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Multicenter Study
. 2022 Jan:117:47-56.
doi: 10.1016/j.placenta.2021.10.012. Epub 2021 Oct 23.

Placental deficiency during maternal SARS-CoV-2 infection

Ebru Celik  1 , Cansel Vatansever  2 , Gulin Ozcan  2 , Nilgun Kapucuoglu  3 , Cengiz Alatas  4 , Yesim Besli  5 , Erhan Palaoglu  5 , Tugba Gursoy  6 , Mete Manici  7 , Mert Turgal  1 , Ozlem Dogan  2 , Sebile Guler Cekic  1 , Banu Duru  8 , Baris Ata  1 , Onder Ergonul  9 , Fusun Can  10
Affiliations
Multicenter Study

Placental deficiency during maternal SARS-CoV-2 infection

Ebru Celik et al. Placenta. 2022 Jan.

Abstract

Introduction: Maternal anti-SARS-CoV-2 Spike antibodies can cross the placenta during pregnancy, and neonates born to infected mothers have acquired antibodies at birth. Few studies reported data on the histopathological changes of the placenta during infection and placental infection. SARS-CoV-2 infection may cause impaired development of the placenta, thus predisposing maternal and fetal unfavorable outcomes. The prospective study aims to evaluate the risk of vertical transmission of SARS-CoV-2 and placental passage of anti-Spike antibodies as well as the impact of clinical severity on placental structures.

Methods: This is a prospective cohort study on 30 pregnant women infected by SARS-CoV-2 with their neonates. The demographic features and pregnancy outcomes were collected. Gross and microscopic examinations of the placentas were done. Maternal and umbilical cord sera were obtained at the time of delivery. Nasopharyngeal swabs were collected from neonates immediately after birth.

Results: The concentrations of total anti-SARS-CoV-2 Spike antibodies were higher in pregnant women with moderate to severe/critical disease. The maternal total anti-SARS-CoV-2 Spike levels were correlated with those of neonatal levels. The rate of placental abnormalities is high in the mothers with severe disease, and those with positive anti-SARS-CoV-2 IgM. All neonates had negative nasopharyngeal swabs for SARS- CoV-2 infections and all placentas were negative in immunohistochemical staining for Spike protein.

Discussion: The maternally derived anti-SARS-CoV-2 Spike antibody can transmit to neonates born to infected mothers regardless of gestational age. Our results indicated that the disease severity is associated with ischemic placental pathology which may result in adverse pregnancy outcomes.

Keywords: COVID-19; Placental pathological findings; Pregnancy; SARS-CoV-2 infection.

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Conflict of interest statement

There is nothing to declare.

Figures

Fig. 1
Fig. 1
Mild perivillous fibrin deposition around tertiary villi (Fibrin deposition is shown by arrows) (case no. 29) (×10, hematoxylin& eosin).
Fig. 2
Fig. 2
Santral infarctus in case no. 20. There is loss of basophilia within the villi karyorectic debris within villi stroma and between villi (×20, hematoxylin& eosin).
Fig. 3
Fig. 3
(a) Thrombus within a vessel in a stem villus (×5) (b) higher magnification of the fibrin thrombus in the same vessel (×20, hematoxylin& eosin) (case no. 16).
Fig. 4
Fig. 4
(a) Lymphocyte and eosinophil infiltration on the wall of the chorionic vessel, area in square is highlighted in Fig. 4 (b) (case no. 14) (×2, hematoxylin& eosin), (b) in the same case eosinophils are marked by arrows in a higher magnification (×20, hematoxylin& eosin).
Fig. 5
Fig. 5
(a) Granular positive immunoreactivity with anti-spike antibody in the positive control pelet prepared from SARS-CoV2 infected Vero E6 cells (×20), (b) there is no positive immunoreactivity in negative control pellet with Anti-Spike antibody, which is prepared from non-infected Vero E6 cells (×20), (c) negative immunoreactivity in the negative control pellet which is prepared from SARS-CoV-2 infected Vero E6 cells and incubated with the diluent (PBS) instead of Anti-Spike antibody and then with secondary antibody.
Fig. 6
Fig. 6
There is no positive immunoreactivity with anti-spike antibody in syncytiotrphoblast, which is marked by arrows in the placenta of case no. 18 (×20).
See this image and copyright information in PMC

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