OBJECTIVE: SARS-CoV-2 is known to impact multiple organ systems, with growing data to suggest the potential for placental infection and resultant pathology. Understanding how maternal COVID-19 disease can affect placental histopathology has been limited by small study cohorts with mild disease, review by multiple pathologists, and potential confounding by maternal-fetal comorbidities that can also influence placental findings. This study aims to identify pathologic placental findings associated with COVID-19 disease and severity, as well as to distinguish them from changes related to coexisting maternal-fetal comorbidities. METHODS: This is an observational study of 61 pregnant women with confirmed SARS-CoV-2 infection who delivered and had a placental histological evaluation at NYU Langone Health between March 19, 2020 and June 30, 2020. Primary outcomes were the prevalence of placental histopathologic features and their association with maternal-fetal comorbidities and severity of COVID-19 related hypoxia. Analysis was performed using Fisher's exact test and t-test with p < 0.05 considered significant. RESULTS: Sixty-one placentas were included in the study cohort, 71% from pregnancies complicated by at least one maternal-fetal comorbidity. Twenty-five percent of placentas were small for gestational age and 77% exhibited at least one feature of maternal vascular malperfusion. None of the histopathologic features in the examined placentas were associated with the presence of any specific maternal-fetal comorbidity. Thirteen percent of the cohort required maternal respiratory support for COVID-19 related hypoxia. Villous trophoblast necrosis was associated with maternal supplemental oxygen requirement (67 vs. 33%, p = 0.04) and intubation (67 vs. 33%, p = 0.01). CONCLUSION: In pregnancies complicated by COVID-19 disease, there was a high prevalence of placental histopathologic changes identified, particularly features of maternal vascular malperfusion, which could not be attributed solely to the presence of maternal-fetal comorbidities. The significantly increased prevalence of villous trophoblast necrosis in women needing respiratory support suggests a connection to the severity of COVID-19 illness.
OBJECTIVE: SARS-CoV-2 is known to impact multiple organ systems, with growing data to suggest the potential for placental infection and resultant pathology. Understanding how maternal COVID-19 disease can affect placental histopathology has been limited by small study cohorts with mild disease, review by multiple pathologists, and potential confounding by maternal-fetal comorbidities that can also influence placental findings. This study aims to identify pathologic placental findings associated with COVID-19 disease and severity, as well as to distinguish them from changes related to coexisting maternal-fetal comorbidities. METHODS: This is an observational study of 61 pregnant women with confirmed SARS-CoV-2 infection who delivered and had a placental histological evaluation at NYU Langone Health between March 19, 2020 and June 30, 2020. Primary outcomes were the prevalence of placental histopathologic features and their association with maternal-fetal comorbidities and severity of COVID-19 related hypoxia. Analysis was performed using Fisher's exact test and t-test with p < 0.05 considered significant. RESULTS: Sixty-one placentas were included in the study cohort, 71% from pregnancies complicated by at least one maternal-fetal comorbidity. Twenty-five percent of placentas were small for gestational age and 77% exhibited at least one feature of maternal vascular malperfusion. None of the histopathologic features in the examined placentas were associated with the presence of any specific maternal-fetal comorbidity. Thirteen percent of the cohort required maternal respiratory support for COVID-19 related hypoxia. Villous trophoblast necrosis was associated with maternal supplemental oxygen requirement (67 vs. 33%, p = 0.04) and intubation (67 vs. 33%, p = 0.01). CONCLUSION: In pregnancies complicated by COVID-19 disease, there was a high prevalence of placental histopathologic changes identified, particularly features of maternal vascular malperfusion, which could not be attributed solely to the presence of maternal-fetal comorbidities. The significantly increased prevalence of villous trophoblast necrosis in women needing respiratory support suggests a connection to the severity of COVID-19 illness.
Authors: M A Beesley; J R Davidson; F Panariello; S Shibuya; D Scaglioni; B C Jones; K Maksym; O Ogunbiyi; N J Sebire; D Cacchiarelli; A L David; P De Coppi; Mfm Gerli Journal: BJOG Date: 2021-11-18 Impact factor: 7.331
Authors: Lydia L Shook; Sara Brigida; James Regan; James P Flynn; Abbas Mohammadi; Behzad Etemad; Molly R Siegel; Mark A Clapp; Jonathan Z Li; Drucilla J Roberts; Andrea G Edlow Journal: J Infect Dis Date: 2022-03-02 Impact factor: 5.226
Authors: Paola Ayala-Ramírez; Marcelo González; Carlos Escudero; Laura Quintero-Arciniegas; Fernanda R Giachini; Raiany Alves de Freitas; Alicia E Damiano; Reggie García-Robles Journal: Front Physiol Date: 2022-03-30 Impact factor: 4.566
Authors: Suzanne M Newton; Emily L Reeves; Emily O'Malley Olsen; Kate R Woodworth; Sherry L Farr; Romeo R Galang; Megan R Reynolds; Elizabeth Harvey; Jing Shi; Eirini Nestoridi; Jerusha Barton; Van P Ngo; Mamie Lush; Nicole D Longcore; Paula Dzimira; Lucille K Im; Ayomide Sokale; Samantha Siebman; Camille Delgado López; Tiffany Chen; Evan L Mobley; Salma Khuwaja; Paul A Romitti; Carolyn Fredette; Esther M Ellis; Kristin Silcox; Aron J Hall; Eduardo Azziz-Baumgartner; Suzanne M Gilboa; Carrie K Shapiro-Mendoza; Van T Tong Journal: J Perinatol Date: 2022-08-04 Impact factor: 3.225