Viruses,
Год журнала:
2023,
Номер
15(5), С. 1069 - 1069
Опубликована: Апрель 27, 2023
In
2020,
a
new
coronavirus,
called
severe
acute
respiratory
syndrome
coronavirus
2
(SARS-CoV-2),
emerged
in
China.
SARS-CoV-2
infection
has
been
shown
to
be
highly
morbid
pregnant
women,
being
risk
factor
for
several
obstetric
conditions
leading
increased
maternal
and
neonatal
mortality.
A
few
studies
since
2020
have
maternal–fetal
transmission
noted
placental
abnormalities
grouped
under
the
term
placentitis.
We
hypothesized
that
these
lesions
could
responsible
exchange
therefore
cardiotocographic
monitoring,
premature
fetal
extraction.
The
objective
is
identify
clinical,
biochemical,
histological
determinants
associated
with
occurrence
of
non-reassuring
heart
rate
(NRFHR)
outside
labor
fetuses
SARS-CoV-2-infected
mothers.
conducted
retrospective
multicenter
case
series
natural
history
infections
resulting
delivery
due
NRFHR.
Collaboration
was
sought
maternity
hospitals
CEGORIF,
APHP
Brussels
hospitals.
investigators
were
contacted
by
e-mail
on
three
successive
occasions
over
period
one
year.
Data
from
17
mothers
analyzed.
Most
women
had
mild
infection;
only
two
presented
infection.
No
woman
vaccinated.
found
substantial
proportion
coagulopathy
at
birth:
elevation
APTT
ratio
(62%),
thrombocytopenia
(41%)
liver
cytolysis
(58.3%).
Iatrogenic
prematurity
15
fetuses,
100%
born
cesarean
emergency
criteria.
One
male
neonate
died
day
birth
peripartum
asphyxia.
Three
cases
recorded
following
WHO
Placental
analysis
revealed
eight
placentitis,
causing
insufficiency.
total,
placentas
analyzed
showed
least
lesion
suggestive
during
pregnancy
likely
generate
morbidity
relation
damage
This
may
consequence
induced
as
well
acidosis
most
situations.
occurred
unvaccinated
no
identified
factor,
contrast
clinical
forms.
Human Reproduction Update,
Год журнала:
2023,
Номер
30(2), С. 133 - 152
Опубликована: Ноя. 28, 2023
Abstract
BACKGROUND
Pregnant
women
infected
with
severe
acute
respiratory
syndrome
coronavirus
2
(SARS-CoV-2)
are
more
likely
to
experience
preterm
birth
and
their
neonates
be
stillborn
or
admitted
a
neonatal
unit.
The
World
Health
Organization
declared
in
May
2023
an
end
the
disease
2019
(COVID-19)
pandemic
as
global
health
emergency.
However,
pregnant
still
becoming
SARS-CoV-2
there
is
limited
information
available
regarding
effect
of
infection
early
pregnancy
on
outcomes.
OBJECTIVE
AND
RATIONALE
We
conducted
this
systematic
review
determine
prevalence
loss
SARS-Cov-2
compare
risk
without
infection.
SEARCH
METHODS
Our
based
prospectively
registered
protocol.
search
PregCov19
consortium
was
supplemented
extra
electronic
specifically
up
10
March
PubMed,
Google
Scholar,
LitCovid.
included
retrospective
prospective
studies
infection,
provided
that
they
contained
losses
first
and/or
second
trimester.
Primary
outcome
miscarriage
defined
before
20
weeks
gestation,
however,
reported
22
24
were
also
included.
Additionally,
we
report
occur
at
trimester
specifying
gestational
age,
for
only
when
study
presented
stillbirths
foetal
separately
from
miscarriages.
Data
stratified
into
Secondary
outcomes
ectopic
(any
extra-uterine
pregnancy),
termination
pregnancy.
At
least
three
researchers
independently
extracted
data
assessed
quality.
calculated
odds
ratios
(OR)
differences
(RDs)
corresponding
95%
CI
pooled
using
random
effects
meta-analysis.
To
estimate
prevalence,
performed
meta-analysis
proportions.
Heterogeneity
by
I2.
OUTCOMES
120
comprising
total
168
444
infection;
which
18
233
Evidence
level
considered
low
moderate
certainty,
mostly
owing
selection
bias.
did
not
find
evidence
association
between
(OR
1.10,
0.81–1.48;
I2
=
0.0%;
RD
0.0012,
−0.0103
0.0127;
0%;
9
studies,
4439
women).
Miscarriage
occurred
9.9%
(95%
6.2–14.0%;
68%;
46
1797
women)
SARS
CoV-2
1.2%
0.3–2.4%;
34%;
33
studies;
3159
proportion
pregnancies
1.4%
0.02–4.2%;
66%;
14
950
Termination
0.6%
0.01–1.6%;
79%;
39
1166
WIDER
IMPLICATIONS
found
no
indication
increases
provide
better
estimates,
well-designed
needed
include
conception
consider
clinical
manifestation
severity
loss,
well
potential
confounding
factors
such
previous
loss.
For
practice,
should
advised
take
precautions
avoid
exposure
receive
vaccination.
BMJ,
Год журнала:
2024,
Номер
unknown, С. e079364 - e079364
Опубликована: Июль 17, 2024
To
evaluate
the
risk
of
major
congenital
anomalies
according
to
infection
with
or
vaccination
against
covid-19
during
first
trimester
pregnancy.
Prospective
Nordic
registry
based
study.
Sweden,
Denmark,
and
Norway.
343
066
liveborn
singleton
infants
in
Norway,
an
estimated
start
pregnancy
between
1
March
2020
14
February
2022,
identified
using
national
health
registries.
Major
were
categorised
EUROCAT
(European
Surveillance
Congenital
Anomalies)
definitions.
The
after
was
assessed
by
logistic
regression,
adjusting
for
maternal
age,
parity,
education,
income,
country
origin,
smoking,
body
mass
index,
chronic
conditions,
date
17
704
(5.2%)
had
a
anomaly.
When
evaluating
associated
trimester,
adjusted
odds
ratio
ranged
from
0.84
(95%
confidence
interval
0.51
1.40)
eye
1.12
(0.68
1.84)
oro-facial
clefts.
Similarly,
(0.31
2.31)
nervous
system
1.69
(0.76
3.78)
abdominal
wall
defects.
Estimates
10
11
subgroups
less
than
1.04,
indicating
no
notable
increased
risk.
Covid-19
not
anomalies.
Journal of Perinatology,
Год журнала:
2025,
Номер
unknown
Опубликована: Март 6, 2025
To
characterize
stillbirth
evaluations,
including
the
frequency
and
yield
of
investigations
for
infections
causing
stillbirth.
Retrospective
cohort
stillbirths
at
three
university-affiliated
perinatal
centers
from
2017
to
2022.
The
primary
outcome
was
adherence
American
College
Obstetrics
Gynecology
core
evaluation
recommendations
(placental
pathology,
fetal
autopsy,
genetic
testing).
We
further
characterized
prevalence
specific
testing
evaluate
infection-attributable
etiologies.
included
399
stillbirths.
Placental
pathology
performed
in
387
cases
(97.0%),
163
(40.9%),
autopsy
126
(31.6%).
Fetal
bacterial
cultures
were
obtained
73
(18.2%)
cases;
potential
pathogens
isolated
21/73
(28.8%).
Viral
sent
infrequently,
with
variable
yield.
Six
had
identified
as
probable
Adherence
poor,
infection
infrequent.
Infection-attributable
may
be
underestimated.
American Journal of Obstetrics and Gynecology,
Год журнала:
2025,
Номер
232(4), С. S160 - S175.e7
Опубликована: Апрель 1, 2025
COVID-19
in
pregnancy
is
associated
with
placental
immune
activation,
inflammation,
and
vascular
malperfusion,
but
its
impact
on
syncytiotrophoblast
biology
function
unclear.
This
study
aimed
to
determine
the
effects
of
maternal
syncytiotrophoblasts
using
single-nucleus
transcriptional
profiling
compare
stress
responses
preeclampsia.
For
characterization
syncytiotrophoblasts,
we
used
RNA
sequencing
platform,
single-cell
combinatorial
indexing
(sci-RNA-seq3),
profile
villi
fetal
membranes
from
unvaccinated
patients
symptomatic
at
birth
(n
=
4),
gestational
age-matched
controls
a
case
critical
second
trimester
delivery
term
1).
Clustering
nuclei
differential
gene
expression
analysis
was
performed
Seurat.
Gene
ontology
conducted
Enrichr.
High-confidence
target
identify
key
transcription
factor
nodes
governing
response
SARS-CoV-2
infection.
Bioinformatic
approaches
were
further
dataset
published
preeclampsia
signatures.
Tissue
analysis,
including
immunofluorescence,
validate
data
histology
for
an
expanded
cohort
placentas:
6),
asymptomatic
3),
5),
severe
features
7).
The
analyzed
comprised
15
cell
clusters
47,889
nuclei.
We
identified
3
representing
fusing
mature
overlapping
distinct
COVID-19.
analyses
indicated
that
following
alterations
syncytiotrophoblasts:
(1)
endoplasmic
reticulum
activation
signaling
pathways,
unfolded
protein
integrated
response;
(2)
regulation
by
CCAAT/enhancer-binding
beta
(CEBPB),
master
lineage;
(3)
upregulation
preeclampsia-associated
genes.
Using
complementary
methods,
confirmed
increased
levels
proteins
(eg,
BiP,
G3BP1)
(spliced
XBP1
mRNA),
CEBPB
(phosphorylation)
Increased
cytotrophoblast
proliferation
(Ki-67)
also
detected
COVID-19,
consistent
trophoblast
injury.
Markers
demonstrated
similarities
phenotype
Maternal
lineage
factor,
CEBPB.
Similarities
between
provide
insights
into
their
clinical
association.
The
effects
of
SARS-CoV-2
infection
before
or
during
pregnancy
on
outcomes
are
still
largely
unknown.
We
hypothesized
that
COVID-19
in
early
is
a
risk
factor
for
adverse
outcomes,
particularly
miscarriage.
examined
the
relationship
between
and
including
spontaneous
abortion,
ectopic
pregnancy,
preterm
delivery
large,
retrospective,
electronic
health
record
(EHR)-based
cohort,
from
2019
to
2023.
Generalized
estimating
equation
modeling
was
performed
identify
factors
outcomes.
Study
exposures
included
age,
race/ethnicity,
comorbidity
burden,
neighborhood-level
social
vulnerability.
In
Southeast
Texas
Pregnancy
COVID
Cohort
(26,783
episodes),
miscarriage
among
episodes
with
miscarriage,
livebirth,
outcome
6.3%
(1514/
24,119).
multivariable
modeling,
history
both
mild
moderate
severe
were
associated
(adjusted
odds
ratio
(aOR)
2.48,
confidence
interval
(CI)
2.21-2.78
aOR
2.81,
CI
1.8-4.38,
respectively).
Additionally,
same
model,
first
trimester
(aOR
2.31,
1.96-2.72
2.45,
1.12-5.35,
prior
identified
as
abortion
this
study
sample.
These
findings
highlight
importance
vaccination
post-COVID
management
pregnant
people
those
planning
pregnancy.
Journal of Infection,
Год журнала:
2024,
Номер
88(2), С. 215 - 217
Опубликована: Янв. 11, 2024
During
the
COVID-19
pandemic,
when
SARS-CoV-2
B1.617.2
(Delta)
variant
was
dominant,
infected
pregnant
women
had
a
4-fold
increased
risk
of
stillbirth
compared
with
non-infected
(2.70%
vs.
0.63%).1DeSisto
C.L.
Wallace
B.
Simeone
R.M.
Polen
K.
Ko
J.Y.
Meaney-Delman
D.
et
al.Risk
for
among
and
without
at
delivery
hospitalization
-
United
States,
March
2020-September
2021.MMWR
Morb
Mortal
Wkly
Rep.
2021;
70:
1640-1645https://doi.org/10.15585/mmwr.mm7047e1Crossref
PubMed
Google
Scholar
The
placenta
in
these
stillbirths
showed
COVID
placentitis,
combination
within
syncytiotrophoblast
triad
histological
features:
chronic
histiocytic
intervillositis,
trophoblast
necrosis,
massive
perivillous
fibrin
deposition.
placentitis
only
occurred
minority
who
tested
positive
pregnancy
(∼1.5%).2Colley
C.S.
Hutchinson
J.C.
Whitten
S.M.
Siassakos
Sebire
N.J.
Hillman
S.L.
Routine
placental
histopathology
findings
from
testing
during
pregnancy:
Retrospective
cohort
comparative
study.BJOG.
2023;
130:
959-967https://doi.org/10.1111/1471-0528.17476Crossref
Scopus
(3)
Fetal
deaths
Delta
wave
usually
days
mild
maternal
infection,
stillborn
fetuses
were
appropriately-grown
gestational
age
(AGA).3Alcover
N.
Regiroli
G.
Benachi
A.
Vauloup-Fellous
C.
Vivanti
De
Luca
Systematic
review
synthesis
late
miscarriages
following
infections.Am
J
Obstet
Gynecol.
229:
118-128https://doi.org/10.1016/j.ajog.2023.01.019Abstract
Full
Text
PDF
(6)
Chronic
intervillositis
(CHI)
has
also
been
reported
alongside
other
infections,
including
malaria,
cytomegalovirus
listeriosis.4Marchaudon
V.
Devisme
L.
Petit
S.
Ansart-Franquet
H.
Vaast
P.
Subtil
unknown
etiology:
clinical
features
consecutive
series
69
cases.Placenta.
2011;
32:
140-145https://doi.org/10.1016/j.placenta.2010.11.021Crossref
(60)
In
cases,
infiltration
CD68+
histiocytes
leads
to
obliteration
intervillous
space,
preventing
maternal-fetal
exchange
that
is
vital
fetal
growth
survival.
emerged
as
latest
pathogen
capable
causing
CHI.
Its
global
scale
thrown
importance
this
finding
its
potential
catastrophic
consequences
into
sharp
relief.
CHI
occurs
absence
resembles
histologically,
but
distinct
devastating
disorder
associated
recurrent
loss.5Labarrere
Mullen
E.
Fibrinoid
trophoblastic
necrosis
intervillositis:
an
extreme
villitis
etiology.Am
Reprod
Immunol
Microbiol.
1987;
15:
85-91https://doi.org/10.1111/j.1600-0897.1987.tb00162.xCrossref
(83)
This
form
affects
1
2000
pregnancies
diagnosed
>5%
space
occupied
by
histiocytes,
infection.6Sauvestre
F.
Mattuizzi
Sentilhes
Poingt
M.
Blanco
Houssin
al.Chronic
Development
grading
scoring
system
strongly
poor
perinatal
outcomes.Am
Surg
Pathol.
2020;
44:
1367-1373https://doi.org/10.1097/PAS.0000000000001549Crossref
(7)
It
causes
miscarriage,
severe
restriction,
carries
high
recurrence
(100%
cases).
etiology
non-infectious
poorly
understood,
similarity
rejected
solid
organ
allografts
suggests
immunological
mechanism.7Cornish
E.F.
McDonnell
T.
Williams
D.J.
inflammatory
disorders
adverse
outcome.Front
Immunol.
2022;
13825075https://doi.org/10.3389/fimmu.2022.825075Crossref
(21)
On
basis,
over
last
30
years,
have
treated
subsequent
variety
immunosuppressive
regimens.
These
tempered
may
improve
outcomes.7Cornish
Scholar,
8Brady
C.A.
Batra
Church
Tower
Crocker
I.P.
al.Immunomodulatory
therapy
reduces
severity
lesions
intervillositis.Front
Med.
8753220https://doi.org/10.3389/fmed.2021.753220Crossref
(14)
uncertain
whether
(or
infections)
recurs
same
way
(immune-CHI).
important
knowledge
gap,
it
unclear
previous
due
should
be
considered
immunosuppression
future
pregnancy.
aim
study
investigate
hypothesis
SARS-CoV-2-associated
(COVID-CHI)
does
not
recur.
We
identified
our
maternity
services
had:
(1)
or
miscarriage
histologically
proven
COVID-CHI;
(2)
completed
histology
available
(primary
cohort).
Demographic,
medical,
obstetric
outcome
data
collected.
then
approached
larger
group
(validation
cohort)
designing
online
survey,
which
disseminated
social
media
support
forum.
Only
loss
COVID-CHI
(whatever
outcome)
eligible.
survey
anonymously,
no
patient-identifiable
work
approved
relevant
research
ethics
committees
(London:
19/LO/0105;
Leiden:
B21.034;
Paris:
CEROG
2021-OBST-0503).
All
participants
primary
provided
written
informed
consent
publication.
Five
underwent
institutions.
five
ended
live
birth
infant
Comparative
shown
Fig.
1.
A
further
14
resulting
overall
19
women.
total
21
pregnancies,
19/21
(90%)
16/21
(76%)
available.
Table
compares
outcomes
index
pregnancies.Table
1Maternal
demographics,
medication
use,
ending
death
(n
=
19),
followed
one
more
21).
Birthweight
centiles
calculated
using
INTERGROWTH-21st
birthweight
centile
calculator.
P-values
Mann-Whitney
U
test
(given
non-normal
distribution
data)
GraphPad
Prism.*
Low-dose
aspirin
(LDA):
75-160
mg
daily.
Prophylactic
low-molecular-weight
heparin
(LMWH):
variable
formulations,
e.g.
enoxaparin
40
once
daily.†
four
patients
hydroxychloroquine
and/or
prednisolone
their
received
LDA
prophylactic
LMWH.‡
Two
another
pathology
(non-CHI)
detected
placenta.
One
focal
ischemia
vascular
malperfusion
preeclampsia;
distal
villous
immaturity
large-for-gestational-age
Open
table
new
tab
*
†
LMWH.
‡
results
show
despite
similarities
immune-CHI,
are
inflammation.
rate
90%
overall,
100%
those
progressed
beyond
16
weeks'
gestation.
Immunosuppression
appears
unnecessary
COVID-CHI,
most
went
on
normal
immunomodulatory
treatment.
confirm
earlier
observation
fetus
affected
AGA
(median
35th
cohort).3Alcover
Although
smaller
than
unaffected
siblings,
acute
pathology,
opposed
restriction
(recurrent)
immune-CHI.4Marchaudon
interesting
speculate
why
proved
pathogenic
Alpha
Omicron
variants.
Possible
mechanisms
include
higher
levels
viremia
enhanced
cleavage
S
protein
furin,
serine
protease
highly
expressed
syncytiotrophoblast.
Furin-mediated
facilitates
viral
entry
host
cells
via
binding
angiotensin-converting
enzyme-2
(ACE2)
receptor.9Takeda
Proteolytic
activation
spike
protein.Microbiol
66:
15-23https://doi.org/10.1111/1348-0421.12945Crossref
(75)
Since
superseded
Omicron,
there
known
cases
infection.
However,
continues
circulate
variants
could
lead
Vaccination
COVID-associated
therefore
remain
strong
recommendation
all
women,
especially
COVID-CHI.10Magnus
M.C.
Örtqvist
A.K.
Dahlqwist
Ljung
R.
Skår
Oakley
al.Association
vaccination
outcomes.JAMA.
327:
1469-1477https://doi.org/10.1001/jama.2022.3271Crossref
(85)
several
limitations:
small
numbers,
self-reporting
validation
cohort,
incomplete
pregnancies.
Quantifying
dependent
specimens
being
submitted
analysis
(irrespective
examined
expert
pathologist.
Given
rarity
patient
described
here
particularly
hard-to-reach
group.
experienced
themselves
motivated
address
uncertainties
about
implications
diagnosis,
demonstrated
dedicated
180
members.
Our
provides
reassurance
can
expect
outcome.
observations
likely
apply
infections
CHI,
remains
confirmed.
Unlike
inflammation
required.
Dr
Emily
Cornish
supported
MRC
Clinical
Research
Training
Fellowship
(MR/V028731/1)
funds
investigation
pathogenesis
intervillositis.
Sam
Schoenmakers
funding
Strong
Babies.
Thomas
MRF
fellowship
(MRF-057-0004-RG-MCDO-C0800).
Professor
David
NIHR
University
College
London
Hospitals
Biomedical
Centre.