Pregnant women with COVID-19: the placental involvement and consequences

Abstract

SARS-CoV-2, the leading cause of COVID-19 pandemic, was detected for the first time in Wuhan. In this study, we investigated the potential undesirable maternal and feto-neonatal consequences of COVID-19, and the related pathophysiological alterations in mother, neonate, and especially in the placenta as a vital organ, were reviewed. Also, the possibility of vertical transmission of virus and placental abnormalities were evaluated. The pregnant women were a vulnerable population for COVID-19, and several obstetric consequences were reported following SARS-CoV-2 infection. The higher risk of abruption, preterm labor, maternal death, stillbirth, intrauterine growth restriction, and newborns with fetal distress were adverse pregnancy and perinatal outcomes of COVID-19. Despite the ACE2 expression on placental components was confirmed, there is no agreement on the mother–child vertical transmission of this virus. Therefore, feto-neonatal consequences might be associated with placental abnormalities. The placental abnormalities are characterized by feto-maternal vascular malperfusion. Additionally, these adverse consequences lead to early termination of pregnancy in some cases, mostly via cesarean section. The pregnant women screening, coordination between healthcare personnel and neonatal unit, and infected women quarantine may decrease the risk of maternal and neonatal death after delivery.

Investigating the association between severity of COVID-19 infection during pregnancy and neonatal outcomes

“…Majority of the pregnant women had mild symptoms of COVID-19 (73.5%) and only 26.5% had moderate to severe manifestation. Consistently, a previous study reported 86.0% mild cases and around 14.0% between severe and critical cases among pregnant women infected with COVID-19 15 . Additionally, similar proportions were observed among the general population 16 .…”

A review of the main placenta histopathological findings reported in coronavirus disease 2019

“…Adverse pregnancy outcomes, such as placental abruption, preterm delivery, and stillbirth, are linked to placental maternal vascular malperfusion (MVM) lesions, with a higher prevalence in infected pregnant women as compared to a control group. 40 MVM lesions may be associated with the duration, timing, and severity of the infection, which, in turn, can result in preterm deliveries. 20 There is a recognizable pattern of placental injury associated with abnormal uterine perfusion.…”

Neuropathogenesis of severe acute respiratory syndrome coronavirus 2

“…The data on the consequences of SARS-CoV-2 infection during pregnancy on both maternal and fetal outcomes is limited. A key concern has been whether SARS-CoV-2 may infect or cross the placenta [ 44 ]. A recent review including 1457 pregnancies concluded that the risk of premature birth, maternal death, fetal death, fetal distress, and neonatal asphyxia were all increased in pregnancies affected by SARS-CoV-2 [ 45 ].…”