COVID-19 and Hypertensive Disorders of Pregnancy (HDP): A Portuguese Multicentric Retrospective Cohort Study of HDP in SARS-CoV-2 Infected Patients

Mira, Ana Rita; Pinho, António De; Calado-Araújo, Mónica; Ferreira, Catarina; David, Daniela; Enes, M.; Vaz-de-Macedo, Carolina

doi:10.7759/cureus.36483

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…Although early reports indicated increased rates of hypertension in COVID-19-infected pregnant women [20], several population-based and longitudinal studies did not confirm an association between PE and COVID-19 [21,22]. COVID-19 during pregnancy may manifest as a PE-like syndrome, which is differentiated from true PE by lower sFlt-1to-PlGF ratios [23].…”

Section: Sars-cov-2 Infection and Chronic Placental Pathologymentioning

confidence: 99%

SARS-CoV-2 Infection in Late Pregnancy and Childbirth from the Perspective of Perinatal Pathology

Debelenko

2023

JDB

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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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Section: Sars-cov-2 Infection and Chronic Placental Pathologymentioning

confidence: 99%

SARS-CoV-2 Infection in Late Pregnancy and Childbirth from the Perspective of Perinatal Pathology

Debelenko

2023

JDB

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Pathogenetic traits of preeclampsia in COVID-19. A relevant literature review

Rudenko,

Ishkaraeva,

Zazerskaya

2024

Journal of obstetrics and women's diseases

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The aim of this study was to present the latest data on the association of preeclampsia and coronavirus infection and on the preeclampsia-like syndrome, and to analyze the current literature on the pathogenetic relationships between COVID-19 and preeclampsia and on morphological changes in placental tissue in patients with these gestational complications. A significant portion of studies indicate an increased risk of developing preeclampsia in patients with coronavirus infection during pregnancy, regardless of gestational age, especially in severe COVID-19, but other researchers report no association between coronavirus infection and the onset of preeclampsia. The supposed pathogenetic connection between these pathologies consists in the development of systemic endothelial dysfunction and dysregulation of the renin-angiotensin-aldosterone system, while the direct effect of SARS-CoV-2 on the placentation is poorly understood and is a subject of debate. A new concept of the so-called “preeclampsia-like syndrome” has been introduced, which presumably occurs in patients with a severe form of the novel coronavirus infection as its extrapulmonary manifestation. The measurement of the ratio of soluble fms-like tyrosine kinase-1 activity to the level of placental growth factor ratio has been proposed as a differential diagnostic test between preeclampsia and the preeclampsia-like syndrome, but its prognostic value remains ambiguous. The morphological examination of placentas in patients with coronavirus infection and preeclampsia indicates the signs of maternal and fetal vascular malperfusion. The literature on the association between coronavirus infection and preeclampsia remains controversial, however, the better half of the researchers is indicative of a significant increase in the risk of developing this serious complication in pregnant women with COVID-19, especially for its severe form. New information about the preeclampsia-like syndrome, as well as the virtual absence of studies of placental morphology in patients with preeclampsia and coronavirus infection during pregnancy, dictate the need for further study to better understand the association between these two pathologies, determine the possibilities of patient surveillance and prevent complications.

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SARS-CoV-2 Infection and Adverse Maternal and Perinatal Outcomes: A Cohort Study of Pregnant People in a Maternity Hospital in Rio de Janeiro, Brazil

Brendolin,

Wakimoto,

de Oliveira

et al. 2024

Preprint

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Background Early in the COVID-19 pandemic, there was no evidence that COVID-19 posed greater risk to pregnant people. Over the subsequent year, it became clear that pregnancy rendered more at higher risk of severe COVID-19. There is, however, a paucity of data regarding COVID-19 perinatal outcomes in low-middle income countries (LMIC). The aim of this study was to evaluate the effect of SARS-CoV-2 infection on adverse maternal and perinatal outcomes in a reference maternity hospital, in a low income setting in Rio de Janeiro during the COVID-19 pandemic. Methods The study was conducted a prospective cohort study of 1,185 pregnant people ≥ 16 years admitted to a maternity hospital and their infants from March 2020 to March 2022. Participants with laboratory confirmed SARS CoV-2 infection were considered infected. An exploratory analysis of qualitative variables was conducted with absolute and relative frequencies and 95% confidence intervals calculated. Survival functions were estimated by the Kaplan-Meier method, and the Cox proportional hazards model was employed to interpret the effects of SARS-CoV-2 infection on time to adverse maternal and perinatal outcomes, adjusted for vaccination, comorbidity and gestational trimester. Results A total of 21% (249/1185) patients were infected with SARS-CoV-2, with a median age of 26 (range: 16–47). Cesarean section deliveries were performed in 54% (135/249) SARS CoV-2 + participants vs 41.7% (391/936) of uninfected, p = < 0.001. SARS CoV-2 vertical transmission was observed in 6 of 169 (3.6%) tested neonates. Preterm deliveries occurred more frequently in patients testing positive for SARS-CoV-2 (30.7% vs 23.6). In the survival analysis, no effect of SARS-CoV-2 infection was observed on prematurity (HR: 0.85, 95% CI: 0.66–1.11) and adverse perinatal outcomes including fetal distress (HR: 0.94, 95% CI: 0.59–1.49); stillbirth (HR: 0.84, 95% IC: 0.42–1.71) and neonatal death (HR: 0.91, 95% CI: 0.39–2.14), even after adjusting for vaccination, comorbidity and gestational trimester of infection. Intensive care unit admission and/or death occurred in 68 of 1185 participants (5.7%); 44 of 249 participants (17.7%) infected with SARS CoV-2 vs. 24 of 936 uninfected participants (2.5%). Patients infected with SARS-CoV-2 were at greater risk of adverse maternal outcomes (crude HR: 6.12, 95% CI: 3.70-10.14; adjusted HR: 5.60, 95% CI: 3.35–9.37) than uninfected pregnant participants. All 21 participants who died were unvaccinated against COVID-19. Conclusion The risk of maternal death due to COVID-19 highlights the need for adequate preventive measures, particularly vaccination, during the prenatal and postpartum periods.

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COVID-19 and Hypertensive Disorders of Pregnancy (HDP): A Portuguese Multicentric Retrospective Cohort Study of HDP in SARS-CoV-2 Infected Patients

Cited by 3 publications

References 22 publications

SARS-CoV-2 Infection in Late Pregnancy and Childbirth from the Perspective of Perinatal Pathology

SARS-CoV-2 Infection in Late Pregnancy and Childbirth from the Perspective of Perinatal Pathology

Pathogenetic traits of preeclampsia in COVID-19. A relevant literature review

SARS-CoV-2 Infection and Adverse Maternal and Perinatal Outcomes: A Cohort Study of Pregnant People in a Maternity Hospital in Rio de Janeiro, Brazil

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