Severe SARS-CoV-2 placenta infection can impact neonatal outcome in the absence of vertical transmission

• Published in: The Journal of clinical investigation 2021-03, Vol.131 (6), p.1-6
• Main Authors: Cribiù, Fulvia Milena, Erra, Roberta, Pugni, Lorenza, Rubio-Perez, Carlota, Alonso, Lidia, Simonetti, Sara, Croci, Giorgio Alberto, Serna, Garazi, Ronchi, Andrea, Pietrasanta, Carlo, Lunghi, Giovanna, Fagnani, Anna Maria, Piñana, Maria, Matter, Matthias, Tzankov, Alexandar, Terracciano, Luigi, Anton, Andres, Ferrazzi, Enrico, Ferrero, Stefano, Iurlaro, Enrico, Seoane, Joan, Nuciforo, Paolo
• Format: Article
• Language: English
• Subjects: Adult; Autopsy; Biomedical research; Cohort Studies; Complications and side effects; Concise Communication; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - transmission; COVID-19 - virology; Diseases; Female; Gene Expression Profiling; Humans; Infant, Newborn; Infants (Newborn); Infectious Disease Transmission, Vertical; Inflammation; Neonates; Newborn babies; Pandemics; Pediatric research; Perinatal infection; Phenotypes; Placenta; Placenta - pathology; Placenta - virology; Placenta Diseases - genetics; Placenta Diseases - pathology; Placenta Diseases - virology; Pregnancy; Pregnancy Complications, Infectious - genetics; Pregnancy Complications, Infectious - pathology; Pregnancy Complications, Infectious - virology; Pregnancy Outcome; RNA, Viral - genetics; RNA, Viral - isolation & purification; SARS-CoV-2 - genetics; SARS-CoV-2 - isolation & purification; SARS-CoV-2 - pathogenicity; Severe acute respiratory syndrome coronavirus 2; Transcription; Viral infections; Viruses; Womens health; Young Adult
• ISSN: 0021-9738; 1558-8238
• DOI: 10.1172/JCI145427

The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pathophysiology of the placenta and its impact on pregnancy outcome has not yet been fully elucidated. Here, we present a comprehensive clinical, morphological, and molecular analysis of placental tissues from pregnant women with and without SARS-CoV-2 infection. SARS-CoV-2 could be detected in half of placental tissues from SARS-CoV-2-positive women. The presence of the virus was not associated with any distinctive pathological, maternal, or neonatal outcome features. SARS-CoV-2 tissue load was low in all but one patient who exhibited severe placental damage leading to neonatal neurological manifestations. The placental transcriptional response induced by high viral load of SARS-CoV-2 showed an immunopathology phenotype similar to autopsy lung tissues from patients with severe coronavirus disease 2019. This finding contrasted with the lack of inflammatory response in placental tissues from SARS-CoV-2-positive women with low viral tissue load and from SARS-CoV-2-negative women. Importantly, no evidence of vertical transmission of SARS-CoV-2 was found in any newborns, suggesting that the placenta may be an effective maternal-neonatal barrier against the virus even in the presence of severe infection. Our observations suggest that severe placental damage induced by the virus may be detrimental for the neonate independently of vertical transmission.