest new therapeutic approaches. METHODS We performed a cross-sectional study between March 1, 2020, and September 1, 2020. Participants were assigned into the convalescent COVID-19 group if they had a previous COVID-19 infection during pregnancy or the healthy control group. RNA-Seq was performed on human umbilical cord mesenchymal stem cells (hUMSCs) and human amniotic mesenchymal stem cells (hAMSCs). Immunohistochemical staining, cytokine testing, lymphocyte subset analysis, RNA-Seq, and functional analyses were performed on the placental and umbilical cord blood (UCB) and compared between the two groups. RESULTS A total of 40 pregnant women were enrolled, with 13 in the convalescent group and 27 in the control group. There were 1024, 46, and 32 differentially expressed genes (DEGs) identified in the placental tissue, hUMSCs, and hAMSCs between the convalescent and control groups, respectively. Enrichment analysis showed those DEGs were associated with immune homeostasis, antiviral activity, cell proliferation, and tissue repair. Levels of IL-6, TNF-α, total lymphocyte counts, B lymphocytes, Tregs percentages, and IFN-γ expressing CD4+ and CD8+ T cells were statistically different between two groups (p ≤ 0.05). ACE2 and TMPRSS2 expressed on the placenta were not different between the two groups (p > 0.05). CONCLUSION Multiple changes in immune responses occurred in the placental tissue, hUMSCs, and hAMSCs after maternal recovery from COVID-19, which might imply their protective roles against COVID-19 infection.
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Affiliation(s)
- Xing Xin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430032, Hubei, P.R. China
| | - Weiqi Yao
- Wuhan Optics Valley Vcanbiopharma Co. Ltd, Wuhan, 430000, Hubei, P.R. China
- VCANBIO Cell & Gene Engineering Corp., Ltd, Tianjin, 300384, P.R. China
- Department of Biology and medicine, Hubei University of Technology, Wuhan, 430068, Hubei, P.R. China
- Wuhan Optics Valley Vcanbio Cell & Gene Technology Co., Ltd, Wuhan, 430000, Hubei, P.R. China
- Hubei Engineering Research Center for Human Stem Cell Preparation, Application and Resource Preservation, Wuhan, 430000, Hubei, P.R. China
| | - Zijing Zhang
- Department of Medical office, Wuchang Shouyi College Hospital, Wuhan, 430064, Hubei, P.R. China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430032, Hubei, P.R. China
| | - Shufang Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430032, Hubei, P.R. China
| | - Ying Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430032, Hubei, P.R. China
| | - Cong Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430032, Hubei, P.R. China
| | - Long Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430032, Hubei, P.R. China
| | - Hailong Huang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430077, Hubei, P.R. China
| | - Tengyun Dong
- Wuhan Optics Valley Vcanbiopharma Co. Ltd, Wuhan, 430000, Hubei, P.R. China
- Wuhan Optics Valley Vcanbio Cell & Gene Technology Co., Ltd, Wuhan, 430000, Hubei, P.R. China
- Hubei Engineering Research Center for Human Stem Cell Preparation, Application and Resource Preservation, Wuhan, 430000, Hubei, P.R. China
| | - Haibo Dong
- Wuhan Optics Valley Vcanbio Cell & Gene Technology Co., Ltd, Wuhan, 430000, Hubei, P.R. China
- Hubei Engineering Research Center for Human Stem Cell Preparation, Application and Resource Preservation, Wuhan, 430000, Hubei, P.R. China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430032, Hubei, P.R. China.
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430032, Hubei, P.R. China.
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12
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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: 10] [Impact Index Per Article: 10.0] [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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13
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Vayalumkal JV, Soraisham AS, Abou Mehrem A, Ghosh A, Dunn JKE, Fonseca K, Zhou H, Berenger BM, Chan ES, Brundler MA, Lin YC, Evans DH, Rousso S, Kuret V, Conly JM. Congenital SARS-CoV-2 Infection in Two Neonates with Confirmation by Viral Culture of the Placenta in One Case. Viruses 2023; 15:1310. [PMID: 37376610 DOI: 10.3390/v15061310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/19/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Congenital infections with SARS-CoV-2 are uncommon. We describe two confirmed congenital SARS-CoV-2 infections using descriptive, epidemiologic and standard laboratory methods and in one case, viral culture. Clinical data were obtained from health records. Nasopharyngeal (NP) specimens, cord blood and placentas when available were tested by reverse transcriptase real-time PCR (RT-PCR). Electron microscopy and histopathological examination with immunostaining for SARS-CoV-2 was conducted on the placentas. For Case 1, placenta, umbilical cord, and cord blood were cultured for SARS-CoV-2 on Vero cells. This neonate was born at 30 weeks, 2 days gestation by vaginal delivery. RT-PCR tests were positive for SARS-CoV-2 from NP swabs and cord blood; NP swab from the mother and placental tissue were positive for SARS-CoV-2. Placental tissue yielded viral plaques with typical morphology for SARS-CoV-2 at 2.8 × 102 pfu/mL confirmed by anti-spike protein immunostaining. Placental examination revealed chronic histiocytic intervillositis with trophoblast necrosis and perivillous fibrin deposition in a subchorionic distribution. Case 2 was born at 36 weeks, 4 days gestation. RT-PCR tests from the mother and infant were all positive for SARS-CoV-2, but placental pathology was normal. Case 1 may be the first described congenital case with SARS-CoV-2 cultivated directly from placental tissue.
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Affiliation(s)
- Joseph V Vayalumkal
- Department of Pediatrics, Alberta Health Services, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Amuchou S Soraisham
- Department of Pediatrics, Alberta Health Services, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, Alberta Health Services, University of Calgary, Calgary, AB T2N 4N1, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Anirban Ghosh
- Department of Pediatrics, Alberta Health Services, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Jessica K E Dunn
- Department of Pediatrics, Alberta Health Services, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Kevin Fonseca
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB T2N 4W4, Canada
- Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Hong Zhou
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB T2N 4W4, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Byron M Berenger
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, AB T2N 4W4, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Elaine S Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Marie-Anne Brundler
- Department of Pediatrics, Alberta Health Services, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Yi-Chan Lin
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - David H Evans
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Sharon Rousso
- Department of Pediatrics, Red Deer Regional Hospital, Red Deer, AB T4N 4E7, Canada
| | - Verena Kuret
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - John M Conly
- Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Medicine, Alberta Health Services and University of Calgary, Calgary, AB T2N 4N1, Canada
- Snyder Institute for Chronic Diseases and O'Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 4N1, Canada
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14
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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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General Approach to Delivery and Resuscitation of Newborn Infants from Mothers at Risk or Proven COVID-19. Semin Fetal Neonatal Med 2023; 28:101432. [PMID: 37024369 PMCID: PMC10062715 DOI: 10.1016/j.siny.2023.101432] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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16
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Trinh QD, Pham NTK, Takada K, Ushijima H, Komine-Aizawa S, Hayakawa S. Roles of TGF-β1 in Viral Infection during Pregnancy: Research Update and Perspectives. Int J Mol Sci 2023; 24:ijms24076489. [PMID: 37047462 PMCID: PMC10095195 DOI: 10.3390/ijms24076489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
Transforming growth factor-beta 1 (TGF-β1) is a pleiotropic growth factor playing various roles in the human body including cell growth and development. More functions of TGF-β1 have been discovered, especially its roles in viral infection. TGF-β1 is abundant at the maternal-fetal interface during pregnancy and plays an important function in immune tolerance, an essential key factor for pregnancy success. It plays some critical roles in viral infection in pregnancy, such as its effects on the infection and replication of human cytomegalovirus in syncytiotrophoblasts. Interestingly, its role in the enhancement of Zika virus (ZIKV) infection and replication in first-trimester trophoblasts has recently been reported. The above up-to-date findings have opened one of the promising approaches to studying the mechanisms of viral infection during pregnancy with links to corresponding congenital syndromes. In this article, we review our current and recent advances in understanding the roles of TGF-β1 in viral infection. Our discussion focuses on viral infection during pregnancy, especially in the first trimester. We highlight the mutual roles of viral infection and TGF-β1 in specific contexts and possible functions of the Smad pathway in viral infection, with a special note on ZIKV infection. In addition, we discuss promising approaches to performing further studies on this topic.
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Affiliation(s)
- Quang Duy Trinh
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Ngan Thi Kim Pham
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kazuhide Takada
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hiroshi Ushijima
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Shihoko Komine-Aizawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Satoshi Hayakawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
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17
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De Luca D, Vauloup-Fellous C, Benachi A, Vivanti A. Transmission of SARS-CoV-2 from mother to fetus or neonate: What to know and what to do? Semin Fetal Neonatal Med 2023; 28:101429. [PMID: 36935314 PMCID: PMC10010052 DOI: 10.1016/j.siny.2023.101429] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
SARS-CoV-2 can be vertically transmitted from the mother to the fetus and the neonate. This transmission route is rare compared to the environmental or horizontal spread and therefore, the risk can be deemed inconsequential by some medical providers. However, severe, although just as rare, feto-neonatal consequences are possible: fetal demise, severe/critical neonatal COVID-19 and multi-inflammatory syndrome (MIS-N) have been described. Therefore, it is important for the clinicians to know the mechanism of vertical transmission, how to recognize this, and how to deal with neonatal COVID-19 and MIS-N. Our knowledge about this field has significantly increased in the last three years. This is a summary of the pathophysiology, diagnostics, and therapeutics of vertical SARS-CoV-2 transmission that clinicians apply in their clinical practice.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.
| | - Christelle Vauloup-Fellous
- Division of Virology, "Paul Brousse" Hospital, Paris Saclay University Hospitals, APHP, Villejuif, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Alexandre Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
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18
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Asalkar MR, Thakkarwad SM, Bacchewad RP, Sharma NH. Perinatal Outcome in Maternal COVID-19 infection at a Tertiary care Institute- A cross Sectional Study. J Obstet Gynaecol India 2022; 73:123-131. [PMID: 36465798 PMCID: PMC9702842 DOI: 10.1007/s13224-022-01673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract COVID 19 pandemic is one of the biggest challenge to health system of developing as well as developed countries. Because of the novelty of the virus, limited data were available regarding perinatal outcome. The objective of this study is to find out the perinatal outcome in COVID-19 infected mothers who delivered during COVID Pandemic. Methodology A cross sectional study was carried out at PCMC'S Post-Graduate Institute and YCM Hospital Pune (Maharashtra) from 1 May 2020 to 31 October 2021 which was a dedicated COVID hospital during COVID pandemic. A total of 362 maternity patients (including 5 twin pregnancies) having COVID 19 infection who gave birth to 367 Newborns were studied. Maternal COVID -19 infection was diagnosed either by RTPCR test or Rapid Antigen test. Demographic variables, maternal symptoms, labour and neonatal outcome were recorded. RT PCR of neonates at birth was performed. Data was analyzed statistically by using Epi Info Software. Aim To analyze the perinatal outcome among COVID-19 infected mothers who delivered during Covid pandemic. Objectives Study was conducted with the primary objective to analyze the labour outcome, maternal symptoms and secondarily to study maternal demographic profile and to compare disease severity during 1st and 2nd wave of COVID and to detect possibility of vertical transmission of COVID-19 in neonates of covid positive mothers. Results 74.2% patients from young reproductive age (21-30 years age) were affected. All socioeconomic classes were affected. 61% patients were multigravida. Normal BMI was noted in 49.8%. 28.2% deliveries were preterm. Caesarean section rate was 50.5%. Following obstetric high risk factors were noted-anaemia in 34.2% followed by previous LSCS in 26.2% cases and preeclampsia in 18.7%Overall 54.6% patients were asymptomatic while 45.4% were symptomatic. Symptomatology between 1st and 2nd wave showed statistical significance (p value < .05%) for mild, moderate and severe symptoms. Myalgia, cough, fever and fatigue were common presenting symptoms. 14% patients required ICU/HDU care. HDU/ICU requirement showed statistical significance (p value < .05) between 1st and 2nd wave. Overall maternal mortality was 1.1% (4 maternal deaths in 2nd wave) with no mortality in 1st wave.96.4% were live births. Birth weight was more than 2.5 kg in 62% cases and 21.3% cases required NICU. Vertical transmission of COVID was seen in 1.1% cases. Conclusion Pregnant patients with moderate and severe disease are at higher risk of perinatal complications. ICU/HDU management with multidisciplinary management may reduce morbidity and mortality. Neonatal affection due to COVID may not be severe but may increase prematurity due to iatrogenic intervention.
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Affiliation(s)
- M. R. Asalkar
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, Maharashtra 411018 India
| | - S. M. Thakkarwad
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, Maharashtra 411018 India
| | - R. P. Bacchewad
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, Maharashtra 411018 India
| | - N. H. Sharma
- Department of Obstetrics and Gynaecology, PGI-YCMH Pimpri, Pune, Maharashtra 411018 India
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19
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Twanow JDE, McCabe C, Ream MA. The COVID-19 Pandemic and Pregnancy: Impact on Mothers and Newborns. Semin Pediatr Neurol 2022; 42:100977. [PMID: 35868726 PMCID: PMC9122838 DOI: 10.1016/j.spen.2022.100977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic has markedly, and likely permanently, changed health care. This includes changing the obstetric and perinatal care of mothers and infants, and by extension, the care of their families. Infection during pregnancy is associated with an increased risk for severe coronavirus disease 2019 illness and related complications that can significantly impact maternal health and the health of the neonate. Viral transmission from mother to fetus is possible, but rare during pregnancy, and current health care policies focusing on maternal masking, and hand washing allows infected mothers to safely care for neonates (including nursing or feeding with expressed breast milk). The newly developed vaccines have been shown to be safe and effective for pregnant and breast-feeding mothers, with measurable antibody levels in cord blood and breast milk potentially providing a level of passive immunity to neonates. While studies looking at short-term outcomes for neonates have been reassuring, it is critical that we continue to work to understand and improve the care of pregnant woman and newborns with coronavirus disease 2019 to optimize long term outcomes. Although the knowledge base continues to evolve, the available evidence influencing the care of pregnant women and their infants is summarized in this focused review.
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Affiliation(s)
- Jaime-Dawn E. Twanow
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH,Address reprint requests to Jaime-Dawn E. Twanow, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Corinne McCabe
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH
| | - Margie A. Ream
- Nationwide Children's Hospital Columbus, OH,The Ohio State University College of Medicine, Columbus, OH
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20
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Zaigham M, Gisselsson D, Sand A, Wikström A, von Wowern E, Schwartz DA, Iorizzo L, Nelander M, Blomberg M, Papadogiannakis N, Holmström S, Leijonhfvud Å, Sengpiel V. Clinical-pathological features in placentas of pregnancies with SARS-CoV-2 infection and adverse outcome: case series with and without congenital transmission. BJOG 2022; 129:1361-1374. [PMID: 35243759 PMCID: PMC9111112 DOI: 10.1111/1471-0528.17132] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/03/2022] [Accepted: 02/14/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and live-born infants presenting with fetal distress. DESIGN Retrospective, observational. SETTING Nationwide. POPULATION Five stillborn and nine live-born infants from 13 pregnant women infected with SARS-CoV-2 seeking care at seven different maternity units in Sweden. METHODS Clinical outcomes and placental pathology were studied in 14 cases (one twin pregnancy) of maternal SARS-CoV-2 infection with impaired fetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus-related pathology on the villous capillary endothelium, trophoblast and other cells. MAIN OUTCOME MEASURES Maternal and fetal clinical outcomes and placental pathology in stillborn and live-born infants. RESULTS Reduced fetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of fetal distress among live-born infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the live-born infants died during the postnatal period. Signs of fetal distress led to emergency caesarean section in all live-born infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one live-born neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillositis and trophoblast necrosis were associated with SARS-CoV-2 placental infection and congenital transmission. CONCLUSIONS SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute fetal hypoxia leading to intrauterine fetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillositis and trophoblast degeneration.
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Affiliation(s)
- Mehreen Zaigham
- Obstetrics & Gynaecology, Institution of Clinical Sciences LundLund UniversityLundSweden
- Department of Obstetrics and GynaecologySkåne University HospitalLundSweden
| | - David Gisselsson
- Clinical Genetics and Pathology, Laboratory MedicineSkåne University HospitalLundSweden
- Division of Clinical Genetics, Department of Laboratory MedicineLund UniversityLundSweden
| | - Anna Sand
- Department of Women's and Children's HealthKarolinska InstituteStockholmSweden
- Department of Obstetrics and GynaecologyKarolinska University HospitalStockholmSweden
| | | | - Emma von Wowern
- Department of Obstetrics and GynaecologySkåne University HospitalLundSweden
- Perinatal and Cardiovascular EpidemiologyInstitution of Clinical Sciences Malmö, Lund UniversityLundSweden
| | - David A. Schwartz
- Department of PathologyMedical College of Georgia, Augusta UniversityAugustaGeorgiaUSA
| | - Linda Iorizzo
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science HelsingborgLund UniversityLundSweden
| | - Maria Nelander
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Marie Blomberg
- Department of Obstetrics and Gynaecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Department of PathologyKarolinska University HospitalStockholmSweden
| | - Sandra Holmström
- Department of Obstetrics and GynaecologyHalland HospitalVarbergSweden
| | - Åsa Leijonhfvud
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science HelsingborgLund UniversityLundSweden
| | - Verena Sengpiel
- Department of Obstetrics and GynaecologySahlgrenska Academy, University of GothenburgGothenburgSweden
- Region Västra Götaland, Sahlgrenska University HospitalDepartment of Obstetrics and GynaecologyGothenburgSweden
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21
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Sessa R, Anastasi E, Brandolino G, Brunelli R, Di Pietro M, Filardo S, Masciullo L, Terrin G, Viscardi MF, Porpora MG. What is the Hidden Biological Mechanism Underlying the Possible SARS-CoV-2 Vertical Transmission? A Mini Review. Front Physiol 2022; 13:875806. [PMID: 35600312 PMCID: PMC9117645 DOI: 10.3389/fphys.2022.875806] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS- CoV-2) represents an emerging infection that is spreading around the world. Among susceptible patients, pregnant women are more likely to develop serious complications and negative obstetric outcomes. Vertical transmission constitutes a debating issue which has not been completely understood. This review aims at describing the currently available evidence on SARS-CoV2 vertical transmission. We carried out a computerized literature search in the Cochrane Library, PubMed, Scopus and Web of Science, selecting the most relevant studies on vertical transmission from the outbreak onset until February 2022. The analysis of the available literature identifies the presence of SARS-CoV2 genome in different biological specimens, confirming the hypothesis that a transplacental infection can occur. In spite of the high number of infected people around the world, mother-to-child infections have been infrequently reported but it can be observed under certain biologic conditions. A deep knowledge of the underlying mechanisms of SARS-CoV2 vertical transmission is of paramount importance for planning an adequate management for the affected mothers and newborns.
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Affiliation(s)
- Rosa Sessa
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, Rome, Italy
| | - Emanuela Anastasi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Gabriella Brandolino
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Marisa Di Pietro
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, Rome, Italy
| | - Simone Filardo
- Department of Public Health and Infectious Diseases, Microbiology Section, Sapienza University of Rome, Rome, Italy
| | - Luisa Masciullo
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Maria Federica Viscardi
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Rome, Italy
- *Correspondence: Maria Grazia Porpora,
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22
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Allotey J, Chatterjee S, Kew T, Gaetano A, Stallings E, Fernández-García S, Yap M, Sheikh J, Lawson H, Coomar D, Dixit A, Zhou D, Balaji R, Littmoden M, King Y, Debenham L, Llavall AC, Ansari K, Sandhu G, Banjoko A, Walker K, O'Donoghue K, van Wely M, van Leeuwen E, Kostova E, Kunst H, Khalil A, Brizuela V, Broutet N, Kara E, Kim CR, Thorson A, Oladapo OT, Zamora J, Bonet M, Mofenson L, Thangaratinam S. SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis. BMJ 2022; 376:e067696. [PMID: 35296519 PMCID: PMC8924705 DOI: 10.1136/bmj-2021-067696] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the rates of SARS-CoV-2 positivity in babies born to mothers with SARS-CoV-2 infection, the timing of mother-to-child transmission and perinatal outcomes, and factors associated with SARS-CoV-2 status in offspring. DESIGN Living systematic review and meta-analysis. DATA SOURCES Major databases between 1 December 2019 and 3 August 2021. STUDY SELECTION Cohort studies of pregnant and recently pregnant women (including after abortion or miscarriage) who sought hospital care for any reason and had a diagnosis of SARS-CoV-2 infection, and also provided data on offspring SARS-CoV-2 status and risk factors for positivity. Case series and case reports were also included to assess the timing and likelihood of mother-to-child transmission in SARS-CoV-2 positive babies. DATA EXTRACTION Two reviewers independently extracted data and assessed study quality. A random effects model was used to synthesise data for rates, with associations reported using odds ratios and 95% confidence intervals. Narrative syntheses were performed when meta-analysis was inappropriate. The World Health Organization classification was used to categorise the timing of mother-to-child transmission (in utero, intrapartum, early postnatal). RESULTS 472 studies (206 cohort studies, 266 case series and case reports; 28 952 mothers, 18 237 babies) were included. Overall, 1.8% (95% confidence interval 1.2% to 2.5%; 140 studies) of the 14 271 babies born to mothers with SARS-CoV-2 infection tested positive for the virus with reverse transcriptase polymerase chain reaction (RT-PCR). Of the 592 SARS-CoV-2 positive babies with data on the timing of exposure and type and timing of tests, 14 had confirmed mother-to-child transmission: seven in utero (448 assessed), two intrapartum (18 assessed), and five during the early postnatal period (70 assessed). Of the 800 SARS-CoV-2 positive babies with outcome data, 20 were stillbirths, 23 were neonatal deaths, and eight were early pregnancy losses; 749 babies were alive at the end of follow-up. Severe maternal covid-19 (odds ratio 2.4, 95% confidence interval 1.3 to 4.4), maternal death (14.1, 4.1 to 48.0), maternal admission to an intensive care unit (3.5, 1.7 to 6.9), and maternal postnatal infection (5.0, 1.2 to 20.1) were associated with SARS-CoV-2 positivity in offspring. Positivity rates using RT-PCR varied between regions, ranging from 0.1% (95% confidence interval 0.0% to 0.3%) in studies from North America to 5.7% (3.2% to 8.7%) in studies from Latin America and the Caribbean. CONCLUSION SARS-CoV-2 positivity rates were found to be low in babies born to mothers with SARS-CoV-2 infection. Evidence suggests confirmed vertical transmission of SARS-CoV-2, although this is likely to be rare. Severity of maternal covid-19 appears to be associated with SARS-CoV-2 positivity in offspring. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178076. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.
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Affiliation(s)
- John Allotey
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Tania Kew
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Andrea Gaetano
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Magnus Yap
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Jameela Sheikh
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Heidi Lawson
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dyuti Coomar
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Anushka Dixit
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Dengyi Zhou
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Rishab Balaji
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Megan Littmoden
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Luke Debenham
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | - Kehkashan Ansari
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Gurimaan Sandhu
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Adeolu Banjoko
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | | | | | - Madelon van Wely
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elizabeth van Leeuwen
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Elena Kostova
- Netherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Heinke Kunst
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | | | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Nathalie Broutet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Edna Kara
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caron Rahn Kim
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Javier Zamora
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lynne Mofenson
- Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, USA
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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23
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Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) including Variant Analysis by Mass Spectrometry in Placental Tissue. Viruses 2022; 14:v14030604. [PMID: 35337011 PMCID: PMC8953811 DOI: 10.3390/v14030604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Among neonates, tested positive for SARS-CoV-2, the majority of infections occur through postpartum transmission. Only few reports describe intrauterine or intrapartum SARS-CoV-2 infections in newborns. To understand the route of transmission, detection of the virus or virus nucleic acid in the placenta and amniotic tissue are of special interest. Current methods to detect SARS-CoV-2 in placental tissue are immunohistochemistry, electron microscopy, in-situ hybridization, polymerase chain reaction (PCR) and next-generation sequencing. Recently, we described an alternative method for the detection of viral ribonucleic acid (RNA), by combination of reverse transcriptase-PCR and mass spectrometry (MS) in oropharyngeal and oral swabs. In this report, we could detect SARS-CoV-2 in formal-fixed and paraffin-embedded (FFPE) placental and amniotic tissue by multiplex RT-PCR MS. Additionally, we could identify the British variant (B.1.1.7) of the virus in this tissue by the same methodology. Combination of RT-PCR with MS is a fast and easy method to detect SARS-CoV-2 viral RNA, including specific variants in FFPE tissue.
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24
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Reagan-Steiner S, Bhatnagar J, Martines RB, Milligan NS, Gisondo C, Williams FB, Lee E, Estetter L, Bullock H, Goldsmith CS, Fair P, Hand J, Richardson G, Woodworth KR, Oduyebo T, Galang RR, Phillips R, Belyaeva E, Yin XM, Meaney-Delman D, Uyeki TM, Roberts DJ, Zaki SR. Detection of SARS-CoV-2 in Neonatal Autopsy Tissues and Placenta. Emerg Infect Dis 2022; 28:510-517. [PMID: 35138244 PMCID: PMC8888232 DOI: 10.3201/eid2803.211735] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Severe coronavirus disease in neonates is rare. We analyzed clinical, laboratory, and autopsy findings from a neonate in the United States who was delivered at 25 weeks of gestation and died 4 days after birth; the mother had asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and preeclampsia. We observed severe diffuse alveolar damage and localized SARS-CoV-2 by immunohistochemistry, in situ hybridization, and electron microscopy of the lungs of the neonate. We localized SARS-CoV-2 RNA in neonatal heart and liver vascular endothelium by using in situ hybridization and detected SARS-CoV-2 RNA in neonatal and placental tissues by using reverse transcription PCR. Subgenomic reverse transcription PCR suggested viral replication in lung/airway, heart, and liver. These findings indicate that in utero SARS-CoV-2 transmission contributed to this neonatal death.
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Affiliation(s)
| | | | - Roosecelis B. Martines
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Nicholas S. Milligan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Carly Gisondo
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Frank B. Williams
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Elizabeth Lee
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Lindsey Estetter
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Hannah Bullock
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Cynthia S. Goldsmith
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Pamela Fair
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Julie Hand
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Gillian Richardson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Kate R. Woodworth
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Titilope Oduyebo
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Romeo R. Galang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Rebecca Phillips
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Elizaveta Belyaeva
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Xiao-Ming Yin
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Dana Meaney-Delman
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Timothy M. Uyeki
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Drucilla J. Roberts
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
| | - Sherif R. Zaki
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Reagan-Steiner, J. Bhatnagar, R.B. Martines, E. Lee, L. Estetter, H. Bullock, C.S. Goldsmith, P. Fair, K.R. Woodworth, T. Oduyebo, R.R. Galang, D. Meaney-Delman, T.M. Uyeki, S.R. Zaki)
- Tulane University School of Medicine, New Orleans, Louisiana, USA (N.S. Milligan, E. Belyaeva, X.-M. Yin)
- Oschner Health, New Orleans (C. Gisondo, F.B. Williams, R. Phillips)
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA (E. Lee)
- Synergy America, Inc., Duluth, Georgia, USA (L. Estetter, H. Bullock)
- Louisiana Department of Health, Baton Rouge, Louisiana, USA (J. Hand, G. Richardson)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D.J. Roberts)
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Stillbirth after COVID-19 in Unvaccinated Mothers Can Result from SARS-CoV-2 Placentitis, Placental Insufficiency, and Hypoxic Ischemic Fetal Demise, Not Direct Fetal Infection: Potential Role of Maternal Vaccination in Pregnancy. Viruses 2022; 14:v14030458. [PMID: 35336864 PMCID: PMC8950737 DOI: 10.3390/v14030458] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
Stillbirth is a recently recognized complication of COVID-19 in pregnant women. Other congenitally transmitted infections from viruses, bacteria and parasites can cause stillbirth by infecting fetal organs following transplacental transmission of the agent from the maternal bloodstream. However, recent research on pregnant women with COVID-19 having stillbirths indicates that there is another mechanism of stillbirth that can occur in placentas infected with SARS-CoV-2. In these cases, viral infection of the placenta results in SARS-CoV-2 placentitis, a combination of concurrent destructive findings that include increased fibrin deposition which typically reaches the level of massive perivillous fibrin deposition, chronic histiocytic intervillositis and trophoblast necrosis. These three pathological lesions, in some cases together with placental hemorrhage, thrombohematomas and villitis, result in severe and diffuse placental parenchymal destruction. This pathology can involve greater than one-half of the placental volume, averaging 77% in the largest study of 68 cases, effectively rendering the placenta incapable of performing its function of oxygenating the fetus. This destructive placental process can lead to stillbirth and neonatal death via malperfusion and placental insufficiency which is independent of fetal infection. Fetal autopsies show no evidence that direct infection of fetal organs is contributory. Because all mothers examined have been unvaccinated, maternal vaccination may prevent viremia and consequent placental infection.
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Placental SARS-CoV-2 distribution correlates with level of tissue oxygenation in COVID-19-associated necrotizing histiocytic intervillositis/perivillous fibrin deposition. Placenta 2022; 117:187-193. [PMID: 34929459 PMCID: PMC8638245 DOI: 10.1016/j.placenta.2021.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/12/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
Introduction Recent evidence supports the – rare – occurrence of vertical transplacental SARS-CoV-2 transmission. We previously determined that placental expression of angiotensin-converting enzyme 2 (ACE2), the SARS-CoV-2 receptor, and associated viral cell entry regulators is upregulated by hypoxia. In the present study, we utilized a clinically relevant model of SARS-CoV-2-associated chronic histiocytic intervillositis/massive perivillous fibrin deposition (CHIV/MPFVD) to test the hypothesis that placental hypoxia may facilitate placental SARS-CoV-2 infection. Methods We performed a comparative immunohistochemical and/or RNAscope in-situ hybridization analysis of carbonic anhydrase IX (CAIX, hypoxia marker), ACE2 and SARS-CoV-2 expression in free-floating versus fibrin-encased chorionic villi in a 20-weeks’ gestation placenta with SARS-CoV-2-associated CHIV/MPVFD. Results The levels of CAIX and ACE2 immunoreactivity were significantly higher in trophoblastic cells of fibrin-encased villi than in those of free-floating villi, consistent with hypoxia-induced ACE2 upregulation. SARS-CoV-2 showed a similar preferential localization to trophoblastic cells of fibrin-encased villi. Discussion The localization of SARS-CoV-2 to hypoxic, fibrin-encased villi in this placenta with CHIV/MPVFD suggests placental infection and, therefore, transplacental SARS-CoV-2 transmission may be promoted by hypoxic conditions, mediated by ACE2 and similar hypoxia-sensitive viral cell entry mechanisms. Understanding of a causative link between placental hypoxia and SARS-CoV-2 transmittability may potentially lead to the development of alternative strategies for prevention of intrauterine COVID-19 transmission.
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Duarte BDP, Krebs VLJ, Calil VMLT, de Carvalho WB, Gibelli MABC, Francisco RPV. Clinical characteristics and evolution of 71 neonates born to mothers with COVID-19 at a tertiary center in Brazil. Clinics (Sao Paulo) 2022; 77:100136. [PMID: 36403430 PMCID: PMC9626400 DOI: 10.1016/j.clinsp.2022.100136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Limited data are available on pregnant women with COVID-19 and their neonates. OBJECTIVE This study aimed to describe clinical characteristics and evolution from birth to discharge of a retrospective cohort of 71 neonates, with one set of twins, born to women with COVID-19 diagnosed at the end of pregnancy. The authors included all newborns admitted into a neonatal unit of a tertiary hospital in Brazil, between March 2020 and March 2021, whose unvaccinated mothers had COVID-19 symptoms and RT-PCR (Real-Time Polymerase Chain Reaction) for SARS-CoV-2 positive within fourteen days prior to delivery. Newborns to mothers with COVID-19 symptoms and negative tests for SARS-CoV-2 were excluded. RESULTS The main route of birth delivery was cesarean, corresponding to 60 pregnant women (84.5%). The foremost indications for cesarean were pregnant with critical disease (24.6%) and acute fetal distress (20.3%). The mean birth weight was 2452 g (865‒3870 g) and the mean gestational age was 345/7 weeks (25‒40 weeks). There were 45 premature newborns (63.3%), of which 21 newborns (29.5%) were less than 32 weeks of gestational age. RT-PCR for SARS-CoV-2 on oropharyngeal swabs was positive in 2 newborns (2.8%) and negative in the other 69 newborns (97.2%). Most newborns (51.4%) needed respiratory support. Therapeutic interventions during hospitalization were inotropic drugs (9.9%), antibiotics (22.8%), parenteral nutrition (26.8%), and phototherapy (46.5%). CONCLUSION Maternal COVID-19 diagnosticated close to delivery has an impact on the first days of neonatal life.
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Affiliation(s)
- Bruna de Paula Duarte
- Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Vera Lucia Jornada Krebs
- Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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28
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A Neonate With Vertical Transmission of COVID-19 and Acute Respiratory Failure: A Case Report. Adv Neonatal Care 2021; 21:482-492. [PMID: 34596092 DOI: 10.1097/anc.0000000000000954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This case describes a case of vertical transmission of COVID-19 from a mother to her neonate. The neonate subsequently developed acute respiratory failure consistent with adult symptoms of COVID-19. CLINICAL FINDINGS This preterm neonate was born at 33 4/7 weeks' gestational age to a COVID-19-positive mother and admitted to the neonatal intensive care unit (NICU) for prematurity and respiratory distress. The neonate developed acute respiratory failure with severe persistent pulmonary hypertension of newborn (PPHN) and required intubation and maximum respiratory and cardiovascular support. The neonate subsequently tested positive for COVID-19 at 24 hours of life. PRIMARY DIAGNOSIS Acute respiratory failure related to COVID-19 infection. INTERVENTIONS The neonate was admitted to the NICU on CPAP. At 11 hours of life, the neonate began to exhibit signs of worsening respiratory distress requiring intubation, mechanical, and high frequency ventilation. An echocardiogram revealed severe PPHN. The neonate required dopamine to manage hypotension and was treated with steroids to decrease inflammation associated with airway edema noted during intubation. Pharmaceutically induced paralysis, analgesia, and sedation was used to manage persistent hypoxia. OUTCOMES The neonate fully recovered from acute respiratory failure and was discharged home with the mother. PRACTICE RECOMMENDATIONS Newborns born to mothers who are positive for COVID-19 are at risk for vertical transmission of COVID-19 and should be monitored closely for acute respiratory failure. Respiratory medical management should include supportive care. Staff should also encourage parents to consider receiving the COVID-19 vaccine to protect their newborn from the possibility of developing acute respiratory failure.
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Fabre M, Calvo P, Ruiz-Martinez S, Peran M, Oros D, Medel-Martinez A, Strunk M, Benito Ruesca R, Schoorlemmer J, Paules C. Frequent Placental SARS-CoV-2 in Patients with COVID-19-Associated Hypertensive Disorders of Pregnancy. Fetal Diagn Ther 2021; 48:801-811. [PMID: 34794139 PMCID: PMC8678236 DOI: 10.1159/000520179] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
Introduction Studies described an increased frequency of hypertensive disorders of pregnancy (HDP) after a COVID-19 episode. There is limited evidence about SARS-CoV-2 viral load in placenta. This study aimed to investigate the relationship between SARS-CoV-2 viral load in the placenta and clinical development of HDP after COVID-19 throughout different periods of gestation. Methods This is a case-control study in women with and without gestational hypertensive disorders after SARS-CoV-2 infection diagnosed by RT-PCR during pregnancy. Patients were matched by gestational age at the moment of COVID-19 diagnosis. We performed an analysis of SARS-CoV-2 RNA levels in placenta. Results A total of 28 women were enrolled. Sixteen patients were diagnosed with COVID-19 during the third trimester and the remaining 12 patients in the other trimesters. Ten placentas (35.7%) were positive for SARS-CoV-2, 9 of them (9/14, 64.3%) belonged to the HDP group versus 1 (1/14, 7.2%) in the control group (p = 0.009). Those cases with the highest loads of viral RNA developed severe preeclampsia (PE). Conclusion Among women diagnosed with COVID-19 during pregnancy, the presence of SARS-CoV-2 in the placenta was more frequent among women suffering from PE or gestational hypertension. Furthermore, the most severe cases of HDP were associated with high placental viral load, not necessarily associated with a positive nasopharyngeal RT-PCR at delivery. Our data suggest that SARS-CoV-2 infection during pregnancy could trigger gestational hypertensive disorders through persistent placental infection and resulting placental damage.
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Affiliation(s)
- Marta Fabre
- Instituto de Investigación Sanitario de Aragón (IIS Aragon) Biochemistry Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain, .,Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain,
| | - Pilar Calvo
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto de Investigación Sanitario de Aragón (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Sara Ruiz-Martinez
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto de Investigación Sanitario de Aragón (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain.,Red de Salud Materno Infantil y Del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de La Investigación y Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0013, Zaragoza, Spain
| | - Maria Peran
- Instituto de Investigación Sanitario de Aragón (IIS Aragon) Biochemistry Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain.,Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain
| | - Daniel Oros
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto de Investigación Sanitario de Aragón (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain.,Red de Salud Materno Infantil y Del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de La Investigación y Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0013, Zaragoza, Spain
| | - Ana Medel-Martinez
- Laboratorio Satélite, Instituto Aragonés de Ciencias de La Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain
| | - Mark Strunk
- Laboratorio Satélite, Instituto Aragonés de Ciencias de La Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain.,Sequencing and Functional Genomics, Instituto Aragonés de Ciencias de La Salud (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain
| | - Rafael Benito Ruesca
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain, Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain
| | - Jon Schoorlemmer
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto Aragonés de Ciencias de La Salud (IACS), Zaragoza, Spain.,ARAID Foundation, Zaragoza, Spain
| | - Cristina Paules
- Placental Pathophysiology & Fetal Programming Research Group, B46_20R & GIIS-028 Del IISA, Instituto de Investigación Sanitario de Aragón (IIS Aragon), Zaragoza, Spain.,Instituto de Investigación Sanitario de Aragón (IIS Aragon), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain.,Red de Salud Materno Infantil y Del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de La Investigación y Fondo Europeo de Desarrollo Regional (FEDER) Ref: RD16/0022/0013, Zaragoza, Spain
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30
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Feist H, Bajwa S, Pecks U. Hypertensive disease, preterm birth, fetal growth restriction and chronic inflammatory disorders of the placenta: experiences in a single institution with a standardized protocol of investigation. Arch Gynecol Obstet 2021; 306:337-347. [PMID: 34693459 DOI: 10.1007/s00404-021-06293-3] [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: 05/09/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Chronic inflammatory disorders of the placenta, in particular villitis of unknown etiology (VUE), chronic deciduitis (CD), chronic chorioamnionitis (CC), chronic histiocytic intervillositis (CHI), and eosinophilic/T-cell chorionic vasculitis (ETCV) can exclusively be diagnosed histologically. Using a standardized procedure for submission and pathological-anatomical examination of placentas in a single perinatal care center, we analyzed the association of chronic placental lesions to perinatal complications. METHODS We reviewed all singleton placentas and miscarriages that were examined histologically over a period of ten years after having implemented a standardized protocol for placental submission in our hospital. Cases with chronic inflammatory lesions were identified, and clinical data were analyzed and compared with a focus on preterm birth, hypertensive disorders, and fetal growth restriction and/or fetal demise. RESULTS In 174 placentas, at least one of the chronic inflammatory entities was diagnosed. CD was the most frequent disorder (n = 95), and had strong associations with preterm birth (47.3% of all cases with CD) and intrauterine fetal demise. VUE (n = 74) was exclusively diagnosed in the third trimester. This disorder was associated with a birth weight below the 10th percentile (45% of the cases) and hypertensive disease in pregnancy. Miscarriage and intrauterine fetal demise were associated with CHI (in 66.7% of cases, n = 18). CONCLUSIONS Chronic inflammatory disorders are frequently observed and contribute to major obstetric and perinatal complications. Further studies are needed to get a better picture of the connection between adverse obstetric outcomes and chronic inflammation to aid in the better counseling of patients.
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Affiliation(s)
- Henning Feist
- Department of Pathology, Diakonissenkrankenhaus Flensburg, Knuthstraße 1, 24939, Flensburg, Germany.
| | - Simin Bajwa
- Department of Obstetrics and Gynecology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
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31
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Lesieur E, Torrents J, Fina F, Zandotti C, Blanc J, Collardeau-Frachon S, Gazin C, Sirgant D, Mezouar S, Otmani Idrissi M, Lepidi H, Bretelle F, Mege JL, Daniel L, Fritih R. Congenital Infection of Severe Acute Respiratory Syndrome Coronavirus 2 With Intrauterine Fetal Death: A Clinicopathological Study With Molecular Analysis. Clin Infect Dis 2021; 75:e1092-e1100. [PMID: 34553751 PMCID: PMC8500004 DOI: 10.1093/cid/ciab840] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Observations of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from mother to fetus have recently been described in the literature. However, the consequences of such transmission, whether fetal or neonatal, are poorly understood. METHODS From a case of in utero fetal death at 24+2 weeks of gestation that occurred 7 days after the diagnosis of symptomatic SARS-CoV-2 infection in the mother, we isolated the incriminating virus by immunochemistry and molecular techniques in several fetal tissues, with a variant analysis of the SARS-CoV-2 genome. RESULTS The fetal demise could be explained by the presence of placental histological lesions, such as histiocytic intervillositis and trophoblastic necrosis, in addition to fetal tissue damage. We observed mild fetal growth retardation and visceral damage to the liver, causing hepatocellular damage and hemosiderosis. To the best of our knowledge, this is the first report in the literature of fetal demise secondary to maternal-fetal transmission of SARSCoV- 2 with a congenital infection and a pathological description of placental and fetal tissue damage. CONCLUSIONS SARS-CoV-2 was identified in both specimens using 3 independent techniques (immunochemistry, real-time quantitative polymerase chain reaction, and realtime digital polymerase chain reaction). Furthermore, the incriminating variant has been identified.
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Affiliation(s)
- Emmanuelle Lesieur
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France,Prenatal Diagnosis Center, Department of Obstetrics and Gynaecology, La Conception Hospital, Aix Marseille University, Boulevard Baille, 13005 Marseille, France,Correspondence: Dr. Emmanuelle Lesieur, Prenatal Diagnosis Center, Department of Obstetrics and Gynaecology, La Conception Hospital, Aix Marseille University, Boulevard Baille, 13005 Marseille. Phone: + 33 491 384 257, mail:
| | - Julia Torrents
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France
| | - Frédéric Fina
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France,ID Solutions, Grabels, France
| | - Christine Zandotti
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Julie Blanc
- Department of Obstetrics and Gynaecology, Nord Hospital, APHM, Chemin des Bourrely, 13015, Marseille, France,EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, 13284, Marseille, France
| | - Sophie Collardeau-Frachon
- Institut de Pathologie Multisite, Groupement Hospitalier Est, Hospices Civils de Lyon, France; Université Claude Bernard Lyon 1, France
| | - Céline Gazin
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Delphine Sirgant
- Department of Obstetrics and Gynaecology, Ste Musse Hospital, 54, rue Henri Sainte Claire Deville, 83000, Toulon, France
| | - Soraya Mezouar
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Myriem Otmani Idrissi
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Hubert Lepidi
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France
| | - Florence Bretelle
- Prenatal Diagnosis Center, Department of Obstetrics and Gynaecology, La Conception Hospital, Aix Marseille University, Boulevard Baille, 13005 Marseille, France,Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Jean-Louis Mege
- IHU Méditerranée infection MEPHI - Aix-Marseille Université – 13005 Marseille, France - IRD – APHM
| | - Laurent Daniel
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France,Aix Marseille University - INSERM 1263 - INRAE 1260, France
| | - Radia Fritih
- Department of Pathology and Neuropathology, La Timone Hospital, Aix Marseille, University, Marseille, France
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Meyer JA, Roman AS, Limaye M, Grossman TB, Flaifel A, Vaz MJ, Thomas KM, Penfield CA. Association of SARS-CoV-2 placental histopathology findings with maternal-fetal comorbidities and severity of COVID-19 hypoxia. J Matern Fetal Neonatal Med 2021; 35:8412-8418. [PMID: 34542385 DOI: 10.1080/14767058.2021.1977791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE SARS-CoV-2 is known to impact multiple organ systems, with growing data to suggest the potential for placental infection and resultant pathology. Understanding how maternal COVID-19 disease can affect placental histopathology has been limited by small study cohorts with mild disease, review by multiple pathologists, and potential confounding by maternal-fetal comorbidities that can also influence placental findings. This study aims to identify pathologic placental findings associated with COVID-19 disease and severity, as well as to distinguish them from changes related to coexisting maternal-fetal comorbidities. METHODS This is an observational study of 61 pregnant women with confirmed SARS-CoV-2 infection who delivered and had a placental histological evaluation at NYU Langone Health between March 19, 2020 and June 30, 2020. Primary outcomes were the prevalence of placental histopathologic features and their association with maternal-fetal comorbidities and severity of COVID-19 related hypoxia. Analysis was performed using Fisher's exact test and t-test with p < 0.05 considered significant. RESULTS Sixty-one placentas were included in the study cohort, 71% from pregnancies complicated by at least one maternal-fetal comorbidity. Twenty-five percent of placentas were small for gestational age and 77% exhibited at least one feature of maternal vascular malperfusion. None of the histopathologic features in the examined placentas were associated with the presence of any specific maternal-fetal comorbidity. Thirteen percent of the cohort required maternal respiratory support for COVID-19 related hypoxia. Villous trophoblast necrosis was associated with maternal supplemental oxygen requirement (67 vs. 33%, p = 0.04) and intubation (67 vs. 33%, p = 0.01). CONCLUSION In pregnancies complicated by COVID-19 disease, there was a high prevalence of placental histopathologic changes identified, particularly features of maternal vascular malperfusion, which could not be attributed solely to the presence of maternal-fetal comorbidities. The significantly increased prevalence of villous trophoblast necrosis in women needing respiratory support suggests a connection to the severity of COVID-19 illness.
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Affiliation(s)
- Jessica A Meyer
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Ashley S Roman
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Meghana Limaye
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Tracy B Grossman
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
| | - Abdallah Flaifel
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Michelle J Vaz
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Kristen M Thomas
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
| | - Christina A Penfield
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA
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Schwartz DA, Bugatti M, Santoro A, Facchetti F. Molecular Pathology Demonstration of SARS-CoV-2 in Cytotrophoblast from Placental Tissue with Chronic Histiocytic Intervillositis, Trophoblast Necrosis and COVID-19. J Dev Biol 2021; 9:33. [PMID: 34449643 PMCID: PMC8395857 DOI: 10.3390/jdb9030033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022] Open
Abstract
A subset of placentas from pregnant women having the SARS-CoV-2 infection have been found to be infected with the coronavirus using molecular pathology methods including immunohistochemistry and RNA in situ hybridization. These infected placentas can demonstrate several unusual findings which occur together-chronic histiocytic intervillositis, trophoblast necrosis and positive staining of the syncytiotrophoblast for SARS-CoV-2. They frequently also have increased fibrin deposition, which can be massive in some cases. Syncytiotrophoblast is the most frequent fetal-derived cell type to be positive for SARS-CoV-2. It has recently been shown that in a small number of infected placentas, villous stromal macrophages, termed Hofbauer cells, and villous capillary endothelial cells can also stain positive for SARS-CoV-2. This report describes a placenta from a pregnant woman with SARS-CoV-2 that had chronic histiocytic intervillositis, trophoblast necrosis, increased fibrin deposition and positive staining of the syncytiotrophoblast for SARS-CoV-2. In addition, molecular pathology testing including RNAscope and immunohistochemistry for SARS-CoV-2 and double-staining immunohistochemistry using antibodies to E-cadherin and GATA3 revealed that cytotrophoblast cells stained intensely for SARS-CoV-2. All of the cytotrophoblast cells that demonstrated positive staining for SARS-CoV-2 were in direct physical contact with overlying syncytiotrophoblast that also stained positive for the virus. The pattern of cytotrophoblast staining for SARS-CoV-2 was patchy, and there were chorionic villi having diffuse positive staining of the syncytiotrophoblast for SARS-CoV-2, but without staining of cytotrophoblast. This first detailed description of cytotrophoblast involvement by SARS-CoV-2 adds another fetal cell type from infected placentas that demonstrate viral staining.
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Affiliation(s)
- David A. Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Mattia Bugatti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.B.); (A.S.); (F.F.)
| | - Amerigo Santoro
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.B.); (A.S.); (F.F.)
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.B.); (A.S.); (F.F.)
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Azinheira Nobrega Cruz N, Stoll D, Casarini D, Bertagnolli M. Role of ACE2 in pregnancy and potential implications for COVID-19 susceptibility. Clin Sci (Lond) 2021; 135:1805-1824. [PMID: 34338772 PMCID: PMC8329853 DOI: 10.1042/cs20210284] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023]
Abstract
In times of coronavirus disease 2019 (COVID-19), the impact of severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 infection on pregnancy is still unclear. The presence of angiotensin-converting enzyme (ACE) 2 (ACE2), the main receptor for SARS-CoV-2, in human placentas indicates that this organ can be vulnerable for viral infection during pregnancy. However, for this to happen, additional molecular processes are critical to allow viral entry in cells, its replication and disease manifestation, particularly in the placenta and/or feto-maternal circulation. Beyond the risk of vertical transmission, COVID-19 is also proposed to deplete ACE2 protein and its biological actions in the placenta. It is postulated that such effects may impair essential processes during placentation and maternal hemodynamic adaptations in COVID-19 pregnancy, features also observed in several disorders of pregnancy. This review gathers information indicating risks and protective features related to ACE2 changes in COVID-19 pregnancies. First, we describe the mechanisms of SARS-CoV-2 infection having ACE2 as a main entry door and current evidence of viral infection in the placenta. Further, we discuss the central role of ACE2 in physiological systems such as the renin-angiotensin system (RAS) and the kallikrein-kinin system (KKS), both active during placentation and hemodynamic adaptations of pregnancy. Significant knowledge gaps are also identified and should be urgently filled to better understand the fate of ACE2 in COVID-19 pregnancies and the potential associated risks. Emerging knowledge will be able to improve the early stratification of high-risk pregnancies with COVID-19 exposure as well as to guide better management and follow-up of these mothers and their children.
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Affiliation(s)
- Nayara Azinheira Nobrega Cruz
- Department of Medicine, Discipline of Nephrology, Federal University of Sao Paulo, São Paulo, Brazil
- Research Center of the Hospital Sacré-Coeur, CIUSSS Nord-de-l’Île-de-Montréal, Montréal, Canada
| | - Danielle Stoll
- Department of Medicine, Discipline of Nephrology, Federal University of Sao Paulo, São Paulo, Brazil
| | - Dulce Elena Casarini
- Department of Medicine, Discipline of Nephrology, Federal University of Sao Paulo, São Paulo, Brazil
| | - Mariane Bertagnolli
- Research Center of the Hospital Sacré-Coeur, CIUSSS Nord-de-l’Île-de-Montréal, Montréal, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, Canada
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35
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Schwartz DA, Baldewijns M, Benachi A, Bugatti M, Bulfamante G, Cheng K, Collins RRJ, Debelenko L, De Luca D, Facchetti F, Fitzgerald B, Levitan D, Linn RL, Marcelis L, Morotti D, Morotti R, Patanè L, Prevot S, Pulinx B, Saad AG, Schoenmakers S, Strybol D, Thomas K, Tosi D, Toto V, van der Meeren LE, Verdijk RM, Vivanti AJ, Zaigham M. Hofbauer cells and coronavirus disease 2019 (COVID-19) in pregnancy: Molecular pathology analysis of villous macrophages, endothelial cells, and placental findings from 22 placentas infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with and without fetal transmission. Arch Pathol Lab Med 2021; 145:1328-1340. [PMID: 34297794 DOI: 10.5858/arpa.2021-0296-sa] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can undergo maternal-fetal transmission, heightening interest in the placental pathology findings from this infection. Transplacental SARS-CoV-2 transmission is typically accompanied by chronic histiocytic intervillositis together with necrosis and positivity of syncytiotrophoblast for SARSCoV-2. Hofbauer cells are placental macrophages that have been involved in viral diseases including HIV and Zika virus, but their involvement in SARS-CoV-2 in unknown. OBJECTIVE - To determine whether SARS-CoV-2 can extend beyond the syncytiotrophoblast to enter Hofbauer cells, endothelium and other villous stromal cells in infected placentas of liveborn and stillborn infants. DESIGN - Case-based retrospective analysis by 29 perinatal and molecular pathology specialists of placental findings from a preselected cohort of 22 SARS-CoV-2-infected placentas delivered to pregnant women testing positive for SARS-CoV-2 from 7 countries. Molecular pathology methods were used to investigate viral involvement of Hofbauer cells, villous capillary endothelium, syncytiotrophoblast and other fetal-derived cells. RESULTS - Chronic histiocytic intervillositis and trophoblast necrosis was present in all 22 placentas (100%). SARS-CoV-2 was identified in Hofbauer cells from 4/22 placentas (18%). Villous capillary endothelial staining was positive in 2/22 cases (9%), both of which also had viral positivity in Hofbauer cells. Syncytiotrophoblast staining occurred in 21/22 placentas (95%). Hofbauer cell hyperplasia was present in 3/22 placentas (14%). In the 7 cases having documented transplacental infection of the fetus, 2 occurred in placentas with Hofbauer cell staining positive for SARS-CoV-2. CONCLUSIONS - SARS-CoV-2 can extend beyond the trophoblast into the villous stroma, involving Hofbauer cells and capillary endothelial cells, in a small number of infected placentas. Most cases of SARS-CoV-2 transplacental fetal infection occur without Hofbauer cell involvement.
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Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA
| | | | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, Clamart, France
| | - Mattia Bugatti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Gaetano Bulfamante
- Hospital Complex for Pathological Anatomy and Medical Genetics, ASST Santi Paolo e Carlo, Milan, Italy Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Rebecca R J Collins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Larisa Debelenko
- Department of Pediatric and Perinatal Pathology, Columbia University Medical Center, New York, NY
| | - Danièle De Luca
- Neonatology Division of Pediatrics, Transportation and Neonatal Critical Care APHP, Paris Saclay University Hospitals, Medical Center "A.Béclère" & Physiopathology and Therapeutic Innovation Unit, Paris-Saclay University, Paris, France
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Brendan Fitzgerald
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - Daniel Levitan
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Rebecca L Linn
- Department of Pathology & Lab Medicine, Perelman School of Medicine at the University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Denise Morotti
- Pathology Unit and Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raffaella Morotti
- Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, CT
| | - Luisa Patanè
- Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sophie Prevot
- Division of Pathology, Bicêtre Hospital, Paris Saclay University Hospitals, APHP, Le Kremlin-Bicêtre, France
| | - Bianca Pulinx
- Department of Clinical Biology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Ali G Saad
- Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, FL
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - David Strybol
- Department of Pathology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Kristen Thomas
- Department of Pathology, NYU Langone Health, Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, NY
| | - Delfina Tosi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Valentina Toto
- Hospital Complex for Pathological Anatomy and Medical Genetics, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, and Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, APHP, Université Paris Saclay, Clamart, France
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Skåne University Hospital, Malmö, Sweden and Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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36
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Mirbeyk M, Saghazadeh A, Rezaei N. A systematic review of pregnant women with COVID-19 and their neonates. Arch Gynecol Obstet 2021; 304:5-38. [PMID: 33797605 PMCID: PMC8017514 DOI: 10.1007/s00404-021-06049-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In December 2019, a novel coronavirus disease (COVID-19) emerged in Wuhan, China, with an incredible contagion rate. However, the vertical transmission of COVID-19 is uncertain. OBJECTIVES This is a systematic review of published studies concerning pregnant women with confirmed COVID-19 and their neonates. SEARCH STRATEGY We carried out a systematic search in multiple databases, including PubMed, Web of Science, Google Scholar, Scopus, and WHO COVID-19 database using the following keywords: (Coronavirus) OR (novel coronavirus) OR (COVID-19) OR (COVID19) OR (COVID 19) OR (SARS-CoV2) OR (2019-nCoV)) and ((pregnancy) OR (pregnant) OR (vertical transmission) OR (neonate) OR (newborn) OR (placenta) OR (fetus) OR (Fetal)). The search took place in April 2020. SELECTION CRITERIA Original articles published in English were eligible if they included pregnant patients infected with COVID-19 and their newborns. DATA COLLECTION AND ANALYSES The outcomes of interest consisted of clinical manifestations of COVID-19 in pregnant patients with COVID-19 and also the effect of COVID-19 on neonatal and pregnancy outcomes. MAIN RESULTS 37 articles involving 364 pregnant women with COVID-19 and 302 neonates were included. The vast majority of pregnant patients were in their third trimester of pregnancy, and only 45 cases were in the first or second trimester (12.4%). Most mothers described mild to moderate manifestations of COVID-19. Of 364 pregnant women, 25 were asymptomatic at the time of admission. The most common symptoms were fever (62.4%) and cough (45.3%). Two maternal deaths occurred. Some pregnant patients (12.1%) had a negative SARS-CoV-2 test but displayed clinical manifestations and abnormalities in computed tomography (CT) scan related to COVID-19. Twenty-two (6.0%) pregnant patients developed severe pneumonia. Two maternal deaths occurred from severe pneumonia and multiple organ dysfunction. Studies included a total of 302 neonates from mothers with COVID-19. Of the studies that provided data on the timing of birth, there were 65 (23.6%) preterm neonates. One baby was born dead from a mother who also died from COVID-19. Of the babies born alive from mothers with COVID-19, five newborns faced critical conditions, and two later died. A total of 219 neonates underwent nasopharyngeal specimen collection for SARS-CoV-2, of which 11 tested positive (5%). Seventeen studies examined samples of the placenta, breast milk, umbilical cord, and amniotic fluid, and all tested negative except one amniotic fluid sample. CONCLUSIONS A systematic review of published studies confirm that the course of COVID-19 in pregnant women resembles that of other populations. However, there is not sufficient evidence to establish an idea that COVID-19 would not complicate pregnancy.
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Affiliation(s)
- Mona Mirbeyk
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amene Saghazadeh
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Children's Medical Center Hospital, Dr. Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.
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Colson A, Depoix CL, Dessilly G, Baldin P, Danhaive O, Hubinont C, Sonveaux P, Debiève F. Clinical and in Vitro Evidence against Placenta Infection at Term by Severe Acute Respiratory Syndrome Coronavirus 2. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1610-1623. [PMID: 34111431 PMCID: PMC8184362 DOI: 10.1016/j.ajpath.2021.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
Despite occasional reports of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy, the question of placental infection and its consequences for the newborn remain unanswered. Herein, we analyzed the placentas of 31 coronavirus disease 2019–positive mothers by reverse transcriptase PCR, immunohistochemistry, and in situ hybridization. Only one case of placental infection was detected, which was associated with intrauterine demise of the fetus. Differentiated primary trophoblasts were then isolated from nonpathologic human placentas at term, differentiated, and exposed to SARS-CoV-2 virions. Unlike for positive control cells Vero E6, the virus inside cytotrophoblasts and syncytiotrophoblasts or in the supernatant 4 days after infection was undetectable. As a mechanism of defense, we hypothesized that trophoblasts at term do not express angiotensin-converting enzyme 2 and transmembrane protease serine 2 (TMPRSS2), the two main host membrane receptors for SARS-CoV-2 entry. The quantification of these proteins in the placenta during pregnancy confirmed the absence of TMPRSS2 at the surface of the syncytium. Surprisingly, a transiently induced experimental expression of TMPRSS2 did not allow the entry or replication of the virus in differentiated trophoblasts. Altogether, these results underline that trophoblasts are not likely to be infected by SARS-CoV-2 at term, but raise concern about preterm infection.
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Affiliation(s)
- Arthur Colson
- Pole of Obstetrics, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Obstetrics, Saint-Luc University Hospital, Brussels, Belgium.
| | - Christophe L Depoix
- Pole of Obstetrics, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Géraldine Dessilly
- Medical Microbiology, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Pamela Baldin
- Department of Pathology, Saint-Luc University Hospital, Brussels, Belgium
| | - Olivier Danhaive
- Division of Neonatology, Saint-Luc University Hospital, Brussels, Belgium; Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Corinne Hubinont
- Pole of Obstetrics, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Obstetrics, Saint-Luc University Hospital, Brussels, Belgium
| | - Pierre Sonveaux
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Frédéric Debiève
- Pole of Obstetrics, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Obstetrics, Saint-Luc University Hospital, Brussels, Belgium
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Rebutini PZ, Zanchettin AC, Stonoga ETS, Prá DMM, de Oliveira ALP, Dezidério FDS, Fonseca AS, Dagostini JCH, Hlatchuk EC, Furuie IN, Longo JDS, Cavalli BM, Dino CLT, Dias VMDCH, Percicote AP, Nogueira MB, Raboni SM, de Carvalho NS, Machado-Souza C, de Noronha L. Association Between COVID-19 Pregnant Women Symptoms Severity and Placental Morphologic Features. Front Immunol 2021; 12:685919. [PMID: 34122449 PMCID: PMC8187864 DOI: 10.3389/fimmu.2021.685919] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
Since the beginning of the pandemic, few papers describe the placenta’s morphological and morphometrical features in SARS-CoV-2–positive pregnant women. Alterations, such as low placental weight, accelerated villous maturation, decidual vasculopathy, infarcts, thrombosis of fetal placental vessels, and chronic histiocytic intervillositis (CHI), have been described.
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Affiliation(s)
- Patricia Zadorosnei Rebutini
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil
| | - Aline Cristina Zanchettin
- Postgraduate Program in Biotechnology Applied in Health of Children and Adolescent, Pelé Pequeno Príncipe, Research Institute, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | | | - Daniele Margarita Marani Prá
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil
| | | | - Felipe da Silva Dezidério
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil
| | - Aline Simoneti Fonseca
- Postgraduate Program in Biotechnology Applied in Health of Children and Adolescent, Pelé Pequeno Príncipe, Research Institute, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | | | - Elisa Carolina Hlatchuk
- Department of Medical Pathology, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Isabella Naomi Furuie
- Department of Tocogynecology, Clinical Hospital, Universidade Federal do Paraná, UFPR, Curitiba, Brazil
| | - Jessica da Silva Longo
- Department of Tocogynecology, Clinical Hospital, Universidade Federal do Paraná, UFPR, Curitiba, Brazil
| | - Bárbara Maria Cavalli
- Postgraduate Program of Tocogynecology and Women's Health, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Carolina Lumi Tanaka Dino
- Postgraduate Program of Tocogynecology and Women's Health, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | | | - Ana Paula Percicote
- Department of Medical Pathology, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Meri Bordignon Nogueira
- Postgraduate Program of Tocogynecology and Women's Health, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil.,Virology Laboratory, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Sonia Mara Raboni
- Department of Infectious Disease, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Newton Sergio de Carvalho
- Postgraduate Program of Tocogynecology and Women's Health, Clinical Hospital, Universidade Federal do Paraná-UFPR, Curitiba, Brazil
| | - Cleber Machado-Souza
- Postgraduate Program in Biotechnology Applied in Health of Children and Adolescent, Pelé Pequeno Príncipe, Research Institute, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Lucia de Noronha
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Brazil
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39
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Schwartz DA, Dhaliwal A. Coronavirus Diseases in Pregnant Women, the Placenta, Fetus, and Neonate. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:223-241. [PMID: 33973182 DOI: 10.1007/978-3-030-63761-3_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the etiological agent of coronavirus disease 2019 (COVID-19), is similar to two other coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), in causing life-threatening respiratory infections and systemic complications in both children and adults. As the COVID-19 pandemic has continued to spread globally, increasing numbers of pregnant women have become infected, raising concern not only for their health but also for the health of their infants. This chapter discusses the effects of coronavirus infections, e.g., MERS, SARS, and COVID 19, on pregnancy and describes the evolving knowledge of COVID 19 among pregnant women. The physiological changes that occur in pregnancy, especially changes in the immune system, are reviewed in terms of their effect on susceptibility to infectious diseases. The effects of COVID-19 on the placenta, fetus, and neonate are also reviewed, including potential clinical outcomes and issues relating to testing and diagnosis. The potential mechanisms of vertical transmission of the virus between pregnant women and their infants are analyzed, including intrauterine, intrapartum, and postpartum infections. Several recent studies have reported the detection of SARS-CoV-2 in tissues from the fetal side of the placenta, permitting the diagnosis of transplacental infection of the fetus by SARS-CoV-2. Placentas from infected mothers in which intrauterine transplacental transmission of SARS-CoV-2 has occurred demonstrate an unusual combination of pathology findings which may represent risk factors for placental as well as fetal infection.
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Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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40
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Schwartz DA, Baldewijns M, Benachi A, Bugatti M, Collins RRJ, De Luca D, Facchetti F, Linn RL, Marcelis L, Morotti D, Morotti R, Parks WT, Patanè L, Prevot S, Pulinx B, Rajaram V, Strybol D, Thomas K, Vivanti AJ. Chronic Histiocytic Intervillositis With Trophoblast Necrosis Is a Risk Factor Associated With Placental Infection From Coronavirus Disease 2019 (COVID-19) and Intrauterine Maternal-Fetal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission in Live-Born and Stillborn Infants. Arch Pathol Lab Med 2021; 145:517-528. [PMID: 33393592 DOI: 10.5858/arpa.2020-0771-sa] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The number of neonates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection. OBJECTIVE.— To characterize the placental pathology findings in a preselected cohort of neonates infected by transplacental transmission arising from maternal infection with SARS-CoV-2, and to identify pathology risk factors for placental and fetal infection. DESIGN.— Case-based retrospective analysis by a multinational group of 19 perinatal specialists of the placental pathology findings from 2 cohorts of infants delivered to mothers testing positive for SARS-CoV-2: live-born neonates infected via transplacental transmission who tested positive for SARS-CoV-2 after delivery and had SARS-CoV-2 identified in cells of the placental fetal compartment by molecular pathology, and stillborn infants with syncytiotrophoblast positive for SARS-CoV-2. RESULTS.— In placentas from all 6 live-born neonates acquiring SARS-CoV-2 via transplacental transmission, the syncytiotrophoblast was positive for coronavirus using immunohistochemistry, RNA in situ hybridization, or both. All 6 placentas had chronic histiocytic intervillositis and necrosis of the syncytiotrophoblast. The 5 stillborn/terminated infants had placental pathology findings that were similar, including SARS-CoV-2 infection of the syncytiotrophoblast, chronic histiocytic intervillositis, and syncytiotrophoblast necrosis. CONCLUSIONS.— Chronic histiocytic intervillositis together with syncytiotrophoblast necrosis accompanies SARS-CoV-2 infection of syncytiotrophoblast in live-born and stillborn infants. The coexistence of these 2 findings in all placentas from live-born infants acquiring their infection prior to delivery indicates that they constitute a pathology risk factor for transplacental fetal infection. Potential mechanisms of infection of the placenta and fetus with SARS-CoV-2, and potential future studies, are discussed.
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Affiliation(s)
- David A Schwartz
- The Department of Pathology, Medical College of Georgia, Augusta (Schwartz)
| | - Marcella Baldewijns
- The Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns)
| | - Alexandra Benachi
- The Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, Clamart, France (Benachi)
| | - Mattia Bugatti
- The Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (Bugatti)
| | - Rebecca R J Collins
- The Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Collins, Rajaram)
| | - Danièle De Luca
- The Division of Pediatrics, Transportation and Neonatal Critical Care APHP, Paris Saclay University Hospitals, Medical Center "A.Béclère" & Physiopathology and Therapeutic Innovation Unit, Paris-Saclay University, Paris, France (De Luca)
| | - Fabio Facchetti
- The Department of Molecular and Translational Medicine, University of Brescia, Italy (Facchetti)
| | - Rebecca L Linn
- The Department of Pathology, Perelman School of Medicine at the University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia (Linn)
| | - Lukas Marcelis
- The Department of Pathology, UZ Leuven, Leuven, Belgium (Marcelis)
| | - Denise Morotti
- The Pathology Unit and Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy (D Morotti)
| | - Raffaella Morotti
- The Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (R Morotti)
| | - W Tony Parks
- The Department of Pathology and Laboratory Medicine, University of Toronto and Mt Sinai Hospital, Toronto, Ontario, Canada (Parks)
| | - Luisa Patanè
- The Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy (Patanè)
| | - Sophie Prevot
- The Division of Pathology, Bicêtre Hospital, Paris Saclay University Hospitals, APHP, Le Kremlin-Bicêtre, France (Prevot)
| | - Bianca Pulinx
- The Department of Clinical Biology (Pulinx), Sint-Truiden, Belgium
| | - Veena Rajaram
- The Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Collins, Rajaram)
| | - David Strybol
- The Department of Pathology (Strybol), Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Kristen Thomas
- The Department of Pathology, NYU Langone Health-Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, New York (Thomas)
| | - Alexandre J Vivanti
- The Department of Obstetrics and Gynecology, Antoine Béclère Hospital, APHP, Université Paris Saclay, Clamart, France (Vivanti)
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Morfeld P, Timmermann B, Groß JV, Lewis P, Cocco P, Erren TC. COVID-19: Heterogeneous Excess Mortality and "Burden of Disease" in Germany and Italy and Their States and Regions, January-June 2020. Front Public Health 2021; 9:663259. [PMID: 34026717 PMCID: PMC8137836 DOI: 10.3389/fpubh.2021.663259] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Total mortality and "burden of disease" in Germany and Italy and their states and regions were explored during the first COVID-19 wave by using publicly available data for 16 German states and 20 Italian regions from January 2016 to June 2020. Based on expectations from 2016 to 2019, simplified Standardized Mortality Ratios (SMRs) for deaths occurring in the first half of 2020 and the effect of changed excess mortality in terms of "burden of disease" were assessed. Moreover, whether two German states and 19 Italian cities appropriately represent the countries within the European monitoring of excess mortality for public health action (EuroMOMO) network was explored. Significantly elevated SMRs were observed (Germany: week 14-18, Italy: week 11-18) with SMR peaks in week 15 in Germany (1.15, 95%-CI: 1.09-1.21) and in week 13 in Italy (1.79, 95%-CI: 1.75-1.83). Overall, SMRs were 1.00 (95%-CI: 0.97-1.04) in Germany and 1.06 (95%-CI: 1.03-1.10) in Italy. Significant SMR heterogeneity was found within both countries. Age and sex were strong modifiers. Loss of life expectancy was 0.34 days (1.66 days in men) for Germany and 5.3 days (6.3 days in men) for Italy [with upper limits of 3 and 6 weeks among elderly populations (≥65 years) after maximum potential bias adjustments]. Restricted data used within EuroMOMO neither represents mortality in the countries as a whole nor in their states and regions adequately. Mortality analyses with high spatial and temporal resolution are needed to monitor the COVID-19 pandemic's course.
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Affiliation(s)
- Peter Morfeld
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany
| | - Barbara Timmermann
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany
| | - J Valérie Groß
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany
| | - Philip Lewis
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany
| | - Pierluigi Cocco
- Department of Medical Sciences and Public Health, Occupational Medicine Unit, University of Cagliari, Cagliari, Italy
| | - Thomas C Erren
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne, Cologne, Germany
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42
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Schwartz DA, Levitan D. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infecting Pregnant Women and the Fetus, Intrauterine Transmission and Placental Pathology During the Coronavirus Disease 2019 (COVID-19) Pandemic: It's Complicated. Arch Pathol Lab Med 2021; 145:925-928. [PMID: 33878167 DOI: 10.5858/arpa.2021-0164-ed] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA (Schwartz); Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA (Levitan)
| | - Daniel Levitan
- Department of Pathology, Medical College of Georgia, Augusta, GA, USA (Schwartz); Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA (Levitan)
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Molecular Pathology Analysis of SARS-CoV-2 in Syncytiotrophoblast and Hofbauer Cells in Placenta from a Pregnant Woman and Fetus with COVID-19. Pathogens 2021; 10:pathogens10040479. [PMID: 33920814 PMCID: PMC8071113 DOI: 10.3390/pathogens10040479] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/07/2023] Open
Abstract
A small number of neonates delivered to women with SARS-CoV-2 infection have been found to become infected through intrauterine transplacental transmission. These cases are associated with a group of unusual placental pathology abnormalities that include chronic histiocytic intervillositis, syncytiotrophoblast necrosis, and positivity of the syncytiotrophoblast for SARS-CoV-2 antigen or RNA. Hofbauer cells constitute a heterogeneous group of immunologically active macrophages that have been involved in transplacental infections that include such viral agents as Zika virus and human immunodeficiency virus. The role of Hofbauer cells in placental infection with SARS-CoV-2 and maternal-fetal transmission is unknown. This study uses molecular pathology techniques to evaluate the placenta from a neonate infected with SARS-CoV-2 via the transplacental route to determine whether Hofbauer cells have evidence of infection. We found that the placenta had chronic histiocytic intervillositis and syncytiotrophoblast necrosis, with the syncytiotrophoblast demonstrating intense positive staining for SARS-CoV-2. Immunohistochemistry using the macrophage marker CD163, SARS-CoV-2 nucleocapsid protein, and double staining for SARS-CoV-2 with RNAscope and anti-CD163 antibody, revealed that no demonstrable virus could be identified within Hofbauer cells, despite these cells closely approaching the basement membrane zone of the infected trophoblast. Unlike some other viruses, there was no evidence from this transmitting placenta for infection of Hofbauer cells with SARS-CoV-2.
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44
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Minckas N, Medvedev MM, Adejuyigbe EA, Brotherton H, Chellani H, Estifanos AS, Ezeaka C, Gobezayehu AG, Irimu G, Kawaza K, Kumar V, Massawe A, Mazumder S, Mambule I, Medhanyie AA, Molyneux EM, Newton S, Salim N, Tadele H, Tann CJ, Yoshida S, Bahl R, Rao SP, Lawn JE. Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection. EClinicalMedicine 2021; 33:100733. [PMID: 33748724 PMCID: PMC7955179 DOI: 10.1016/j.eclinm.2021.100733] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND COVID-19 is disrupting health services for mothers and newborns, particularly in low- and middle-income countries (LMIC). Preterm newborns are particularly vulnerable. We undertook analyses of the benefits of kangaroo mother care (KMC) on survival among neonates weighing ≤2000 g compared with the risk of SARS-CoV-2 acquired from infected mothers/caregivers. METHODS We modelled two scenarios over 12 months. Scenario 1 compared the survival benefits of KMC with universal coverage (99%) and mortality risk due to COVID-19. Scenario 2 estimated incremental deaths from reduced coverage and complete disruption of KMC. Projections were based on the most recent data for 127 LMICs (~90% of global births), with results aggregated into five regions. FINDINGS Our worst-case scenario (100% transmission) could result in 1,950 neonatal deaths from COVID-19. Conversely, 125,680 neonatal lives could be saved with universal KMC coverage. Hence, the benefit of KMC is 65-fold higher than the mortality risk of COVID-19. If recent evidence of 10% transmission was applied, the ratio would be 630-fold. We estimated a 50% reduction in KMC coverage could result in 12,570 incremental deaths and full disruption could result in 25,140 incremental deaths, representing a 2·3-4·6% increase in neonatal mortality across the 127 countries. INTERPRETATION The survival benefit of KMC far outweighs the small risk of death due to COVID-19. Preterm newborns are at risk, especially in LMICs where the consequences of disruptions are substantial. Policymakers and healthcare professionals need to protect services and ensure clearer messaging to keep mothers and newborns together, even if the mother is SARS-CoV-2-positive. FUNDING Eunice Kennedy Shriver National Institute of Child Health & Human Development; Bill & Melinda Gates Foundation; Elma Philanthropies; Wellcome Trust; and Joint Global Health Trials scheme of Department of Health and Social Care, Department for International Development, Medical Research Council, and Wellcome Trust.
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Affiliation(s)
- Nicole Minckas
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organisation, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | - Melissa M. Medvedev
- Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158, United States
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, United Kingdom
- Corresponding author at: Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158, USA.
| | - Ebunoluwa A. Adejuyigbe
- Department of Paediatrics and Child Health, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria
| | - Helen Brotherton
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, United Kingdom
- Medical Research Council Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Harish Chellani
- Department of Paediatrics, Vardhaman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi 110029, India
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Chinyere Ezeaka
- Department of Paediatrics, University of Lagos College of Medicine and Lagos University Teaching Hospital, P.M.B. 12003, Lagos, Nigeria
| | - Abebe G. Gobezayehu
- Maternal and Newborn Health in Ethiopia Partnership, Emory Ethiopia, P.O. Box 793, Addis Ababa, Ethiopia
| | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi and Kenyatta National Hospital, P.O. Box 19676-00202, Nairobi, Kenya
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Kondwani Kawaza
- Department of Paediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, P.B. 360, Chichiri, Blantyre 3, Malawi
| | - Vishwajeet Kumar
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Lucknow 226001, India
| | - Augustine Massawe
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, 45 Kalu Sarai, New Delhi 110016, India
| | - Ivan Mambule
- Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | | | - Elizabeth M. Molyneux
- Department of Paediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, P.B. 360, Chichiri, Blantyre 3, Malawi
| | - Sam Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, P.M.B. SPH-KNUST, Kumasi 00233, Ghana
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O. Box 78 373, Dar es Salaam, Tanzania
| | - Henok Tadele
- Department of Pediatrics and Child Health, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Cally J. Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, United Kingdom
- Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- Department of Neonatal Medicine, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organisation, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organisation, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | - Suman P.N. Rao
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organisation, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
- Department of Neonatology, St John's Medical College Hospital, Sarjapur Road, Bangalore 560034, India
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, United Kingdom
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Zhang P, Heyman T, Greechan M, Dygulska B, Al Sayyed F, Narula P, Lederman S. Maternal, neonatal and placental characteristics of SARS-CoV-2 positive mothers. J Matern Fetal Neonatal Med 2021; 35:5783-5791. [DOI: 10.1080/14767058.2021.1892637] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Peilin Zhang
- Department of Pathology, New York Presbyterian – Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Taryn Heyman
- Department of Obstetrics & Gynecology, New York Presbyterian – Brooklyn Methodist Hospital. Brooklyn, NY, USA
| | - Marisa Greechan
- Department of Pediatrics, New York Presbyterian – Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Beata Dygulska
- Department of Pediatrics, New York Presbyterian – Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Farah Al Sayyed
- Department of Obstetrics & Gynecology, New York Presbyterian – Brooklyn Methodist Hospital. Brooklyn, NY, USA
| | - Pramod Narula
- Department of Pediatrics, New York Presbyterian – Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Sanford Lederman
- Department of Obstetrics & Gynecology, New York Presbyterian – Brooklyn Methodist Hospital. Brooklyn, NY, USA
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Schwartz DA, De Luca D. The Public Health and Clinical Importance of Accurate Neonatal Testing for COVID-19. Pediatrics 2021; 147:peds.2020-036871. [PMID: 33479163 DOI: 10.1542/peds.2020-036871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Daniele De Luca
- Hôpital Antoine Béclère, Université Paris Saclay, Paris, France
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Suy A, Garcia-Ruiz I, Carbonell M, Garcia-Manau P, Rodo C, Maiz N, Sulleiro E, Anton A, Esperalba J, Fernández-Hidalgo N, Frick MA, Camba F, Pumarola T, Carreras E. Gestation and COVID-19: clinical and microbiological observational study (Gesta-COVID19). BMC Pregnancy Childbirth 2021; 21:78. [PMID: 33482757 PMCID: PMC7820822 DOI: 10.1186/s12884-021-03572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) is a novel disease which has been having a worldwide affect since December 2019. Evidence regarding the effects of SARS-CoV-2 during pregnancy is conflicting. The presence of SARS-CoV-2 has been demonstrated in biological samples during pregnancy (placenta, umbilical cord or amniotic fluid); however, maternal and fetal effects of the virus are not well known. METHODS Descriptive, multicentre, longitudinal, observational study in eight tertiary care hospitals throughout Spain, that are referral centres for pregnant women with COVID-19. All pregnant women with positive SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction during their pregnancy or 14 days preconception and newborns born to mothers infected with SARS-CoV-2 will be included. They will continue to be followed up until 4 weeks after delivery. The aim of the study is to investigate both the effect of COVID-19 on the pregnancy, and the effect of the pregnancy status with the evolution of the SARS-CoV-2 disease. Other samples (faeces, urine, serum, amniotic fluid, cord and peripheral blood, placenta and breastmilk) will be collected in order to analyse whether or not there is a risk of vertical transmission and to describe the behaviour of the virus in other fluids. Neonates will be followed until 6 months after delivery to establish the rate of neonatal transmission. We aim to include 150 pregnant women and their babies. Ethics approval will be obtained from all the participating centres. DISCUSSION There is little information known about COVID-19 and its unknown effects on pregnancy. This study will collect a large number of samples in pregnant women which will allow us to demonstrate the behaviour of the virus in pregnancy and postpartum in a representative cohort of the Spanish population.
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Affiliation(s)
- Anna Suy
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Itziar Garcia-Ruiz
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Melchor Carbonell
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pablo Garcia-Manau
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlota Rodo
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nerea Maiz
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Elena Sulleiro
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Andres Anton
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juliana Esperalba
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Marie Antoinette Frick
- Department of Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Fatima Camba
- Department of Neonatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Tomas Pumarola
- Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Elena Carreras
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Gao L, Ren J, Xu L, Ke X, Xiong L, Tian X, Fan C, Yan H, Yuan J. Placental pathology of the third trimester pregnant women from COVID-19. Diagn Pathol 2021; 16:8. [PMID: 33441152 PMCID: PMC7806280 DOI: 10.1186/s13000-021-01067-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Aims To explore the clinical characteristics and placental pathological changes of pregnant women with 2019 novel coronavirus (CoV) disease (COVID-19) in the third trimester, and to assess the possibility of vertical transmission. Methods and results The placenta tissues were evaluated by using immunohistochemistry for inflammatory cells and Hofbauer cells, and using severe acute respiratory syndrome (SARS) CoV-2 RNA Fluorescence In-Situ Hybridization (FISH) and SARS-CoV-2 spike protein immunofluorescence (IF) double staining. All eight placentas from the third trimester pregnancy women were studied. All patients were cured, no clinical or serological evidence pointed to vertical transmission of SARS-CoV-2. Features of maternal vascular malperfusion (MVM) such as increased syncytial knots were present in all 8 cases (8/8), and increased focal perivillous fibrin depositions were presented in 7 cases (7/8). No significate chronic histiocytic intervillositis was noted in the placenta. The number of macrophages and inflammatory cells such as T cells, B cells and plasma cells in the placental villous was not significantly increased in all cases. Moreover, all of eight cases demonstrated negative results by FISH using a SARS-CoV-2 virus RNA probe and by IF using a monoclonal antibody against SARS-CoV-2 spike protein. Conclusions We found no evidence of vertical transmission and adverse maternal-fetal outcomes in the placentas of third trimester COVID-19 pregnancy women, which provided further information for the clinical management of those women in the third trimester. However, further studies are still needed for patients with infections in different stage of gestation, especially in first and second trimester.
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Affiliation(s)
- Likun Gao
- Department of Pathology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Jiacai Ren
- Department of Pathology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Li Xu
- Department of Pathology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Xiaokang Ke
- Department of Pathology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Lin Xiong
- Department of Pathology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Xiaoli Tian
- Department of Pathology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Cuifang Fan
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan City, 430060, Hubei Province, People's Republic of China
| | - Honglin Yan
- Department of Pathology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.
| | - Jingping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuchang District, Wuhan, 430060, Hubei Province, People's Republic of China.
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Joseph NT, Rasmussen SA, Jamieson DJ. The effects of COVID-19 on pregnancy and implications for reproductive medicine. Fertil Steril 2021; 115:824-830. [PMID: 33676752 PMCID: PMC7775651 DOI: 10.1016/j.fertnstert.2020.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
COVID-19 was officially declared a pandemic in March 2020. Since then, our understanding of its effects on pregnancy have evolved rapidly. Emerging surveillance data and large cohort studies suggest that pregnancy is associated with an increased risk of intensive care unit hospitalization, invasive ventilation, and death. Pregnancies complicated by SARS-CoV-2 infection are associated with increased likelihood of cesarean delivery and preterm birth. Intrauterine transmission occurs, but seems to be rare. Critical gaps remain, and rigorous high-quality data are needed to better ascertain pregnancy risks and to inform antenatal and obstetrical management.
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Affiliation(s)
- Naima T Joseph
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Sonja A Rasmussen
- Departments of Pediatrics, Obstetrics and Gynecology, and Epidemiology, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville, Florida
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
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Gutschow K, Davis-Floyd R. The Impacts of COVID-19 on US Maternity Care Practices: A Followup Study. FRONTIERS IN SOCIOLOGY 2021; 6:655401. [PMID: 34150906 PMCID: PMC8212572 DOI: 10.3389/fsoc.2021.655401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/05/2021] [Indexed: 05/06/2023]
Abstract
This article extends the findings of a rapid response article researched in April 2020 to illustrate how providers' practices and attitudes toward COVID-19 had shifted in response to better evidence, increased experience, and improved guidance on how SARS-CoV-2 and COVID-19 impacted maternity care in the United States. This article is based on a review of current labor and delivery guidelines in relation to SARS-CoV-2 and COVID-19, and on an email survey of 28 community-based and hospital-based maternity care providers in the United State, who discuss their experiences and clients' needs in response to a rapidly shifting landscape of maternity care during the COVID-19 pandemic. One-third of our respondents are obstetricians, while the other two-thirds include midwives, doulas, and labor and delivery nurses. We present these providers' frustrations and coping mechanisms in shifting their practices in relation to COVID-19. The primary lessons learned relate to improved testing and accessing PPE for providers and clients; the need for better integration between community- and hospital-based providers; and changes in restrictive protocols concerning labor support persons, rooming-in with newborns, immediate skin-to-skin contact, and breastfeeding. We conclude by suggesting that the COVID-19 pandemic offers a transformational moment to shift maternity care in the United States toward a more integrated and sustainable model that might improve provider and maternal experiences as well as maternal and newborn outcomes.
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Affiliation(s)
- Kim Gutschow
- Departments of Anthropology and Religion, Williams College, Willliamstown, MA, United States
- *Correspondence: Kim Gutschow,
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