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Bernad ES, Duica F, Antoniadis P, Moza A, Lungeanu D, Craina M, Bernad BC, Maghet E, Vasilache IA, Maghiari AL, Arnautu DA, Iacob D. Maternal Fever and Reduced Fetal Movement as Predictive Risk Factors for Adverse Neonatal Outcome in Cases of Congenital SARS-CoV-2 Infection: A Meta-Analysis of Individual Participant Data from Case Reports and Case Series. Viruses 2023; 15:1615. [PMID: 37515301 PMCID: PMC10384546 DOI: 10.3390/v15071615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES To determine risk factors for primary and secondary adverse neonatal outcomes in newborns with congenital SARS-CoV-2 infection. DATA SOURCES PubMed/MEDLINE and Google Scholar from January 2020 to January 2022. STUDY ELIGIBILITY CRITERIA newborns delivered after 24 weeks of gestation with confirmed/possible congenital SARS-CoV-2 infection, according to standard classification criteria. METHODS Execution of the IPD analyses followed the PRISMA-IPD statement. Univariate non-parametric tests compared numerical data distributions. Fisher's exact or Chi-square test determined categorical variables' statistical significance. Multivariate logistic regression revealed risk factors for adverse neonatal outcome. RESULTS Maternal fever was associated with symptomatic congenital infection (OR: 4.55, 95% CI: 1.33-15.57). Two-thirds of women that reported decreased fetal movements were diagnosed with IUFD (p-value = 0.001). Reduced fetal movement increased the risk of intrauterine fetal death by 7.84 times (p-value = 0.016, 95% CI: 2.23-27.5). The risk of stillbirth decreased with gestational age at the time of maternal infection (p-value < 0.05, OR: 0.87, 95% CI: 0.79-0.97). CONCLUSIONS Maternal fever and perception of reduced fetal movement may be predictive risk factors for adverse pregnancy outcome in cases with congenital SARS-CoV-2 infection.
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Affiliation(s)
- Elena S Bernad
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynecology, "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Florentina Duica
- Bucharest Emergency Clinical Hospital, 014461 Bucharest, Romania
- Alessandrescu-Rusescu National Institute for Mother and Child Health, Fetal Medicine Excellence Research Center, 020395 Bucharest, Romania
| | - Panagiotis Antoniadis
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Southern Denmark, 5230 Odense, Denmark
| | - Andreea Moza
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynecology, "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Functional Sciences, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Craina
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinic of Obstetrics and Gynecology, "Pius Brinzeu" County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Brenda C Bernad
- Department of Neuroscience, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Neuropsychology and Behavioral Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Edida Maghet
- 1st Department, Faculty of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy, 300070 Timisoara, Romania
| | - Ingrid-Andrada Vasilache
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Laura Maghiari
- 1st Department, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Diana-Aurora Arnautu
- Department of Cardiology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Daniela Iacob
- Department of Obstetrics and Gynecology, Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Chimenea A, García-Díaz L, Calderón AM, Antiñolo G. Prenatal diagnosis of VACTERL association after early-first trimester SARS-COV-2 infection. Congenit Anom (Kyoto) 2023; 63:44-46. [PMID: 36517451 PMCID: PMC9877562 DOI: 10.1111/cga.12503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/15/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
Organogenesis is a period of fetal development with a special vulnerability to biological and environmental agents. There are some viral infections whose transmission in the first trimester carries a significant risk for the development of congenital anomalies. Although the possibility of vertical transmission of SARS-CoV-2 during pregnancy has been demonstrated, there are no studies evaluating the impact of SARS-CoV-2 infection in the first trimester and its possible association with congenital anomalies. In this communication, we present the case of a pregnant woman with early SARS-CoV-2 infection, prenatally diagnosed with fetal VACTERL association by mid-trimester ultrasound. Further studies are needed to determine the causal association.
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Affiliation(s)
- Angel Chimenea
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain.,Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain
| | - Lutgardo García-Díaz
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain.,Department of Surgery, University of Seville, Seville, Spain
| | - Ana María Calderón
- Department of Gynecology, Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | - Guillermo Antiñolo
- Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain.,Fetal, IVF and Reproduction Simulation Training Centre (FIRST), Seville, Spain.,Department of Surgery, University of Seville, Seville, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain
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3
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Outcome of Newborns with Confirmed or Possible SARS-CoV-2 Vertical Infection-A Scoping Review. Diagnostics (Basel) 2023; 13:diagnostics13020245. [PMID: 36673058 PMCID: PMC9858608 DOI: 10.3390/diagnostics13020245] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Severe acute respiratory syndrome virus 2 (SARS-CoV-2), the virus that causes 2019 coronavirus disease (COVID-19), has been isolated from various tissues and body fluids, including the placenta, amniotic fluid, and umbilical cord of newborns. In the last few years, much scientific effort has been directed toward studying SARS-CoV-2, focusing on the different features of the virus, such as its structure and mechanisms of action. Moreover, much focus has been on developing accurate diagnostic tools and various drugs or vaccines to treat COVID-19. However, the available evidence is still scarce and consistent criteria should be used for diagnosing vertical transmission. Applying the PRISMA ScR guidelines, we conducted a scoping review with the primary objective of identifying the types, and examining the range, of available evidence of vertical transmission of SARS-CoV-2 from mother to newborn. We also aimed to clarify the key concepts and criteria for diagnosis of SARS-CoV-2 vertical infection in neonates and summarize the existing evidence and advance the awareness of SARS-CoV-2 vertical infection in pregnancy. Most studies we identified were case reports or case series (about 30% of poor quality and inconsistent reporting of the findings). Summarizing the existing classification criteria, we propose an algorithm for consistent diagnosis. Registration: INPLASY2022120093.
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4
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Fitzgerald B, O'Donoghue K, McEntagart N, Gillan JE, Kelehan P, O'Leary J, Downey P, Dean J, De Gascun CF, Bermingham J, Armstrong F, Al Fathil A, Maher N, Murphy C, Burke L. Fetal deaths in Ireland due to SARS-CoV-2 placentitis caused by SARS-CoV-2 Alpha. Arch Pathol Lab Med 2022; 146:529-537. [PMID: 35020786 DOI: 10.5858/arpa.2021-0586-sa] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT - A severe third wave of COVID-19 disease affected Ireland in the first 3 months of 2021. In this wave, 1 second trimester miscarriage and 6 stillbirths were observed in the Irish population due to placental insufficiency as a result of SARS-CoV-2 placentitis. This observation was at odds with the country's previous experience with COVID-19 disease in pregnant mothers. OBJECTIVE - To describe the clinical and pathological features of these pregnancy losses. DESIGN - Retrospective review of clinical and pathological data of cases of second trimester miscarriage, stillbirth or neonatal death identified by perinatal pathologists as being due to SARS-CoV-2 placentitis during the third wave of COVID-19 in Ireland. RESULTS - Clinical and pathological data was available for review in 6 pregnancies. Sequencing or genotyping of the virus identified SARS-CoV-2 Alpha (B.1.1.7) in all cases. Three of the 6 cases had maternal thrombocytopenia, while fetal growth restriction was not prominent suggesting a rapidly progressive placental disease. CONCLUSIONS - The identification of SARS-CoV-2 Alpha in all these cases suggests that the emergence of the variant was associated with an increased risk of fetal death due to SARSCoV-2 placentitis when compared to the original virus. Maternal thrombocytopenia, may have potential as a clinical marker of placentitis but other inflammatory markers need investigation. Three of the 6 women had been assessed for reduced fetal movements in hospital some days before the fetal deaths actually occurred; this could suggest that there may be a window for intervention in some cases.
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Affiliation(s)
- Brendan Fitzgerald
- Department of Pathology (Fitzgerald, Burke), Cork University Hospital, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology (O'Donoghue), University College Cork, Cork, Ireland.,Irish Centre for Maternal and Child Health in Cork University Maternity Hospital (O'Donoghue), Cork, Ireland
| | - Noel McEntagart
- Department of Pathology (McEntagart), Rotunda Hospital, Dublin, Ireland
| | - John E Gillan
- Department of Pathology, Coombe Women and Infant's Hospital, Dublin, Ireland (Gillan, Kelehan)
| | - Peter Kelehan
- Department of Pathology, Coombe Women and Infant's Hospital, Dublin, Ireland (Gillan, Kelehan)
| | - John O'Leary
- Department of Pathology, Trinity College Dublin, Dublin, Ireland (O'Leary)
| | - Paul Downey
- Department of Pathology, National Maternity Hospital, Dublin, Ireland (Downey)
| | - Jonathan Dean
- UCD National Virus Reference Laboratory, University College Dublin, Ireland (Dean, De Gascun)
| | - Cillian F De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Ireland (Dean, De Gascun)
| | - John Bermingham
- Department of Obstetrics and Gynaecology, University Hospital Waterford, Ireland (Bermingham)
| | - Fionnvola Armstrong
- Department of Obstetrics and Gynaecology, Our Lady of Lourdes Hospital, Drogheda, Ireland (Armstrong)
| | - Attia Al Fathil
- Department of Obstetrics and Gynaecology, Tipperary University Hospital, Clonmel, Ireland (Al Fathil)
| | - Nicola Maher
- Department of Obstetrics and Gynaecology (Maher), Rotunda Hospital, Dublin, Ireland
| | - Cliona Murphy
- Institute of Obstetricians and Gynaecologists, Dublin, Ireland (Murphy)
| | - Louise Burke
- Department of Pathology (Fitzgerald, Burke), Cork University Hospital, Cork, Ireland.,Department of Pathology (Burke), University College Cork, Cork, Ireland
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5
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Long Version)]. Z Geburtshilfe Neonatol 2021; 226:e1-e35. [PMID: 34918334 DOI: 10.1055/a-1688-9398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).
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Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Deutschland
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Deutschland
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Deutschland
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rolf Schlösser
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Deutschland
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Valdespino-Vázquez MY, Helguera-Repetto CA, León-Juárez M, Villavicencio-Carrisoza O, Flores-Pliego A, Moreno-Verduzco ER, Díaz-Pérez DL, Villegas-Mota I, Carrasco-Ramírez E, López-Martínez IE, Giraldo-Gómez DM, Lira R, Yocupicio-Monroy M, Rodríguez-Bosch M, Sevilla-Reyes EE, Cortés-Bonilla M, Acevedo-Gallegos S, Merchant-Larios H, Cardona-Pérez JA, Irles C. Fetal and placental infection with SARS-CoV-2 in early pregnancy. J Med Virol 2021; 93:4480-4487. [PMID: 33764543 PMCID: PMC8250563 DOI: 10.1002/jmv.26965] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023]
Abstract
To date, mother‐to‐fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), responsible for the coronavirus disease 2019 (COVID‐19) pandemic, remains controversial. Although placental COVID‐19 infection has been documented in some cases during the second‐ and third‐trimesters, no reports are available for the first trimester of pregnancy, and no SARS‐CoV‐2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarriage in a COVID‐19 maternal infection by immunohistochemical, reverse transcription quantitative real‐time polymerase chain reaction, immunofluorescence, and electron microscopy methods. SARS‐CoV‐2 nucleocapsid protein, viral RNA, and particles consistent with coronavirus were found in the placenta and fetal tissues, accompanied by RNA replication revealed by double‐stranded RNA (dsRNA) positive immunostain. Prominent damage of the placenta and fetal organs were associated with a hyperinflammatory process identified by histological examination and immunohistochemistry. The findings provided in this study document that congenital SARS‐CoV‐2 infection is possible during the first trimester of pregnancy and that fetal organs, such as lung and kidney, are targets for coronavirus. The infection and multi‐organic fetal inflammation produced by SARS‐CoV‐2 during early pregnancy should alert clinicians in the assessment and management of pregnant women for possible fetal consequences and adverse perinatal outcomes.
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Affiliation(s)
- María Y Valdespino-Vázquez
- Departamento de Patología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Cecilia A Helguera-Repetto
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Moises León-Juárez
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Oscar Villavicencio-Carrisoza
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Arturo Flores-Pliego
- Departamento de Immunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Elsa R Moreno-Verduzco
- Subdirección de Servicios auxiliares de Diagnóstico, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Diana L Díaz-Pérez
- Departamento de Patología, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Isabel Villegas-Mota
- Departamento de Epidemiología e Infectología Clínica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Elba Carrasco-Ramírez
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Unidad de Microscopía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Irma E López-Martínez
- Unidad de Microscopía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - David M Giraldo-Gómez
- Unidad de Microscopía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Rosalia Lira
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Martha Yocupicio-Monroy
- Posgrado en Ciencias Genómicas, Universidad Autónoma de la Ciudad de México, Mexico City, Mexico
| | - Mario Rodríguez-Bosch
- Subdirección de Ginecología y Obstetricia, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Edgar E Sevilla-Reyes
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Manuel Cortés-Bonilla
- Dirección Médica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Sandra Acevedo-Gallegos
- Departamento de Medicina Materno-Fetal, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Horacio Merchant-Larios
- Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Jorge Arturo Cardona-Pérez
- Dirección General, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Claudine Irles
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
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7
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Samara A, Herlenius E. Is There an Effect of Fetal Mesenchymal Stem Cells in the Mother-Fetus Dyad in COVID-19 Pregnancies and Vertical Transmission? Front Physiol 2021; 11:624625. [PMID: 33679426 PMCID: PMC7928412 DOI: 10.3389/fphys.2020.624625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
Because of the polysystemic nature of coronavirus disease 2019 (COVID-19), during the present pandemic, there have been serious concerns regarding pregnancy, vertical transmission, and intrapartum risk. The majority of pregnant patients with COVID-19 infection present with mild or asymptomatic course of the disease. Some cases were hospitalized, and few needed intensive care unit admission, or mechanical ventilation. There have also been scarce case reports where neonates required mechanical ventilation post COVID-19 pregnancies. Without approved therapies other than dexamethasone, advanced mesenchymal cell therapy is one immunomodulatory therapeutic approach that is currently explored and might hold great promise. We suggest that the circulating fetal stem cells might have an immune-protective effect to mothers and contribute to the often mild and even asymptomatic post-COVID-19 pregnancies. Thus, COVID-19 pregnancies come forth as a paradigm to be further and more comprehensively approached, to understand both the mechanism and action of circulating stem cells in immunoprotection and hypoxia in microcirculation.
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Affiliation(s)
- Athina Samara
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden
| | - Eric Herlenius
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital Karolinska University Hospital, Stockholm, Sweden
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