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Case Reports
. 2022 Aug 26;10(9):1718.
doi: 10.3390/microorganisms10091718.

Unexpected Vertical Transmission of SARS-CoV-2: Discordant Clinical Course and Transmission from Mother to Newborn

Alessandra Boncompagni  1 , Mattia De Agostini  2 , Licia Lugli  1 , Giliana Ternelli  3 , Valeria Colonna  3 , Emanuela Biagioni  4 , Maria Paola Bonasoni  5 , Tiziana Salviato  6 , Liliana Gabrielli  7 , Mirella Falconi  8 , Fabio Facchinetti  3 , Alberto Berardi  1
Affiliations
Case Reports

Unexpected Vertical Transmission of SARS-CoV-2: Discordant Clinical Course and Transmission from Mother to Newborn

Alessandra Boncompagni et al. Microorganisms. .

Abstract

Mother-to-newborn COVID-19 transmission is mainly postnatal, but single-case reports and small case series have also described SARS-CoV-2 transplacental transmission. Unfortunately, studies regarding vertical transmission of SARS-CoV-2 lack systematic approaches to diagnosis and classification. So far, scientific evidence seems to suggest that the severity of maternal infection increases the risk of vertical transmission. We report two neonates born from COVID-19-positive mothers, of which one of the newborns had a vertical infection. The placental involvement, and consequent intrauterine transmission of SARS-CoV-2, were inversely related to the severity of the maternal disease. The description of cases divergent from current evidence on this topic could provide new insights to better understand SARS-CoV-2 vertical transmission.

Keywords: COVID-19; SARS-CoV-2; histopathological findings; infection; newborn; placenta; vertical transmission.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Timeline of clinical course and laboratory tests of the two cases. DOL: day of life; GA: gestational age; NS: nasopharyngeal swab.
Figure 2
Figure 2
Placental pathology findings of the two cases. The Placenta of case 1 weighed 246 g and measured 13 × 12 × 4 cm; the umbilical cord appeared hypercoiled (5 coils per 10 cm) and was 13 cm long with a diameter between 0.9–1.5 cm. No gross anomalies were observed. (A) Hematoxilin and Eosin staining (4HPF): mild subchorionitis with normally developed parenchyma for gestational age. The Placenta of case 2 weighed 347 g and measured 18 × 13 × 3 cm; the umbilical cord had 2 coils every 10 cm and was 27 cm long with a diameter between 1–1.5 cm. Macroscopically, it appeared pale. (B) Hematoxilin and Eosin staining (4HPF): diffuse intervillous fibrinoid deposition with intervillositis mainly represented by lymphocytes, histiocytes and few granulocytes. (C) Immunostaining for SARS-CoV-2 nucleocapsid protein (polyclonal, Novus biological, USA) (10HPF): diffuse positivity in the syncytiotrophoblast. Lymphocyte immunohistochemical characterization (not shown) revealed a prevalence population of TCD4, and few activated TCD8 evidenced by Granzyme B staining. (D) Electron microscopy examination: many viral particles (arrows) in the cytoplasm of the syncytiotrophoblast.
See this image and copyright information in PMC

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