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Comparative Study
. 2025 Jul;18(4):338-343.
doi: 10.1177/19345798251330831. Epub 2025 Apr 10.

The comparison of placental findings and pregnancy outcomes before and during COVID-19 pandemic

Helen Y How  1 , Mureena A Turnquest-Wells  1 , Michael W Daniels  2 , Christina L Waldon  1
Affiliations
Comparative Study

The comparison of placental findings and pregnancy outcomes before and during COVID-19 pandemic

Helen Y How et al. J Neonatal Perinatal Med. 2025 Jul.

Abstract

BackgroundThe impact of SARS-CoV-2 on pregnancy outcomes is unclear, but evidence suggests increased perinatal loss due to placental damage and fetal oxygen deprivation.ObjectiveThis study compared placental findings and fetal outcomes between pre-COVID-19 and COVID-19 periods to assess the association between COVID-19 and abnormal placental pathology and fetal complications. It was hypothesized that COVID-19-positive pregnancies would have higher rates of intrauterine fetal demise and fetal growth restriction due to virus-induced placental injury.Study DesignA retrospective analysis of 34,102 deliveries compared placental and fetal outcomes across two periods: pre-COVID-19 (April 1, 2018-September 30, 2019) and COVID-19 (April 1, 2020-September 30, 2021), with a washout period in between. Placental abnormalities (chorangiosis, chorioamnionitis, and villitis) and fetal outcomes (fetal growth restriction and intrauterine fetal demise) were analyzed using chi-squared tests with odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe COVID-19 period showed a significant increase in placental findings: chorangiosis, chorioamnionitis, villitis, and fetal growth restriction. Placentas from COVID-19-positive mothers had higher rates of these findings, though the increase in fetal growth restriction was not statistically significant. Intrauterine fetal demise rates were higher in COVID-19-negative pregnancies but did not differ between periods.ConclusionRoutine antenatal fetal testing for COVID-19 positivity alone is not warranted. We agree a follow-up fetal growth ultrasound 4 weeks post-infection is advisable per Society for Maternal-Fetal Medicine guidelines. The role of maternal comorbidities in chorangiosis remains unclear, warranting further investigation.

Keywords: COVID-19; SARS-CoV-2; chorangiosis; chorioamnionitis; fetal growth restriction; intrauterine fetal demise; placental findings; pregnancy; pregnancy outcomes; villitis.

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Conflict of interest statement

Conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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