Transient Early Fine Motor Abnormalities in Infants Born to COVID-19 Mothers Are Associated With Placental Hypoxia and Ischemia

The effect of COVID-19 on placental functioning in South African pregnancies: investigation of kisspeptin expression and vascular and inflammatory alterations

The coronavirus disease 2019 (COVID-19) pandemic has passed; however, its long-term effects are yet to be determined. Pregnant women and their neonates faced a higher risk for complications during this pandemic as COVID-19 was reported to result in oxidative and inflammatory stress and the cytokine storm, which would impact pregnancy, namely the trophoblast invasion and placental development and functioning. Therefore, this study aims to determine the effect of COVID-19 on the placental functioning in South African pregnancies through the analysis of kisspeptin and placental morphology. Immunohistochemical analyses of placental samples were performed to detect the expression of kisspeptin. Histopathological analysis was conducted to identify vascular and inflammatory alterations. This study demonstrated that COVID-19 results in a significantly increased expression of placental kisspeptin in both the central (p = 0.001) and peripheral (p < 0.0001) regions as compared with the placentae from control pregnancies. Upon further analysis, the placentae from COVID-19 pregnancies also presented with severe inflammation and maternal and fetal vascular malperfusion compared with the control placentae. A significantly increased expression of placental kisspeptin was observed in COVID-19 positive pregnancies, implying impaired placental functioning. This was further supported by vascular and inflammatory alterations observed in COVID-19-positive placentae, which may suggest that trophoblast invasion was compromised. To date, there still exists small clusters of COVID-19 outbreaks, and our findings highlight the importance of the future surveillance of these mothers and neonates in COVID-19 pregnancies in South Africa, as neonates from other countries have presented with abnormalities.

Early childhood developmental concerns following SARS-CoV-2 infection and COVID-19 vaccination during pregnancy: a Scottish population-level retrospective cohort study

BACKGROUND

Understanding the effects of SARS-CoV-2 infection and COVID-19 vaccination during pregnancy can help inform clinical guidance and tackle vaccine hesitancy. We examined relationships between SARS-CoV-2 infection during pregnancy, COVID-19 vaccination during pregnancy, and early child developmental concerns in children aged 13-15 months in Scotland.

METHODS

We created a large, population-level linked administrative health dataset, combining the COVID-19 in Pregnancy in Scotland (COPS) dataset with age 13-15 month child health review data and other datasets. We included children estimated to have been conceived after May 18, 2020, and born before Sept 30, 2021, and their mothers. We used logistic regression modelling to investigate associations between SARS-CoV-2 infection during pregnancy, COVID-19 vaccination during pregnancy, and developmental concerns (ie, parent or caregiver developmental concerns and health visitor-identified concerns regarding speech-language-communication, problem solving, gross motor, personal-social, and emotional-behavioural development) measured during routine child health reviews at age 13-15 months, including adjustment for confounders and covariates.

FINDINGS

A total of 24 919 child-mother pairs (12 752 [51·2%] male children; 12 167 [48·8%] female children) were included. 1631 (6·5%) children were prenatally exposed to SARS-CoV-2 and 4943 (19·8%) to COVID-19 vaccination. We found no associations between SARS-CoV-2 infection during pregnancy and developmental concerns. After confounder and covariate adjustment, COVID-19 vaccination during pregnancy was associated with reduced odds of developmental concerns regarding problem solving (odds ratio 0·78 [95% CI 0·64-0·95]), personal-social (0·76 [0·61-0·95]), and emotional-behavioural (0·67 [0·48-0·92]) development, but had no associations with other developmental concerns.

INTERPRETATION

SARS-CoV-2 infections during pregnancy do not appear to be linked to early childhood developmental concerns, and COVID-19 vaccinations during pregnancy appear to be safe from the perspective of early childhood developmental concerns. As some developmental concerns do not become apparent until children are older than 13-15 months, future research should continue to monitor outcomes as children grow and develop.

FUNDING

Economic and Social Research Council.

Feasibility and reliability to assess the motor development of infants exposed to gestational COVID-19 using the Alberta Infant Motor Scale remotely

The virus infection severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy is a risk factor for developmental problems. Our objectives were to explore feasibility measures and verify the reliability of synchronously employing the Alberta Infant Motor Scale (AIMS) remotely in infants with prenatal exposure to SARS-CoV-2. Additionally, we explored the motor performance of these infants relative to an unexposed normative sample. An exploratory cross-sectional study was carried out and included 20 infants (10.65±4.99 months) whose mothers tested positive for coronavirus disease 2019 (COVID-19) during pregnancy. Infants were assessed with the AIMS remotely and synchronously via video call by a physical therapist. The calls were recorded. Three independent observers scored the recordings. Parents and assessors answered questions regarding barriers to and facilities for the assessments. A higher proportion of parents (90%) found it easy to understand and replicate the commands provided by the therapist during the assessment (P<0.001). The assessors reported not encountering difficulty in most assessments. Interobserver reliability was good in the standing posture [95% confidence interval (CI): 0.734-0.942, P<0.001] and excellent (95% CI: 0.970-0.996, P<0.001) in prone, supine, and sitting. Intra-rater reliability was excellent (95% CI's: 0.876-1.000, P's<0.001) in all postures. There were no differences between the motor performance of exposed infants compared to the unexposed normative sample. It was feasible to assess the motor performance of infants exposed to SARS-CoV-2 via video call with good to excellent inter- and intra-rater reliabilities, making it an important approach when social distancing is needed.

Antenatal and neonatal exposure to SARS-CoV-2 and children's development: a systematic review and meta-analysis

OBJECTIVES

To conduct a systematic review of the impact of antenatal and neonatal exposure to SARS-CoV-2 on developmental outcomes in preterm and term-born infants.

METHODS

We searched Embase, Emcare, MEDLINE, PsycINFO, Web of Science and grey literature on May 27, 2022 and updated on May 8, 2023. Studies defining exposure with a positive SARS-CoV-2 protein or genetic material, used a contemporaneous non-exposed cohort, and reported developmental outcomes up to 2 years of age were included.

RESULTS

Four out of 828 screened studies were included. Meta-analysis included 815 infants screened for developmental delay (n = 306 exposed; n = 509 non-exposed) between 3- and 11-months of age. Among term-born infants, we did not find an increased risk of delay in communication (odd's ratio: 0.73 (95% CI: 0.24-2.24)), gross motor (1.50 (0.62, 3.62)), fine motor (2.90 (0.58, 14.43)), problem-solving (1.19 (0.54, 2.66)) or personal-social development (1.93 (0.78, 4.75)) in exposed infants. The number of preterm-born infants in the exposed (n = 37) and comparison cohorts (n = 41) were too few to report meaningful comparisons.

CONCLUSION

Evidence regarding the potential impact of antenatal or neonatal exposure to SARS-CoV-2 infection on developmental outcomes in early infancy is limited and inconsistent. Larger cohorts with outcomes beyond the first year of life are needed.

IMPACT

The current evidence examining associations between SARS-CoV-2 exposure during the neonatal period and developmental outcomes in infancy is limited by there being few studies with extremely small sample sizes. Based on sparse data there was no consistent association between antenatal or neonatal exposure to SARS-CoV-2 infection and an adverse impact on developmental outcomes below 12 months of age for babies born preterm or at term. This study highlights that larger cohorts with outcomes assessed beyond the first year are needed to determine the potential longer-term impact of SARS-CoV-2 infection exposure on child development.

Mitochondria in COVID-19: from cellular and molecular perspective

The rapid development of the COVID-19 pandemic resulted in a closer analysis of cell functioning during β-coronavirus infection. This review will describe evidence for COVID-19 as a syndrome with a strong, albeit still underestimated, mitochondrial component. Due to the sensitivity of host mitochondria to coronavirus infection, SARS-CoV-2 affects mitochondrial signaling, modulates the immune response, modifies cellular energy metabolism, induces apoptosis and ageing, worsening COVID-19 symptoms which can sometimes be fatal. Various aberrations across human systems and tissues and their relationships with mitochondria were reported. In this review, particular attention is given to characterization of multiple alterations in gene expression pattern and mitochondrial metabolism in COVID-19; the complexity of interactions between SARS-CoV-2 and mitochondrial proteins is presented. The participation of mitogenome fragments in cell signaling and the occurrence of SARS-CoV-2 subgenomic RNA within membranous compartments, including mitochondria is widely discussed. As SARS-CoV-2 severely affects the quality system of mitochondria, the cellular background for aberrations in mitochondrial dynamics in COVID-19 is additionally characterized. Finally, perspectives on the mitigation of COVID-19 symptoms by affecting mitochondrial biogenesis by numerous compounds and therapeutic treatments are briefly outlined.

Long-Term Growth and Neurodevelopmental Outcomes of Neonates Infected with SARS-CoV-2 during the COVID-19 Pandemic at 18-24 Months Corrected Age: A Prospective Observational Study

INTRODUCTION

During the early coronavirus disease (COVID-19) pandemic in 2020, researchers cautioned about the potential neuroinvasive capability of the virus and long-term neurological consequences. Although a few preliminary studies have found delayed communication, fine motor, and problem-solving skills in infants after COVID-19 infection, there continues to be a paucity of data on long-term development of neonates diagnosed with COVID-19.

METHODS

We conducted a prospective study of 20 neonates who acquired severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the first wave of the pandemic (April-July 2020). At 18-24 months corrected age, we assessed neurodevelopment by Bayley Scales of Infant and Toddler Development, the third edition (BSID-III), along with growth, hearing, and vision evaluation.

RESULTS

The mean corrected age at assessment was 21 months 11 days ± 1 month 28 days. We found developmental delay in nearly half of the children with scores below one standard deviation in either of the BSID-III domains. Mild delay in either motor, cognitive, or language domains was found in 9 (45%) children and moderate delay in 2 (10%). Expressive language, fine motor, and receptive language were predominantly affected. None of the children had hearing impairment, blindness, or significant growth faltering including clinically severe microcephaly. The mean composite cognitive, language, and motor scores were significantly lower in those with neurodevelopmental delay (p value - 0.02, 0.000, and 0.03, respectively) without any differences in their disease characteristics.

CONCLUSION

Neonates infected with SARS-CoV-2 have an increased risk of developmental delays in expressive language, fine motor, and receptive language skills at 18-24 months of age. The severity of delays is predominantly mild.

Impact of respiratory viral infections during pregnancy on the neurological outcomes of the newborn: current knowledge

Brain development is a complex process that begins during pregnancy, and the events occurring during this sensitive period can affect the offspring's neurodevelopmental outcomes. Respiratory viral infections are frequently reported in pregnant women, and, in the last few decades, they have been related to numerous neuropsychiatric sequelae. Respiratory viruses can disrupt brain development by directly invading the fetal circulation through vertical transmission or inducing neuroinflammation through the maternal immune activation and production of inflammatory cytokines. Influenza virus gestational infection has been consistently associated with psychotic disorders, such as schizophrenia and autism spectrum disorder, while the recent pandemic raised some concerns regarding the effects of severe acute respiratory syndrome coronavirus 2 on neurodevelopmental outcomes of children born to affected mothers. In addition, emerging evidence supports the possible role of respiratory syncytial virus infection as a risk factor for adverse neuropsychiatric consequences. Understanding the mechanisms underlying developmental dysfunction allows for improving preventive strategies, early diagnosis, and prompt interventions.

Neonatal outcomes of maternal prenatal coronavirus infection

The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.

Potential molecular and cellular mechanisms for adverse placental outcomes in pregnancies complicated by SARS-CoV-2 infection-A scoping review

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.