Association of SARS-CoV-2 Test Status and Pregnancy Outcomes

Ahlberg, Mia; Neovius, Martin; Saltvedt, Sissel; Söderling, Jonas; Pettersson, Karin; Brandkvist, C.; Stephansson, Olof

doi:10.1001/jama.2020.19124

Cited by 114 publications

(119 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An increasing risk of preterm delivery and CD with increasing severity of COVID-19 has also been reported (14). A previous study from one of the including SE centers found no increased risk of severe outcomes (25), however, they included COVID-19 positive women independently of severity, which might have biased their results.…”

Section: Characteristics Of Women Admitted For Any Reason Are Shown Inmentioning

confidence: 94%

COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries

Engjom

Aabakke

Klungsøyr

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Introduction Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and health care systems. Material and method This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between March 1 and June 30, 2020 and had a positive SARS-CoV-2 PCR test 14 days or fewer prior to the admission. Cause of admission was classified as either obstetric or COVID-19 related. Results In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women needed hospital care due to COVID-19. The rate of admission due to COVID-19 was 0.4 per 1000 deliveries in Denmark, Finland, and Norway and 3.8 per 1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (P < 0.001) and had migrant background (P < 0.001) compared to the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Preterm delivery (n=12, 25%, P < 0.001) and cesarean delivery (n=21, 43,8%, P < 0.001) were more frequent in women with COVID-19 compared to the women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported. Conclusion The risk of admission due to severe COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the rates of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.

show abstract

Section: Characteristics Of Women Admitted For Any Reason Are Shown Inmentioning

confidence: 94%

COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries

Engjom

Aabakke

Klungsøyr

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The effect of SARS-CoV-2 infection in pregnant women is of particular concern: population-based studies suggest that pregnant women with COVID-19 are at increased risk for severe illness compared to non-pregnant women with COVID-19 (1). SARS-CoV-2 infection during pregnancy has also been associated with increased risk of pregnancy complications such as preterm birth, premature rupture of membranes, and preeclampsia (2)(3)(4). However, the mechanisms underlying these poor outcomes are unknown, and their dependence on SARS-CoV-2 infection of the placenta remains poorly understood.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 infection in pregnancy is associated with robust inflammatory response at the maternal-fetal interface

Lu-Culligan

Chavan

Vijayakumar

et al. 2021

Preprint

View full text Add to dashboard Cite

Pregnant women appear to be at increased risk for severe outcomes associated with COVID-19, but the pathophysiology underlying this increased morbidity and its potential impact on the developing fetus is not well understood. In this study of pregnant women with and without COVID-19, we assessed viral and immune dynamics at the placenta during maternal SARS-CoV-2 infection. Amongst uninfected women, ACE2 was detected by immunohistochemistry in syncytiotrophoblast cells of the normal placenta during early pregnancy but was rarely seen in healthy placentas at full term. Term placentas from women infected with SARS-CoV-2, however, displayed a significant increase in ACE2 levels. Using immortalized cell lines and primary isolated placental cells, we determined the vulnerability of various placental cell types to direct infection by SARS-CoV-2 in vitro. Yet, despite the susceptibility of placental cells to SARS-CoV-2 infection, viral RNA was detected in the placentas of only a subset (∼13%) of women in this cohort. Through single cell transcriptomic analyses, we found that the maternal-fetal interface of SARS-CoV-2-infected women exhibited markers associated with pregnancy complications, such as preeclampsia, and robust immune responses, including increased activation of placental NK and T cells and increased expression of interferon-related genes. Overall, this study suggests that SARS-CoV-2 is associated with immune activation at the maternal-fetal interface even in the absence of detectable local viral invasion. While this likely represents a protective mechanism shielding the placenta from infection, inflammatory changes in the placenta may also contribute to poor pregnancy outcomes and thus warrant further investigation.

show abstract

“…The study compared the pregnancy outcomes of the patients infected by SARS-CoV2 to non-infected pregnant patients. They found that SARS-CoV2 does not affect the pregnancy outcomes such as preterm birth, mode of delivery, and postpartum hemorrhage [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Female reproductive tract has low concentration of SARS-CoV2 receptors

2020

View full text Add to dashboard Cite

There has been significant concern regarding fertility and reproductive outcomes during the SARS-CoV2 pandemic. Recent data suggests a high concentration of SARS-Cov2 receptors, ACE2 or TMPRSS2, in nasal epithelium and cornea, which explains person-to-person transmission. We investigated the prevalence of SARS-CoV2 receptors among reproductive tissues by exploring the single-cell sequencing datasets from uterus, myometrium, ovary, fallopian tube, and breast epithelium. We did not detect significant expression of either ACE2 or TMPRSS2 in the normal human myometrium, uterus, ovaries, fallopian tube, or breast. Furthermore, none of the cell types in the female reproductive organs we investigated, showed the co-expression of ACE2 with proteases, TMPRSS2, Cathepsin B (CTSB), and Cathepsin L (CTSL) known to facilitate the entry of SARS2-CoV2 into the host cell. These results suggest that myometrium, uterus, ovaries, fallopian tube, and breast are unlikely to be susceptible to infection by SARS-CoV2.

show abstract

Association of SARS-CoV-2 Test Status and Pregnancy Outcomes

Cited by 114 publications

References 8 publications

COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries

COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries

SARS-CoV-2 infection in pregnancy is associated with robust inflammatory response at the maternal-fetal interface

Female reproductive tract has low concentration of SARS-CoV2 receptors

Contact Info

Product

Resources

About