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

• Published in: Viruses 2021-08, Vol.13 (8), p.1670
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Antigens; CD20 antigen; Cloning; Coronaviruses; COVID-19; Disease transmission; Fibrin; foetal outcome; Infections; Inflammation; Informed consent; Lymphocytes B; Patients; Physiology; Placenta; Polymerase chain reaction; Pregnancy; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Umbilical cord; Vagina; Womens health
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v13081670

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.