Routine placental histopathology findings from women testing positive for SARS‐CoV‐2 during pregnancy: Retrospective cohort comparative study

Abstract

Objective To assess the impact of maternal Coronavirus disease 2019 (COVID‐19) infection on placental histopathological findings in an unselected population and evaluate the potential effect on the fetus, including the possibility of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Design Retrospective cohort comparative study of placental histopathological findings in patients with COVID‐19, compared with controls. Setting During the COVID‐19 pandemic, placentas were studied from women at University College Hospital London who reported and/or tested positive for COVID‐19. Population Of 10 508 deliveries, 369 (3.5%) women had COVID‐19 during pregnancy, with placental histopathology available for 244 women. Methods Retrospective review of maternal and neonatal characteristics, where placental analysis had been performed. This was compared with available, previously published, histopathological findings from placentas of unselected women. Main outcome measures Frequency of placental histopathological findings and relevant clinical outcomes. Results Histological abnormalities were reported in 117 of 244 (47.95%) cases, with the most common diagnosis being ascending maternal genital tract infection. There was no statistically significant difference in the frequency of most abnormalities compared with controls. There were four cases of COVID‐19 placentitis (1.52%, 95% CI 0.04%–3.00%) and one possible congenital infection, with placental findings of acute maternal genital tract infection. The rate of fetal vascular malperfusion (FVM), at 4.5%, was higher compared with controls (p = 0.00044). Conclusions In most cases, placentas from pregnant women infected with SARS‐CoV‐2 virus do not show a significantly increased frequency of pathology. Evidence for transplacental transmission of SARS‐CoV‐2 is lacking from this cohort. There is a need for further study into the association between FVM, infection and diabetes.

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“…However, it is generally accepted that the risk of a mother passing on a COVID-19 infection to her unborn baby is low. This was recently confirmed in a review analyzing 244 placentas from women with COVID-19 during pregnancy, providing evidence of low risk of vertical transmission to the neonate ( 24 ). Placental and fetal infections have only been reported in a few studies, and data on vertical transmission are often inconclusive due to false‐positive testing or the fact that postnatal infection cannot be excluded ( 25 ).…”

Breastfeeding Practices for COVID-19-Infected Mothers: A Systematic Review and Meta-Analysis

“…A more recent study contributed further information to the existing body of knowledge, suggesting that the likelihood of neonates acquiring COVID-19 from their mothers is relatively moderate [ 59 ]. However, separating the two individuals, even with the intention of safeguarding the neonate, may have repercussions for the development of emotional attachment and bonding between them [ 60 , 61 ]. The formation of a strong emotional bond between a mother and her child is crucial for the baby’s holistic development.…”