Placental pathology in SARS-CoV-2 infected pregnancies: A single-institution retrospective cohort analysis

• Published in: Journal of neonatal-perinatal medicine 2024-01, Vol.17 (5), p.623-636
• Main Authors: Le, T., Lee, D., Brown, L.S., Payton, B.W., Sepulveda, P., Sisman, J., Leon, R. L., Chalak, L.F., Mir, I.N.
• Format: Article
• Language: English
• Subjects: Adult; Chorioamnionitis - epidemiology; Chorioamnionitis - pathology; COVID-19 - epidemiology; COVID-19 - pathology; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical - statistics & numerical data; Placenta - pathology; Placenta - virology; Placenta Diseases - epidemiology; Placenta Diseases - pathology; Placenta Diseases - virology; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - pathology; Pregnancy Complications, Infectious - virology; Retrospective Studies; SARS-CoV-2
• ISSN: 1934-5798; 1878-4429; 1878-4429
• DOI: 10.3233/NPM-230177

BACKGROUND: Our objectives were to determine 1) the prevalence and description of placental pathologic lesions in pregnancies complicated by SARS-CoV-2 infection compared to healthy controls and 2) whether the prevalence and/ or pattern of placental pathologic lesions differed in the few neonates who tested positive for SARS-CoV-2 in the first 48 hours of life at a busy urban county hospital. METHODS: This study included all pregnant mothers who tested positive for SARS-CoV-2 and delivered at our institution from March 2020 to June 2021, while control placentas were collected from term pregnancies without complications. RESULTS: Approximately 90% (n = 380/425) of placentas from pregnancies complicated by SARS-CoV-2 infections had placental pathologic lesions, compared to 32% (n = 16/50) of controls. The predominant lesions were acute histologic chorioamnionitis with or without fetal response (n = 209/380, 55%), maternal vascular malperfusion (n = 180/380, 47%), and other inflammatory lesions (n = 148/380, 39%). Only 14 (2.5%) infants tested positive for SARS-CoV-2 within the first 48 hours of life. There were no significant differences in placental histopathology between infants who tested positive vs. those that were negative for SARS-CoV-2. Placental lesions in mothers who tested positive for SARS-CoV-2 during the first vs. second vs. third pregnancy trimesters, were significantly different in the incidence of inflammatory placental pathologic lesions (n = 9/19, 53% vs. n = 37/98, 49% vs. n = 102/439, 31%, respectively; p