Placental deficiency during maternal SARS-CoV-2 infection

Abstract

Introduction Maternal anti-SARS-CoV-2 Spike antibodies can cross the placenta during pregnancy, and neonates born to infected mothers have acquired antibodies at birth. Few studies reported data on the histopathological changes of the placenta during infection and placental infection. SARS-CoV-2 infection may cause impaired development of the placenta, thus predisposing maternal and fetal unfavorable outcomes. The prospective study aims to evaluate the risk of vertical transmission of SARS-CoV-2 and placental passage of anti-Spike antibodies as well as the impact of clinical severity on placental structures. Methods This is a prospective cohort study on 30 pregnant women infected by SARS-CoV-2 with their neonates. The demographic features and pregnancy outcomes were collected. Gross and microscopic examinations of the placentas were done. Maternal and umbilical cord sera were obtained at the time of delivery. Nasopharyngeal swabs were collected from neonates immediately after birth. Results The concentrations of total anti-SARS-CoV-2 Spike antibodies were higher in pregnant women with moderate to severe/critical disease. The maternal total anti-SARS-CoV-2 Spike levels were correlated with those of neonatal levels. The rate of placental abnormalities is high in the mothers with severe disease, and those with positive anti-SARS-CoV-2 IgM. All neonates had negative nasopharyngeal swabs for SARS- CoV-2 infections and all placentas were negative in immunohistochemical staining for Spike protein. Discussion The maternally derived anti-SARS-CoV-2 Spike antibody can transmit to neonates born to infected mothers regardless of gestational age. Our results indicated that the disease severity is associated with ischemic placental pathology which may result in adverse pregnancy outcomes.

COVID-19 and Pregnancy: Risks and Outcomes

“…Other researchers conducted multicenter studies and examined the placentas of individuals who tested positive for SARS-CoV-2 during the second and third trimesters and had live births. Although some microscopic changes were noted, they were not statistically significant compared to the placentas of individuals who did not have COVID-19 ( Celik et al., 2022 ; Tasca et al., 2021 ). Placentitis has been a noted feature in the examination of stillbirth placentas, which may account for increased stillbirth rates in those with COVID-19 ( Konstantinidou et al., 2022 ; Stenton et al., 2022 ).…”

Mecanismos associados à possível transmissão vertical do SARS-CoV-2

“…Em alguns trabalhos analisamos que a transmissão vertical e/ou infecção placentária não foi detectada. Entretanto, quando presente, não era dependente direta da gravidade da progressão da doença, ainda que houvesse associação da positividade de IgM anti-SARS-CoV-2 com as anormalidades placentárias e a gravidade da doença materna 2 (Celik et al, 2022;Fenizia et al, 2020). A taxa de positividade para COVİD-19 foi de 11,4% entre as mulheres com perda gestacional precoce, e a taxa de pacientes assintomáticas positivas foi de 9,5% (Halici-Ozturk et al, 2021).…”

Coronavirus disease 2019 and the placenta: A literature review

“…More preterm deliveries were observed in COVID-19-positive pregnant women with active disease than those with a previous infection or recovered [ 11 ]⁠. SARS-CoV-2 placental infection changes, such as RAS dysregulation and inflammation, can result in placental deficiency and possible adverse maternal and neonatal outcomes, such as preeclampsia and premature births [ 33 , 80 , 111 , 112 ]⁠. Intervillositis may be associated with high IUGR, severe early-pregnancy preeclampsia, and high rates of miscarriage [ 58 ]⁠.…”