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Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms

Background: Although the risk for transplacental transmission of SARS-CoV-2 is rare, placental infections with adverse functional consequences have been reported. This study aims to analyse histological placental findings in pregnancies complicated by SARS-CoV-2 infection and investigate its correla...

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Autores principales: Husen, Marjolein F., van der Meeren, Lotte E., Verdijk, Robert M., Fraaij, Pieter L. A., van der Eijk, Annemiek A., Koopmans, Marion P. G., Freeman, Liv, Bogers, Hein, Trietsch, Marjolijn D., Reiss, Irwin K. M., DeKoninck, Philip L. J., Schoenmakers, Sam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8402730/
https://www.ncbi.nlm.nih.gov/pubmed/34452534
http://dx.doi.org/10.3390/v13081670
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author Husen, Marjolein F.
van der Meeren, Lotte E.
Verdijk, Robert M.
Fraaij, Pieter L. A.
van der Eijk, Annemiek A.
Koopmans, Marion P. G.
Freeman, Liv
Bogers, Hein
Trietsch, Marjolijn D.
Reiss, Irwin K. M.
DeKoninck, Philip L. J.
Schoenmakers, Sam
author_facet Husen, Marjolein F.
van der Meeren, Lotte E.
Verdijk, Robert M.
Fraaij, Pieter L. A.
van der Eijk, Annemiek A.
Koopmans, Marion P. G.
Freeman, Liv
Bogers, Hein
Trietsch, Marjolijn D.
Reiss, Irwin K. M.
DeKoninck, Philip L. J.
Schoenmakers, Sam
author_sort Husen, Marjolein F.
collection PubMed
description Background: Although the risk for transplacental transmission of SARS-CoV-2 is rare, placental infections with adverse functional consequences have been reported. This study aims to analyse histological placental findings in pregnancies complicated by SARS-CoV-2 infection and investigate its correlation with clinical symptoms and perinatal outcomes. We want to determine which pregnancies are at-risk to prevent adverse pregnancy outcomes related to COVID-19 in the future. Methods: A prospective, longitudinal, multicentre, cohort study. All pregnant women presenting between April 2020 and March 2021 with a nasopharyngeal RT-PCR-confirmed SARS-CoV-2 infection were included. Around delivery, maternal, foetal and placental PCR samples were collected. Placental pathology was correlated with clinical maternal characteristics of COVID-19. Results: Thirty-six patients were included, 33 singleton pregnancies (n = 33, 92%) and three twin pregnancies (n = 3, 8%). Twenty-four (62%) placentas showed at least one abnormality. Four placentas (4/39, 10%) showed placental staining positive for the presence of SARS-CoV-2 accompanied by a unique combination of diffuse, severe inflammatory placental changes with massive perivillous fibrin depositions, necrosis of syncytiotrophoblast, diffuse chronic intervillositis, and a specific, unprecedented CD20+ B-cell infiltration. This SARS-CoV-2 placental signature seems to correlate with foetal distress (75% vs. 15.6%, p = 0.007) but not with the severity of maternal COVID-19 disease. Conclusion: We describe a unique placental signature in pregnant patients with COVID-19, which has not been reported in a historical cohort. We show that the foetal environment can be seriously compromised by disruption of placental function due to local, devastating SARS-CoV-2 infection. Maternal clinical symptoms did not predict the severity of the SARS-CoV-2-related placental signature, resulting in a lack of adequate identification of maternal criteria for pregnancies at risk. Close foetal monitoring and pregnancy termination in case of foetal distress can prevent adverse pregnancy outcomes due to COVID-19 related placental disease.
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spelling pubmed-84027302021-08-29 Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms Husen, Marjolein F. van der Meeren, Lotte E. Verdijk, Robert M. Fraaij, Pieter L. A. van der Eijk, Annemiek A. Koopmans, Marion P. G. Freeman, Liv Bogers, Hein Trietsch, Marjolijn D. Reiss, Irwin K. M. DeKoninck, Philip L. J. Schoenmakers, Sam Viruses Article Background: Although the risk for transplacental transmission of SARS-CoV-2 is rare, placental infections with adverse functional consequences have been reported. This study aims to analyse histological placental findings in pregnancies complicated by SARS-CoV-2 infection and investigate its correlation with clinical symptoms and perinatal outcomes. We want to determine which pregnancies are at-risk to prevent adverse pregnancy outcomes related to COVID-19 in the future. Methods: A prospective, longitudinal, multicentre, cohort study. All pregnant women presenting between April 2020 and March 2021 with a nasopharyngeal RT-PCR-confirmed SARS-CoV-2 infection were included. Around delivery, maternal, foetal and placental PCR samples were collected. Placental pathology was correlated with clinical maternal characteristics of COVID-19. Results: Thirty-six patients were included, 33 singleton pregnancies (n = 33, 92%) and three twin pregnancies (n = 3, 8%). Twenty-four (62%) placentas showed at least one abnormality. Four placentas (4/39, 10%) showed placental staining positive for the presence of SARS-CoV-2 accompanied by a unique combination of diffuse, severe inflammatory placental changes with massive perivillous fibrin depositions, necrosis of syncytiotrophoblast, diffuse chronic intervillositis, and a specific, unprecedented CD20+ B-cell infiltration. This SARS-CoV-2 placental signature seems to correlate with foetal distress (75% vs. 15.6%, p = 0.007) but not with the severity of maternal COVID-19 disease. Conclusion: We describe a unique placental signature in pregnant patients with COVID-19, which has not been reported in a historical cohort. We show that the foetal environment can be seriously compromised by disruption of placental function due to local, devastating SARS-CoV-2 infection. Maternal clinical symptoms did not predict the severity of the SARS-CoV-2-related placental signature, resulting in a lack of adequate identification of maternal criteria for pregnancies at risk. Close foetal monitoring and pregnancy termination in case of foetal distress can prevent adverse pregnancy outcomes due to COVID-19 related placental disease. MDPI 2021-08-23 /pmc/articles/PMC8402730/ /pubmed/34452534 http://dx.doi.org/10.3390/v13081670 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Husen, Marjolein F.
van der Meeren, Lotte E.
Verdijk, Robert M.
Fraaij, Pieter L. A.
van der Eijk, Annemiek A.
Koopmans, Marion P. G.
Freeman, Liv
Bogers, Hein
Trietsch, Marjolijn D.
Reiss, Irwin K. M.
DeKoninck, Philip L. J.
Schoenmakers, Sam
Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms
title Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms
title_full Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms
title_fullStr Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms
title_full_unstemmed Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms
title_short Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms
title_sort unique severe covid-19 placental signature independent of severity of clinical maternal symptoms
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8402730/
https://www.ncbi.nlm.nih.gov/pubmed/34452534
http://dx.doi.org/10.3390/v13081670
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