SARS-COV2 placentitis and pregnancy outcome: A multicentre experience during the Alpha and early Delta waves of coronavirus pandemic in England

Stenton, Sophie; McPartland, Jo; Shukla, R. K.; Turner, Kerry; Marton, T.; Hargitai, Beáta; Bamber, AR; Pryce, Jeremy; Peres, Cesar L; Burguess, Nadia; Wagner, Bart; Ciolka, Barbara; Simmons, William; Hurrell, Daniel; Sekar, Thivya; Moldovan, Corina; Trayers, Claire; Bryant, Victoria; Palm, Liina; Cohen, Marta C.

doi:10.1016/j.eclinm.2022.101389

Cited by 42 publications

(47 citation statements)

References 18 publications

(29 reference statements)

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“…Only an extensive meta-analysis is available with 1452 cases retrieved from 30 publications [ 16 ]. Other two recent series, although less consistent in the number of cases, will be taken into account for comparison [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, it is highly unlikely that SARS-CoV-2 in the third trimester affected cord development and twisting. Instead, in most of the studies [ 16 , 19 , 20 ], this information was not mentioned, and only the weight centile was assessed. In our population, most of the placentas presented a weight between the 10th and 90th centile (66.6%), with only 9.3% below the 10th centile and 4.6% above the 90th (weight was not reported for one in five cases).…”

Section: Discussionmentioning

confidence: 99%

“…In the already mentioned meta-analysis [ 16 ], small placentas were recorded in 87/585 (15%) cases and big specimens were reported in 61/495 (12%) cases. In the series by Stenton et al [ 20 ], 47/58 (81%) placentas had a normal weight, only 8/58 (13.8%) were small, and 3/58 (5.2%) were big for gestation, respectively. On the whole, including also our cases, this data suggests that SARS-CoV-2 does not significantly affect placental weight.…”

Section: Discussionmentioning

confidence: 99%

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Placental Characteristics of a Large Italian Cohort of SARS-CoV-2-Positive Pregnant Women

et al. 2022

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The variety of placental morphological findings with SARS-CoV-2 maternal infections has raised the issue of poor agreement in histopathological evaluation. The aims of this study were: to describe the histopathological placental features of a large sample of SARS-CoV-2-positive women who gave birth in Italy during the COVID-19 pandemic, to analyse the factors underlying these lesions, and to analyse the impact of placental impairment on perinatal outcomes. From 25 February 2020 to 30 June 2021, experienced perinatal pathologists examined 975 placentas of SARS-CoV-2-positive mothers enrolled in a national prospective study, adopting the Amsterdam Consensus Statement protocol. The main results included the absence of specific pathological findings for SARS-CoV-2 infections, even though a high proportion of placentas showed signs of inflammation, possibly related to a cytokine storm induced by the virus, without significant perinatal consequences. Further research is needed to better define the clinical implications of placental morphology in SARS-CoV-2 infections, but the results of this large cohort suggest that placentas do not seem to be a preferential target for the new Coronavirus infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Placental Characteristics of a Large Italian Cohort of SARS-CoV-2-Positive Pregnant Women

et al. 2022

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“…fetal distress with evidence of pathognomonic SARS-CoV-2placentitis. [23][24][25] Secondary effectiveness outcomes included 28-day non-COVID-19 related admissions and rates of individual components of the composite outcome.…”

Section: Discussionmentioning

confidence: 99%

Monoclonal Antibodies for Treatment of SARS-CoV-2 Infection During Pregnancy

McCreary

Lemon

Megli

et al. 2022

Preprint

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IMPORTANCEMonoclonal antibody (mAb) treatment decreases hospitalization and death in high-risk outpatients with mild to moderate COVID-19. However, no studies have evaluated adverse events and effectiveness of mAbs in pregnant persons compared to no mAb treatment.OBJECTIVETo determine the frequency of drug-related adverse events and obstetric-associated safety outcomes after treatment with mAb compared to no mAb treatment, and the association between mAb treatment and a composite of 28-day COVID-19-related hospital admission or emergency department visit, COVID-19-associated delivery, or mortality.DESIGN, SETTING, PARTICIPANTSPropensity-score matched cohort study of persons aged 12 years of age or older with a pregnancy episode and any documented positive SARS-CoV-2 test (polymerase chain reaction or antigen test) in the UPMC health system from April 30, 2021 to January 21, 2022.EXPOSURESBamalanivmab and etesevimab, casirivimab and imdevimab, or sotrovimab treatment compared to no mAb treatment.MAIN OUTCOMES AND MEASURESDrug-related adverse events, obstetric-associated safety outcomes among persons who delivered, and a risk-adjusted composite of 28-day COVID-19-related hospital admission or ED visit, COVID-19-associated delivery, or mortality.RESULTSAmong 944 pregnant persons (median [IQR] age 30 [26, 33] years, White (79.5%, N=750), median [IQR] Charlson Comorbidity Index Score 0 (0,0)), 552 persons received mAb treatment (58%). Median gestational age at COVID-19 diagnosis or treatment was 179 days (IQR: 123, 227), and most persons received sotrovimab (69%, N=382). Of those with known vaccination status, 178 (62%) were fully vaccinated. Drug-related adverse events were uncommon (N=8, 1.4%), and there were no differences in any obstetric-associated outcome among 276 persons who delivered. After propensity score matching, the frequency of the composite 28-day COVID-19-associated outcome was 4.0 per 100 persons (95% CI 1.9, 6.2) in mAb-treated compared to 3.7 per 100 persons (95% CI 1.7, 5.8) in non-treated controls (risk difference = 0.31 per 100 persons [95% CI -2.6, 3.3). There were no deaths among mAb-treated patients compared to 1 death in the non-treated controls (p = 0.24). There were more non-COVID-19-related hospital admissions in the mAb-treated persons (risk difference 2.8 per 100 persons (95% CI 1.1, 4.5)).CONCLUSIONS AND RELEVANCEIn pregnant persons with mild to moderate COVID-19, adverse events after mAb treatment were mild and rare. There was no difference in obstetric-associated safety outcomes between mAb treatment and no treatment among persons who delivered. MAb treatment was associated with similar 28-day COVID-19-associated outcomes and more non-COVID-19-related hospital admissions compared to no mAb treatment.Key PointsQUESTIONAmong pregnant persons with COVID-19, is monoclonal antibody (mAb) treatment associated with drug-related adverse events, similar frequency of obstetric-associated safety outcomes, and improved COVID-19-related clinical outcomes compared to no mAb treatment?FINDINGSIn 944 pregnant persons with COVID-19, drug-related adverse events were mild and infrequent. Obstetric-associated safety outcomes were similar between mAb treatment and no treatment. There was no evidence of difference in risk of COVID-19-related hospital admission, COVID-19-associated delivery, or mortality between mAb treatment and no mAb treatment.MEANINGIn pregnant persons with mild to moderate COVID-19, adverse events after mAb treatment were uncommon, and there was no difference in obstetric-associated safety outcomes between mAb treatment and no treatment. MAb treatment was associated with similar 28-day risk of a COVID-19-associated outcome and more non-COVID-19-related hospital admissions compared to no mAb treatment.

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“…We are surprised and disappointed by the maternal-fetal medicine authors' limited appreciation of the value of placental examination, which has utility in many clinical and practice management arenas, including in the acute care setting (eg, histologic diagnosis of placental infections), in maternal care management in subsequent pregnancies by identification of pathologies with known recurrence risks or that may be either treatable or preventable (eg, placental accreta spectrum disorders, 2 massive perivillous fibrin deposition, 3 severe maternal hypertensive diseases, chronic villitis, and chronic histiocytic intervillositis), 4 in better understanding antenatal and intrapartum events that contribute to long-term neonatal morbidity and adult diseases and disorders (eg, fetal vascular malperfusion, 5 nonimmune hydrops, and twin-twin transfusion syndrome), 6 and in creating opportunities for recognition and diagnosis of emerging perinatal diseases (eg, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] placentitis [7][8][9] ). In addition, placental examination is an indispensable part of comprehensive audits of antenatal clinical management in the setting of a poor outcome, providing potentially critical data for the assessment of preexisting or ancillary factors and events.…”

Section: Pathologic Assessment Of the Placenta: Evidence Compared Wit...mentioning

confidence: 99%

Pathologic Assessment of the Placenta: Evidence Compared With Tradition

Pınar

Gordijn

Grynspan

et al. 2022

Obstetrics &Amp; Gynecology

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vascular malperfusion (MVM) group (118/78 vs 116/75). 4 In fact, treated hypertension was nominally higher in the non-MVM group (9.4% vs 8.2%). 4 The final difference among the 27 outcomes assessed was a higher low-density lipoprotein concentration in the MVM group (110 vs 101 mg/dL). 4 On the basis of these findings, we agree that, "Future studies of nonselected evaluations are warranted to expand and replicate our findings," 4 but we disagree that we should be sending placentas for pathologic evaluation so as to inform future medical care.We applaud the research contributions of Dr. Himes and colleagues and encourage the continuation and expansion of such placental research. 2,4 One day, placental research may evolve to the point that it can appropriately inform subsequent clinical practice. Until that day, we stand by our conclusion that, ".strict adherence to the ethical practice of outcomes-focused, evidence-based, and cost-effective medicine does not support the majority of placental pathology examinations that are currently performed." 1

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SARS-COV2 placentitis and pregnancy outcome: A multicentre experience during the Alpha and early Delta waves of coronavirus pandemic in England

Cited by 42 publications

References 18 publications

Placental Characteristics of a Large Italian Cohort of SARS-CoV-2-Positive Pregnant Women

Placental Characteristics of a Large Italian Cohort of SARS-CoV-2-Positive Pregnant Women

Monoclonal Antibodies for Treatment of SARS-CoV-2 Infection During Pregnancy

Pathologic Assessment of the Placenta: Evidence Compared With Tradition

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