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Merriel A, Fitzgerald B, O'Donoghue K. SARS-CoV-2-Placental effects and association with stillbirth. BJOG 2024; 131:385-400. [PMID: 37984971 DOI: 10.1111/1471-0528.17698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/02/2023] [Accepted: 10/14/2023] [Indexed: 11/22/2023]
Abstract
SARS-CoV-2 has had a significant impact on pregnancy outcomes due to the effects of the virus and the altered healthcare environment. Stillbirth has been relatively hidden during the COVID-19 pandemic, but a clear link between SARS-CoV-2 and poor fetal outcome emerged in the Alpha and Delta waves. A small minority of women/birthing people who contracted COVID-19 developed SARS-CoV-2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases of delivery just before imminent fetal demise and we shall discuss how some cases are sub-clinical. What is surprising, is that SARS-CoV-2 placentitis is often not associated with severe maternal COVID-19 infection and this makes it difficult to predict. The worst outcomes seem to be with diffuse placental disease which occurs within 21 days of COVID-19 diagnosis. Poor outcomes are often pre-dated by reduced fetal movements but are not associated with ultrasound changes. In some cases, there has also been maternal thrombocytopenia, or coagulation abnormalities, which may provide a clue as to which pregnancies are at risk of fetal demise if a further variant of concern is to emerge. In future, multidisciplinary collaboration and cross-boundary working must be prioritised, to identify quickly such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. While we wait to see if COVID-19 brings a future variant of concern, we must focus on appropriate future management of women who have had SARS-CoV-2 placentitis. As a placental condition with an infectious aetiology, SARS-CoV-placentitis is unlikely to recur in a subsequent pregnancy and thus a measured approach to subsequent pregnancy management is needed.
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Affiliation(s)
- Abi Merriel
- Centre for Women's Health Research, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Liverpool Women's Hospital, Liverpool, UK
| | | | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
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2
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Schaumann N, Suhren JT. An Update on COVID-19-Associated Placental Pathologies. Z Geburtshilfe Neonatol 2024; 228:42-48. [PMID: 38330958 DOI: 10.1055/a-2220-7469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
COVID-19 pregnancies are associated with increased rates of premature delivery and stillbirths. It is still a matter of debate whether there is a COVID-19-associated pattern of placenta pathology. We updated our previously published results on a systematic literature review and meta-analysis of COVID-19 pregnancies. In total, 38 reports on 3677 placentas were evaluated regarding histopathological changes. Maternal vascular malperfusion (32%), fetal vascular malperfusion (19%), acute and chronic inflammation (20% and 22%) were frequent pathologies. In non-COVID-19 pregnancies, placentas show similar histologic patterns and mainly similar frequencies of manifestation. It has to be taken into account that there might be an observation bias, because some findings are diagnosed as a "pathology" that might have been classified as minor or unspecific findings in non-COVID-19 placentas. COVID-19 placentitis occurs in 1-2% of cases at the most. In conclusion, this updated meta-analysis indicates that COVID-19 infection during pregnancy does not result in an increased rate of a specific placenta pathology and COVID-19 placentitis is rare.
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Affiliation(s)
- Nora Schaumann
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jan-Theile Suhren
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
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3
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Delle Chiaie L, Stolpner I, Dettmer MS, Baltz-Ghahremanpour K. Acute placental insufficiency two weeks after an asymptomatic COVID-19 maternal infection: the deleterious effects of the SARS-CoV-2 placentitis. Arch Gynecol Obstet 2024; 309:723-726. [PMID: 36912992 PMCID: PMC10009343 DOI: 10.1007/s00404-023-06991-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Loredana Delle Chiaie
- Clinic of Obstetrics and Gynecology, Klinikum Stuttgart-Olgahospital/Frauenklinik, Kriegsbergstraße 62, 70174, Stuttgart, Germany.
| | - Ilona Stolpner
- Clinic of Obstetrics and Gynecology, Klinikum Stuttgart-Olgahospital/Frauenklinik, Kriegsbergstraße 62, 70174, Stuttgart, Germany
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Debelenko L. SARS-CoV-2 Infection in Late Pregnancy and Childbirth from the Perspective of Perinatal Pathology. J Dev Biol 2023; 11:42. [PMID: 37987372 PMCID: PMC10660738 DOI: 10.3390/jdb11040042] [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: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023] Open
Abstract
This review focuses on SARS-CoV-2 infection in placental and fetal tissues. Viremia is rare in infected pregnant women, and the virus is seldom amplified from placental tissues. Definite and probable placental infection requires the demonstration of viral RNA or proteins using in situ hybridization (ISH) and immunohistochemistry (IHC). Small subsets (1.0-7.9%, median 2.8%) of placentas of SARS-CoV-2-positive women showed definite infection accompanied by a characteristic histopathology named SARS-CoV-2 placentitis (SP). The conventionally accepted histopathological criteria for SP include the triad of intervillositis, perivillous fibrin deposition, and trophoblast necrosis. SP was shown to be independent of the clinical severity of the infection, but associated with stillbirth in cases where destructive lesions affecting more than 75% of the placental tissue resulted in placental insufficiency and severe fetal hypoxic-ischemic injury. An association between maternal thrombophilia and SP was shown in a subset of cases, suggesting a synergy of the infection and deficient coagulation cascade as one of the mechanisms of the pathologic accumulation of fibrin in affected placentas. The virus was amplified from fetal tissues in approximately 40% of SP cases, but definite fetal involvement demonstrated using ISH or IHC is exceptionally rare. The placental pathology in SARS-CoV-2-positive women also includes chronic lesions associated with placental malperfusion in the absence of definite or probable placental infection. The direct viral causation of the vascular malperfusion of the placenta in COVID-19 is debatable, and common predispositions (hypertension, diabetes, and obesity) may play a role.
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Affiliation(s)
- Larisa Debelenko
- Department of Pathology and Cell Biology, Columbia University-Irving Medical Center, New York, NY 10032, USA
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Chaudhry S, Aboudawoud O, Hardy G. A History of COVID-19 in Pregnancy: A Narrative Review. J Clin Med 2023; 12:5722. [PMID: 37685788 PMCID: PMC10488531 DOI: 10.3390/jcm12175722] [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: 07/30/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the world causing a global pandemic. During a pandemic, it becomes increasing important to evaluate the effects on specific populations at risk. In this narrative review, we analyzed the literature regarding COVID-19 infection on the pregnant population as they are at increased risk of infection. COVID-19 did seem to significantly increase the risk of obstetric complications, specifically in underserved and marginalized populations. In general, COVID-19 rarely directly infected the fetus and placenta, apart from a very rare complication called COVID placentitis. In actuality, the mothers were at greatest direct risk due to COVID-19 infection. The most important takeaway from this pandemic is the prospective lesson and effect it had on social determinants of health. Women did not have safe access to antenatal care, leading to a plethora of indirect obstetric complications due to COVID-19. In conclusion, it was women who suffered from the pandemic, not the placenta nor the fetus. It is our duty as physicians to protect pregnant women, allowing the placenta to protect the fetus.
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Affiliation(s)
- Shahrukh Chaudhry
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA; (S.C.); (O.A.)
| | - Omar Aboudawoud
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA; (S.C.); (O.A.)
| | - Ghislain Hardy
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
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Petersen E, Chudakova D, Erdyneeva D, Zorigt D, Shabalina E, Gudkov D, Karalkin P, Reshetov I, Mynbaev OA. COVID-19-The Shift of Homeostasis into Oncopathology or Chronic Fibrosis in Terms of Female Reproductive System Involvement. Int J Mol Sci 2023; 24:ijms24108579. [PMID: 37239926 DOI: 10.3390/ijms24108579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
The COVID-19 pandemic caused by the SARS-CoV-2 coronavirus remains a global public health concern due to the systemic nature of the infection and its long-term consequences, many of which remain to be elucidated. SARS-CoV-2 targets endothelial cells and blood vessels, altering the tissue microenvironment, its secretion, immune-cell subpopulations, the extracellular matrix, and the molecular composition and mechanical properties. The female reproductive system has high regenerative potential, but can accumulate damage, including due to SARS-CoV-2. COVID-19 is profibrotic and can change the tissue microenvironment toward an oncogenic niche. This makes COVID-19 and its consequences one of the potential regulators of a homeostasis shift toward oncopathology and fibrosis in the tissues of the female reproductive system. We are looking at SARS-CoV-2-induced changes at all levels in the female reproductive system.
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Affiliation(s)
- Elena Petersen
- Moscow Institute of Physics and Technology, 141701 Dolgoprudny, Russia
| | - Daria Chudakova
- Moscow Institute of Physics and Technology, 141701 Dolgoprudny, Russia
| | - Daiana Erdyneeva
- Moscow Institute of Physics and Technology, 141701 Dolgoprudny, Russia
| | - Dulamsuren Zorigt
- Moscow Institute of Physics and Technology, 141701 Dolgoprudny, Russia
| | | | - Denis Gudkov
- Moscow Institute of Physics and Technology, 141701 Dolgoprudny, Russia
| | - Pavel Karalkin
- P.A. Herzen Moscow Research Institute of Oncology, 125284 Moscow, Russia
- Institute of Cluster Oncology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Igor Reshetov
- Institute of Cluster Oncology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Ospan A Mynbaev
- Moscow Institute of Physics and Technology, 141701 Dolgoprudny, Russia
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Coler B, Wu TY, Carlson L, Burd N, Munson J, Dacanay M, Cervantes O, Esplin S, Kapur RP, Feltovich H, Adams Waldorf KM. Diminished antiviral innate immune gene expression in the placenta following a maternal SARS-CoV-2 infection. Am J Obstet Gynecol 2023; 228:463.e1-463.e20. [PMID: 36126729 PMCID: PMC9482164 DOI: 10.1016/j.ajog.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 is caused by the SARS-CoV-2 virus and is associated with critical illness requiring hospitalization, maternal mortality, stillbirth, and preterm birth. SARS-CoV-2 has been shown to induce placental pathology. However, substantial gaps exist in our understanding of the pathophysiology of COVID-19 disease in pregnancy and the long-term impact of SARS-CoV-2 on the placenta and fetus. To what extent a SARS-CoV-2 infection of the placenta alters the placental antiviral innate immune response is not well understood. A dysregulated innate immune response in the setting of maternal COVID-19 disease may increase the risk of inflammatory tissue injury or placental compromise and may contribute to deleterious pregnancy outcomes. OBJECTIVE We sought to determine the impact of a maternal SARS-CoV-2 infection on placental immune response by evaluating gene expression of a panel of 6 antiviral innate immune mediators that act as biomarkers of the antiviral and interferon cytokine response. Our hypothesis was that a SARS-CoV-2 infection during pregnancy would result in an up-regulated placental antiviral innate immune response. STUDY DESIGN We performed a case-control study on placental tissues (chorionic villous tissues and chorioamniotic membrane) collected from pregnant patients with (N=140) and without (N=24) COVID-19 disease. We performed real-time quantitative polymerase chain reaction and immunohistochemistry, and the placental histopathology was evaluated. Clinical data were abstracted. Fisher exact test, Pearson correlations, and linear regression models were used to examine proportions and continuous data between patients with active (<10 days since diagnosis) vs recovered COVID-19 (>10 days since diagnosis) at the time of delivery. Secondary regression models adjusted for labor status as a covariate and evaluated potential correlation between placental innate immune gene expression and other variables. RESULTS SARS-CoV-2 viral RNA was detected in placental tissues from 5 women with COVID-19 and from no controls (0/24, 0%). Only 1 of 5 cases with detectable SARS-CoV-2 viral RNA in placental tissues was confirmed to express SARS-CoV-2 nucleocapsid and spike proteins in syncytiotrophoblast cells. We detected a considerably lower gene expression of 5 critical innate immune mediators (IFNB, IFIT1, MXA, IL6, IL1B) in the chorionic villi and chorioamniotic membranes from women with active or recovered COVID-19 than controls, which remained significant after adjustment for labor status. There were minimal correlations between placental gene expression and other studied variables including gestational age at diagnosis, time interval between COVID-19 diagnosis and delivery, prepregnancy body mass index, COVID-19 disease severity, or placental pathology. CONCLUSION A maternal SARS-CoV-2 infection was associated with an impaired placental innate immune response in chorionic villous tissues and chorioamniotic membranes that was not correlated with gestational age at COVID-19 diagnosis, time interval from COVID-19 diagnosis to delivery, maternal obesity, disease severity, or placental pathology.
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Affiliation(s)
- Brahm Coler
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Tsung-Yen Wu
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Lindsey Carlson
- Women and Newborn Research, Intermountain Health Care, Salt Lake City, UT
| | - Nicole Burd
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Jeff Munson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Matthew Dacanay
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Sean Esplin
- Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, UT
| | - Raj P Kapur
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA; Department of Pathology, Seattle Children's Hospital, Seattle, WA
| | - Helen Feltovich
- Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, UT.
| | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA.
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Damman E, Trecourt A, de la Fournière B, Lebreton F, Gaillot-Durand L, Fichez A, Chauvy L, Thonnon C, Destras G, Devouassoux-Shisheboran M, Allias F. Predictive factors for severe placental damage in pregnant women with SARS-CoV-2 infection. Placenta 2023; 136:1-7. [PMID: 36963271 PMCID: PMC10022462 DOI: 10.1016/j.placenta.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION SARS-Cov-2 infection during pregnancy can lead to severe placental lesions characterized by massive perivillous fibrin deposition, histiocytic intervillositis and trophoblast necrosis. Diffuse placental damage of this kind is rare, but can sometimes lead to obstetric complications, such as intrauterine fetal death (IUFD). The objectives of this study were to identify possible predictors of severe placental lesions. METHODS We retrospectively studied 96 placentas from SARS-Cov-2 positive pregnant women who gave birth between March 2020 and March 2022. Cases with and without severe placental lesions were compared in terms of clinical and laboratory findings. RESULTS Twelve of the 96 patients had severe placental lesions. There was no significant association with diabetes, obesity or severe clinical maternal disease. In contrast, presence of severe placental lesions was significantly associated with neonatal intensive care, cesarean section, prematurity, IUFD, intrauterine growth restriction (IUGR), gestational age, maternal hypofibrinogenemia and thrombocytopenia. No cases of severe placental lesions were observed in vaccinated patients or in those with the Omicron variant. DISCUSSION In these patients, severe placental lesions due to SARS-Cov-2 were significantly associated with the presence of coagulation abnormalities (hypofibrinogenemia and thrombocytopenia), IUGR and gestational age. These results support laboratory and ultrasound monitoring of these parameters in pregnant women with SARS-Cov-2 infection, especially during the second trimester, to predict potential negative fetal outcomes.
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Affiliation(s)
- Elise Damman
- Medipath Montpellier, 80 rue de Pythagore, 34170, Castelnau-Le-Lez, France
| | - Alexis Trecourt
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Benoit de la Fournière
- Department of Gynecology and Obstetrics, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Frédérique Lebreton
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Lucie Gaillot-Durand
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Axel Fichez
- Department of Gynecology and Obstetrics, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Lauriane Chauvy
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Cyrielle Thonnon
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Gregory Destras
- Department of Virology, Infective Agents Institute, National Reference Center for Respiratory Viruses, Hospices civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France
| | - Fabienne Allias
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, 69310, Pierre-Bénite, France.
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Giuliani F, Deantoni S, Papageorghiou AT. Vaginal vs cesarean delivery for COVID-19 in pregnancy. Am J Obstet Gynecol 2023; 228:358-359. [PMID: 36288753 PMCID: PMC9672662 DOI: 10.1016/j.ajog.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Francesca Giuliani
- Neonatal Special Care Unit, Regina Margherita Children's Hospital, Turin, Italy.
| | - Sonia Deantoni
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
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10
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Wong YP, Tan GC, Khong TY. SARS-CoV-2 Transplacental Transmission: A Rare Occurrence? An Overview of the Protective Role of the Placenta. Int J Mol Sci 2023; 24:ijms24054550. [PMID: 36901979 PMCID: PMC10002996 DOI: 10.3390/ijms24054550] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
The outbreak of the coronavirus disease 2019 (COVID-19) pandemic, caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global public health crisis, causing substantial concern especially to the pregnant population. Pregnant women infected with SARS-CoV-2 are at greater risk of devastating pregnancy complications such as premature delivery and stillbirth. Irrespective of the emerging reported cases of neonatal COVID-19, reassuringly, confirmatory evidence of vertical transmission is still lacking. The protective role of the placenta in limiting in utero spread of virus to the developing fetus is intriguing. The short- and long-term impact of maternal COVID-19 infection in the newborn remains an unresolved question. In this review, we explore the recent evidence of SARS-CoV-2 vertical transmission, cell-entry pathways, placental responses towards SARS-CoV-2 infection, and its potential effects on the offspring. We further discuss how the placenta serves as a defensive front against SARS-CoV-2 by exerting various cellular and molecular defense pathways. A better understanding of the placental barrier, immune defense, and modulation strategies involved in restricting transplacental transmission may provide valuable insights for future development of antiviral and immunomodulatory therapies to improve pregnancy outcomes.
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Affiliation(s)
- Yin Ping Wong
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Department of Pathology, SA Pathology, Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia
- Correspondence: (Y.P.W.); (G.C.T.)
| | - Geok Chin Tan
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Correspondence: (Y.P.W.); (G.C.T.)
| | - T. Yee Khong
- Department of Pathology, SA Pathology, Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia
- Department of Pathology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia
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11
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Wai JY, Wood EM, Hornaday KK, Slater DM. Potential molecular and cellular mechanisms for adverse placental outcomes in pregnancies complicated by SARS-CoV-2 infection-A scoping review. PLoS One 2023; 18:e0283453. [PMID: 36952548 PMCID: PMC10035918 DOI: 10.1371/journal.pone.0283453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Emerging evidence suggests that SARS-CoV-2 infection during pregnancy can result in placental damage and poor placental outcomes. However, the mechanisms by which SARS-CoV-2 infection leads to placental damage are not well understood. With a rapid expansion of literature on this topic, it is critical to assess the quality and synthesize the current state of literature. The objective of this scoping review is to highlight underlying mechanisms of SARS-CoV-2 mediated placental pathology in pregnant individuals and identify literature gaps regarding molecular and cellular mechanisms of poor placental outcomes. METHODS The review was conducted and reported following the recommendations of the PRISMA extension for Scoping Reviews. The study protocol was registered with Open Science Framework (https://osf.io/p563s/). Five databases (MEDLINE, EMBASE, Scopus, CINAHL, PubMed) were searched for studies published between September 2019 until April 2022. Studies assessing placental outcomes with respect to SARS-CoV-2 infection in pregnancy were eligible for inclusion. Outcomes of interest included histopathology, and molecular or cellular analysis. All records were uploaded into Covidence and extracted using the Joanna Briggs Institute method. Studies were assessed for risk of bias using the Newcastle Ottawa scale and a narrative synthesis of results was generated. RESULTS Twenty-seven studies reporting on molecular and/or cellular mechanisms of SARS-CoV-2 mediated placental outcomes were included in this review. SARS-CoV-2 infection was associated with perturbations in the ACE2 pathway, inflammatory mediators and immune cell populations and mitochondrial function in placentas. CONCLUSIONS Our findings suggest that changes in the ACE2 pathway, mitochondrial dysfunction, and/or inflammatory processes may lead to placental damage observed in SARS-CoV-2 infection during pregnancy. More research is needed to understand the role of these pathways further, in addition to data collection related to trimester, severity, and strain.
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Affiliation(s)
- Janelle Y Wai
- Department of Physiology and Pharmacology, Cumming School of Medicine at the University of Calgary, Calgary, Canada
| | - Eilidh M Wood
- Department of Physiology and Pharmacology, Cumming School of Medicine at the University of Calgary, Calgary, Canada
| | - Kylie K Hornaday
- Department of Physiology and Pharmacology, Cumming School of Medicine at the University of Calgary, Calgary, Canada
| | - Donna M Slater
- Department of Physiology and Pharmacology, Cumming School of Medicine at the University of Calgary, Calgary, Canada
- Department of Obstetrics and Gynecology in the Cumming School of Medicine at the University of Calgary, Calgary, Canada
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