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Fetal and placental infection with SARS-CoV-2 in early pregnancy.

ABSTRACT: To date, mother-to-fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) pandemic, remains controversial. Although placental COVID-19 infection has been documented in some cases during the second- and third-trimesters, no reports are available for the first trimester of pregnancy, and no SARS-CoV-2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarriage in a COVID-19 maternal infection by immunohistochemical, reverse transcription quantitative real-time polymerase chain reaction, immunofluorescence, and electron microscopy methods. SARS-CoV-2 nucleocapsid protein, viral RNA, and particles consistent with coronavirus were found in the placenta and fetal tissues, accompanied by RNA replication revealed by double-stranded RNA (dsRNA) positive immunostain. Prominent damage of the placenta and fetal organs were associated with a hyperinflammatory process identified by histological examination and immunohistochemistry. The findings provided in this study document that congenital SARS-CoV-2 infection is possible during the first trimester of pregnancy and that fetal organs, such as lung and kidney, are targets for coronavirus. The infection and multi-organic fetal inflammation produced by SARS-CoV-2 during early pregnancy should alert clinicians in the assessment and management of pregnant women for possible fetal consequences and adverse perinatal outcomes.

SUBMITTER: Valdespino-Vazquez MY

PROVIDER: S-EPMC8250563 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Fetal and placental infection with SARS-CoV-2 in early pregnancy.

Valdespino-Vázquez María Y MY Helguera-Repetto Cecilia A CA León-Juárez Moises M Villavicencio-Carrisoza Oscar O Flores-Pliego Arturo A Moreno-Verduzco Elsa R ER Díaz-Pérez Diana L DL Villegas-Mota Isabel I Carrasco-Ramírez Elba E López-Martínez Irma E IE Giraldo-Gómez David M DM Lira Rosalia R Yocupicio-Monroy Martha M Rodríguez-Bosch Mario M Sevilla-Reyes Edgar E EE Cortés-Bonilla Manuel M Acevedo-Gallegos Sandra S Merchant-Larios Horacio H Cardona-Pérez Jorge Arturo JA Irles Claudine C

Journal of medical virology 20210406 7

To date, mother-to-fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) pandemic, remains controversial. Although placental COVID-19 infection has been documented in some cases during the second- and third-trimesters, no reports are available for the first trimester of pregnancy, and no SARS-CoV-2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarri ...[more]

PMID: 33764543

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Project description:ObjectiveThis study aimed to report the spectrum of placental pathology findings in pregnancies complicated by SARS-CoV-2 infection.Data sourcesMEDLINE, Embase, Google Scholar, and the Web of Science databases were searched up to August 11, 2021.Study eligibility criteriaHistopathologic anomalies included maternal vascular malperfusion, fetal vascular malperfusion, acute inflammatory pathology, chronic inflammatory pathology, increased perivillous fibrin, and intervillous thrombosis. Moreover, subanalyses of symptomatic women only and high-risk pregnancies were performed.MethodsHistopathologic analysis of the placenta included gross examination, histopathology on hematoxylin and eosin, immunohistochemistry, fluorescence in situ hybridization, quantitative reverse transcription-polymerase chain reaction on placental tissue, and transmission electron microscope. Random-effect meta-analyses were used to analyze the data.ResultsA total of 57 studies (1009 pregnancies) were included. Maternal vascular malperfusion was reported in 31.4% of placentas (95% confidence interval, 21.0-42.8), whereas fetal vascular malperfusion was observed in 26.9% of cases (95% confidence interval, 19.2-35.4). Acute and chronic inflammatory pathologies were reported in 22.6% (95% confidence interval, 16.8-28.9) and 26.2% (95% confidence interval, 18.9-34.2) of cases, respectively. Increased perivillous fibrin was observed in 32.7% (95% confidence interval, 24.1-42.0) of placentas undergoing histopathologic analysis, whereas intervillous thrombosis was observed in 14.6% of cases (95% confidence interval, 10.6-21.8). Other placental findings, including a basal plate with attached myometrial fibers, microscopic accretism, villous edema, increased circulating nucleated red blood cells, or membranes with hemorrhage, were reported in 38% of cases (95% confidence interval, 28.5-48.0), whereas only 17.4% of cases (95% confidence interval, 10.9-25.0) did not present any abnormal histologic findings. The subanalyses according to maternal symptoms owing to SARS-CoV-2 infection or the presence of a high-risk pregnancy showed a similar distribution of the different histopathologic anomalies to that reported in the main analysis. Moreover, the risk of placental histopathologic anomalies was higher when considering only case-control studies comparing women with SARS-CoV-2 infection with healthy controls.ConclusionIn pregnant women with SARS-CoV-2 infection, a significant proportion of placentas showed histopathologic findings, suggesting placental hypoperfusion and inflammation. Future multicenter prospective blinded studies are needed to correlate these placental lesions with pregnancy outcomes.

Dataset Information

Fetal and placental infection with SARS-CoV-2 in early pregnancy.

Publications

Fetal and placental infection with SARS-CoV-2 in early pregnancy.

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