Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

Abstract

Objectives.The goal of this study is to describe placental pathology after infection with SARS-CoV-2 before the predominance of variants of concern (pre-VOC) and during eras of predominant transmission of the Alpha & Gamma (co-circulating), Delta, and Omicron variants. Methods. We used county-level variant data to establish population-level variant proportions, SARS-CoV-2 PCR to identify cases, and IgG serology to exclude latent infections from controls and histopathologic examination to identify placental pathology. Results. We report findings in 870 placentas from pregnancies complicated by SARS-CoV-2 including 90 with infection in the Alpha/Gamma era, 60 from the Delta era and 56 from the Omicron era. Features of maternal vascular malperfusion (MVM), including decidual arteriopathy, were significantly more frequent after SARS-CoV-2 infection. The risk of these findings varied over time, with the highest rates in the Delta era. Increased COVID-19 severity and the presence of comorbidities strengthened these associations. Conclusion. MVM is a feature of SARS-CoV-2 infection in pregnancy. Lesion frequency changed with the predominant circulating virus and should be considered with new variants.

Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate

“…The placental cells also presented apoptosis, senescence, and ferroptosis [105] . The frequency of placenta alterations such as maternal vascular abnormal perfusion and decidual artery disease changes with the VOC to which they were exposed [124] . Interestingly, these placental alterations had a higher incidence in cases infected with the Delta variant [124] .…”

Fetal growth retardation as a complication of post-COVID endotheliitis: causes, consequences, ways of prevention

“…Так, при зараженні штамом Омікрон на тлі ожиріння були більш виражені зміни судин плаценти. Усі дослідники погоджуються, що інфікування SARS-CoV-2 під час вагітності достовірно пов'язане з подальшим витком прееклампсії [28].…”

COVID-19 y placenta: afectación histopatológica y materno fetal

“…Después de la aparición de variantes del SARS-CoV-2 (76-80), con mutaciones en la proteína S que confieren mayor transmisibilidad, se podría plantear la hipótesis de que la transmisión transplacentaria puede estar asociada con cepas hipervirulentas de SARS-CoV-2. Sin embargo, se han descrito placentas afectadas por la cepa original de SARS-CoV-2 sin mutaciones (64,80).…”

“…En algunos estudios, en mujeres embarazadas infectadas con SARS-CoV-2, se han informado cambios histopatológicos placentarios no patognomónicos como vasculopatía decidual e intervellositis (60,80,86,87).…”

“…Estos cambios histopatológicos pueden estar asociados con RCIU, parto prematuro, aborto espontáneo y muerte fetal, generando preocupación en los médicos tratantes sobre los resultados adversos del embarazo relacionados con la COVID-19 (60,80,86,88).…”