Outcomes of Maternal-Newborn Dyads After Maternal SARS-CoV-2

Verma, Sourabh; Bradshaw, Chanda; Auyeung, N.S. Freda; Lumba, Rishi; Farkas, Jonathan S.; Sweeney, Nicole; Wachtel, Elena V.; Bailey, Sean M.; Noor, Asif; Kunjumon, Bgee; Cicalese, Erin; Hate, Rahul; Lighter, Jennifer; Alessi, Samantha; Schweizer, William; Hanna, Nazeeh; Roman, Ashley S.; Dreyer, Benard P.; Mally, Pradeep

doi:10.1542/peds.2020-005637

Cited by 53 publications

(54 citation statements)

References 21 publications

(23 reference statements)

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“…An important metric that remains uncertain is the probability of a pregnant woman with COVID-19 having a neonate testing positive for the virus. Recent estimates of the prevalence of COVID-19 test positivity among these neonates vary, with studies reporting between less than 1% [54], 2 to 2.5% [55,56], 4% [57] and up to 5% [58] of newborns testing positive for the coronavirus.…”

Section: Discussionmentioning

confidence: 99%

Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2

Schwartz

Morotti

2020

Viruses

115

112

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The mechanism(s) by which neonates testing positive for coronavirus disease 2019 (COVID-19) acquire their infection has been largely unknown. Transmission of the etiological agent, SARS-CoV-2, from mother to infant has been suspected but has been difficult to confirm. This communication summarizes the spectrum of pathology findings from pregnant women with COVID-19 based upon the infection status of their infants and addresses the potential interpretation of these results in terms of the effects of SARS-CoV-2 on the placenta and the pathophysiology of maternal-fetal infection. Placentas from pregnant women with COVID-19 and uninfected neonates show significant variability in the spectrum of pathology findings. In contrast, placentas from infected maternal-neonatal dyads are characterized by the finding of mononuclear cell inflammation of the intervillous space, termed chronic histiocytic intervillositis, together with syncytiotrophoblast necrosis. These placentas show prominent positivity of syncytiotrophoblast by SARS-CoV-2, fulfilling the published criteria for transplacental viral transmission as confirmed in fetal cells through identification of viral antigens by immunohistochemistry or viral nucleic acid using RNA in situ hybridization. The co-occurrence of chronic histiocytic intervillositis and trophoblast necrosis appears to be a risk factor for placental infection with SARS-CoV-2 as well as for maternal-fetal viral transmission, and suggests a potential mechanism by which the coronavirus can breach the maternal-fetal interface.

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Section: Discussionmentioning

confidence: 99%

Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2

Schwartz

Morotti

2020

Viruses

115

112

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“…5 Although placental and neonatal SARS-CoV-2 transmission have been reported [1][2][3][6][7][8] , current evidence suggests that this event is not common. 9,10 Two case reports from China describing detectable neonatal IgM soon after birth could represent true vertical transmission of disease, or could represent falsepositive IgM testing. 2,3 We did not detect IgM antibodies in any cord blood sera samples even in cases of critical maternal illness or preterm delivery, supporting that maternal-fetal SARS-CoV-2 transmission is rare.…”

Section: Determination Of Correlates Of Maternal and Neonatal Immunitmentioning

confidence: 99%

Transplacental Transfer of SARS-CoV-2 Antibodies

Flannery

Gouma

Dhudasia

et al. 2020

Preprint

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We measured SARS-CoV-2 antibody levels in serum samples from 1,471 mother/newborn dyads and found efficient transplacental transfer of SARS-CoV-2 IgG antibodies in 72 of 83 seropositive pregnant women. Transfer ratios >1.0 were observed among women with an asymptomatic SARS-CoV-2 infection as well as those with mild, moderate and severe COVID-19. Our findings demonstrate the potential for maternally-derived antibodies to provide neonatal protection from SARS-CoV-2 infection.

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“…Forty‐one percent of these mothers were asymptomatic but tested positive during universal screening upon admission. However, preterm delivery was significantly increased in symptomatic compared to asymptomatic mothers ( P = .006) 62 …”

Section: Possible Effect(s) Of Covid‐19 Infection In the Pregnant Uterusmentioning

confidence: 93%

“…However, preterm delivery was significantly increased in symptomatic compared to asymptomatic mothers (P = .006). 62 As discussed earlier, there is growing recognition that cytokines play a pivotal role in the maintenance of a healthy pregnancy. 63,64 A pro-inflammatory production of these immune modulators due to infections (bacterial/viral) can lead to pathologic pregnancy, including preterm labor, abortion, preeclampsia, and intrauterine growth restriction.…”

Section: P Oss Ib Le Effec T(s) Of Covid -19 Infec Ti On In the Prementioning

confidence: 98%

Is pregnancy an immunological contributor to severe or controlled COVID‐19 disease?

Hanna

Sharma

2020

American J Rep Immunol

Self Cite

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Since its emergence in Wuhan as a novel coronavirus disease, it has taken only a few months since January 2020 for it to be recognized as a widespread COVID-19 pandemic which has contributed to global health devastation. As pointed out by health experts, it is a once in a century pandemic of our times. Clinical observations so far indicate that the older population and immune compromised individuals, particularly in African American and Hispanic/Latino communities, are at much higher risk for infection with this novel coronavirus. In this regard, pregnancy offers an altered immunity scenario which may allow severe COVID-19 disease. The literature is so far highly conflicting on this issue. This review will offer a conceptual basis for severe or controlled disease and address trepidations for pregnant women associated with COVID-19 pandemic, particularly in the comparative context of clinical consequences of other coronaviruses such as SARS and MERS. We will highlight the possible consequences of COVID-19 on the general health of pregnant women as well as its possible effects at the maternal-fetal interface. For the placenta-related pathology, we will focus our discussion on the temporal expression of ACE2 throughout gestation for possible propagation of SARS-CoV-2 in the placenta in infected women and ensuing consequences.

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Outcomes of Maternal-Newborn Dyads After Maternal SARS-CoV-2

Cited by 53 publications

References 21 publications

Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2

Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2

Transplacental Transfer of SARS-CoV-2 Antibodies

Is pregnancy an immunological contributor to severe or controlled COVID‐19 disease?

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