Evidence of Placental Villous Inflammation and Apoptosis in Third-Trimester Symptomatic SARS-CoV-2 Maternal Infection

PURPOSE

In view of conflicting reports on the ability of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) to infect placental tissue, this study aimed to further evaluate the impact of inflammation and placental damage from symptomatic third-trimester maternal COVID-19 infection.

MATERIALS AND METHODS

This case-control study included 32 placenta samples each from symptomatic COVID-19 pregnancy and normal non-COVID-19 pregnancy. The villous placental area's inflammatory expression [angiotensin converting enzyme-2 (ACE-2), transmembrane protease serine-2 (TMPRSS2), interferon-γ (IFN-γ), interleukin-6 (IL-6), and SARS-CoV-2 spike protein] and apoptotic rate were examined using immunohistochemistry and Terminal deoxynucleotidyl transferase dUTP Nick-End Labeling (TUNEL) assay. Comparison and correlation analysis were used based on COVID-19 infection, placental SARS-CoV-2 spike protein evidence, and maternal severity status.

RESULTS

Higher expressions of TMPRSS2, IFN-γ, and trophoblast apoptotic rate were observed in the COVID-19 group (p<0.001), whereas ACE-2 and IL-6 expressions were not significantly different from the control group (p>0.05). Additionally, SARS-CoV-2 spike protein was detected in 8 (25%) placental samples of COVID-19 pregnancy. COVID-19 subgroup analysis revealed increased IFN-γ, trophoblast, and stromal apoptosis (p<0.01). Moreover, the results of the current study revealed no correlation between maternal COVID-19 severity and placental inflammation as well as the apoptotic process.

CONCLUSION

The presence of SARS-CoV-2 spike protein as well as altered inflammatory and apoptotic processes may indicate the presence of placental disturbance in third-trimester maternal COVID-19 infection. The lack of correlation between placental disruption and maternal severity status suggests the need for more research to understand the infection process and any potential long-term impacts on all offsprings born to COVID-19-infected pregnant women.

Devastating pregnancy outcomes in the second wave of the COVID-19 pandemic

BACKGROUND

This study analyzed pregnancy outcomes in postpartum women who were infected with COVID-19 during their pregnancy in resource-limited settings during the second wave of the COVID-19 pandemic.

MATERIALS AND METHODS

This cross-sectional study included all pregnant women with COVID-19 at a tertiary referral hospital in Surabaya, Indonesia, from June to August 2021. Patients were classified according to clinical presentation into asymptomatic-mild, moderate, and severe-critical. Data regarding their basic maternal characteristics, clinical symptoms, delivery, and neonatal outcomes were collected and analyzed across these severity levels through ANOVA, Kruskal-Wallis, or Mann-Whitney U test by incorporating SPSS Statistics software version 29.0.

RESULTS

During the second wave of COVID-19 in Indonesia, a total of 184 COVID-19 cases were reported, with high mortality rate (22%). Only 26.6% of these cases were asymptomatic-mild, and the remaining 73.4% had more severe conditions. The severe-critical group had significantly lower gestational age, slower onset of diseases/symptoms, and higher maternal death proportions than the other two groups (P < 0.001). Clinical symptoms, vital signs, and inflammatory markers (NLR, CRP, and procalcitonin) were also significantly worse in the severe-critical group than in the other groups (P < 0.05). Consequently, severe cases showed a higher cesarean section rate (P = 0.034), lower birth weight, lower Apgar score, higher incidence of perinatal deaths (P < 0.001), and higher incidence of neonatal support (P = 0.003).

CONCLUSIONS

The study's findings specified the devastating consequences of second wave of COVID-19 in a resource-limited setting. Focus on improving the health system and health facilities' capacity is warranted to anticipate all possibilities of other pandemics in the future.