SARS-CoV-2 Infection and Inflammatory Response in a Twin Pregnancy

Abstract

There is growing literature about the SARS-CoV-2 pathogenetic effects exerted during pregnancy and whether vertical transmission or premature birth is possible. It is not well known whether changes in the immune system of pregnant women may lead to a marked susceptibility to infectious processes and the risk of adverse maternal and neonatal complications such as preterm birth, spontaneous abortion, hospitalization in an intensive care unit, transmission to the fetus or newborns, and fetal mortality are poorly understood. Along with this ongoing debate, it is not well defined whether, during pregnancy, the role of host susceptibility in producing a specific inflammatory response to SARS-CoV-2 may represent distinctive markers of risk of vertical transmission. Furthermore, SARS-CoV-2 impact on the vaginal microbiome has not yet been described, despite mounting evidence on its possible effect on the gastrointestinal microbiome and its influence on infectious diseases and preterm labor. This report describes the impact of SARS-CoV-2 on a twin pregnancy diagnosed with infection at the third trimester of gestation including tissue infections, inflammatory response, antibody production, cytokine concentration, and vaginal microbiome composition. We identified a pattern of cytokines including IL1-Ra, IL-9 G-CSF, IL-12, and IL-8 differently expressed, already associated with previously infected patients. We detected a similar concentration of almost all the cytokines tested in both twins, suggesting that the SARS-CoV-2-induced cytokine storm is not substantially impaired during the placental passage. The analysis of the vaginal microbiome did not show relevant signs of dysbiosis, similar to other healthy pregnant women and twin healthy pregnancies. The aim of this report was to analyze the immunological response against SARS-CoV-2 infection and virus tissue tropism in a twin pregnancy.

The Current Evidence Regarding COVID-19 and Pregnancy: Where Are We Now and Where Should We Head to Next?

“…This constitutes an alarming observation that should be considered when clinicians assess and manage pregnant patients, since the risk of adverse perinatal outcomes in cases of infection during the early pregnancy stage could be detrimental [ 82 ]. A report investigating the impact of SARS-CoV-2 on a twin pregnancy diagnosed with infection at the third trimester of gestation, identified a pattern of cytokines including IL1-Ra, IL-9 G-CSF, IL-12, and IL-8 that were differently expressed in both twins, suggesting that the SARS-CoV-2-induced cytokine storm is not impaired during the placental passage [ 83 ]. On the other hand, in an analysis of nineteen placentas of COVID-19 positive women, a variety of pathologies were described, albeit the absence of chronic intervillositis was validated [ 84 ].…”