Morphological placental findings in women infected with SARS-CoV-2 according to trimester of pregnancy and severity of disease

Author(s)

Antolini-Tavares, Arthur ; Nobrega, Guilherme M. ; Luz, Adriana G. ; Lajos, Giuliane J. ; Do-Valle, CarolinaC. Ribeiro ; Souza, Renato T. ; Mysorekar, Indira U. ; Costa, Maria L.

• Document type: Journal article
• Source: Placenta; v. 139, p. 10-pg., 2023-08-01.

Abstract

Introduction: Placental morphology findings in SARS-CoV-2 infection are considered nonspecific, although the role of trimester and severity of infection are underreported. Therefore, we aimed to investigate abnormal placental morphology, according to these two criteria. Methods: This is an ancillary analysis of a prospective cohort study of pregnant women with suspected SARS-CoV2 infection, managed in one maternity, from March 2020 to October 2021. Charting of clinical/obstetric history, trimester and severity of COVID-19 infection, and maternal/perinatal outcomes were done. Placental morphological findings were classified into maternal and fetal circulatory injury and acute/chronic inflammation. We further compared findings with women with suspected disease which tested negative for COVID-19. Diseases' trimester of infection and clinical severity guided the analysis of confirmed COVID-19 cases. Results: Ninety-one placental discs from 85 women were eligible as a COVID-19 group, and 42 discs from 41 women in negative COVID-19 group. SARS-CoV-2 infection occurred in 68.2% during third trimester, and 6.6% during first; 16.5% were asymptomatic, 61.5% non-severe and 22.0% severe symptomatic (two maternal deaths). Preterm birth occurred in 33.0% (one fetal death). Global maternal vascular malperfusion (MVM) were significant in COVID-19 group whether compared with negative COVID-19 tests group; however, fetal vascular malperfusion lesions and low-grade chronic villitis were not. Three placentas had COVID-19 placentitis. Decidual arteriopathy was associated with infection in first/mid trimester, and chorangiosis in asymptomatic infections. Discussion: Placental abnormalities after an infection by COVID-19 were more frequent after first/mid-trimester infections. Extensive placental lesions are rare, although they may be more common upon underlying medical conditions. (AU)

• FAPESP's process: 21/09937-1 - COVID-19 and preeclampsia: cause or consequence?
• Grantee: Maria Laura Costa do Nascimento
• Support Opportunities: Regular Research Grants