tetano
Editor, Senior Moderator
J Med Virol
. 2020 Aug 4.
doi: 10.1002/jmv.26386. Online ahead of print.
Placental SARS-CoV-2 in a Pregnant Woman with Mild COVID-19 Disease
Albert L Hsu[SUP] 1 [/SUP], Minhui Guan[SUP] 2 3 4 [/SUP], Eric Johannesen[SUP] 5 [/SUP], Amanda J Stephens[SUP] 6 [/SUP], Nabila Khaleel[SUP] 7 [/SUP], Nikki Kagan[SUP] 8 [/SUP], Breanna C Tuhlei[SUP] 9 [/SUP], Xiu-Feng Wan[SUP] 2 3 4 10 [/SUP]
Affiliations
Abstract
Background: The full impact of COVID-19 on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality.[SUP]1[/SUP] COVID-19 manifestations appear similar between pregnant and non-pregnant women.[SUP]2[/SUP] OBJECTIVES/STUDY DESIGN: We present a case of placental SARS-CoV-2 virus in a woman with mild COVID-19 disease, then review the literature. RT-PCR was performed to detect SARS-CoV-2. Immunohistochemistry staining was performed with specific monoclonal antibodies to detect SARS-CoV-2 antigen or to identify trophoblasts.
Results: A 29 year-old multigravida presented at 40-4/7 weeks for labor induction. With myalgias two days prior, she tested positive for SARS-CoV-2. We demonstrate maternal vascular malperfusion, with no fetal vascular malperfusion, as well as SARS-CoV-2 virus in chorionic villi endothelial cells, and also rarely in trophoblasts.
Conclusions: To our knowledge, this is the first report of placental SARS-CoV-2 despite mild COVID-19 disease (no symptoms of COVID-19 aside from myalgias); patient had no fever, cough, or shortness of breath, but only myalgias and sick contacts. Despite her mild COVID-19 disease in pregnancy, we demonstrate placental vasculopathy and presence of SARS-CoV-2 virus across the placenta. Evidence of placental COVID-19 raises concern for placental vasculopathy (potentially leading to fetal growth restriction and other pregnancy complications) and possible vertical transmission - especially for pregnant women who may be exposed to COVID-19 in early pregnancy. This raises important questions of whether future pregnancy guidance should include stricter pandemic precautions, such as screening for a wider array of COVID-19 symptoms, increased antenatal surveillance, and possibly routine COVID-19 testing throughout pregnancy. This article is protected by copyright. All rights reserved.
Keywords: Coronavirus < Virus classification; Public policy < Social Science; SARS coronavirus < Virus classification.
. 2020 Aug 4.
doi: 10.1002/jmv.26386. Online ahead of print.
Placental SARS-CoV-2 in a Pregnant Woman with Mild COVID-19 Disease
Albert L Hsu[SUP] 1 [/SUP], Minhui Guan[SUP] 2 3 4 [/SUP], Eric Johannesen[SUP] 5 [/SUP], Amanda J Stephens[SUP] 6 [/SUP], Nabila Khaleel[SUP] 7 [/SUP], Nikki Kagan[SUP] 8 [/SUP], Breanna C Tuhlei[SUP] 9 [/SUP], Xiu-Feng Wan[SUP] 2 3 4 10 [/SUP]
Affiliations
- PMID: 32749712
- DOI: 10.1002/jmv.26386
Abstract
Background: The full impact of COVID-19 on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality.[SUP]1[/SUP] COVID-19 manifestations appear similar between pregnant and non-pregnant women.[SUP]2[/SUP] OBJECTIVES/STUDY DESIGN: We present a case of placental SARS-CoV-2 virus in a woman with mild COVID-19 disease, then review the literature. RT-PCR was performed to detect SARS-CoV-2. Immunohistochemistry staining was performed with specific monoclonal antibodies to detect SARS-CoV-2 antigen or to identify trophoblasts.
Results: A 29 year-old multigravida presented at 40-4/7 weeks for labor induction. With myalgias two days prior, she tested positive for SARS-CoV-2. We demonstrate maternal vascular malperfusion, with no fetal vascular malperfusion, as well as SARS-CoV-2 virus in chorionic villi endothelial cells, and also rarely in trophoblasts.
Conclusions: To our knowledge, this is the first report of placental SARS-CoV-2 despite mild COVID-19 disease (no symptoms of COVID-19 aside from myalgias); patient had no fever, cough, or shortness of breath, but only myalgias and sick contacts. Despite her mild COVID-19 disease in pregnancy, we demonstrate placental vasculopathy and presence of SARS-CoV-2 virus across the placenta. Evidence of placental COVID-19 raises concern for placental vasculopathy (potentially leading to fetal growth restriction and other pregnancy complications) and possible vertical transmission - especially for pregnant women who may be exposed to COVID-19 in early pregnancy. This raises important questions of whether future pregnancy guidance should include stricter pandemic precautions, such as screening for a wider array of COVID-19 symptoms, increased antenatal surveillance, and possibly routine COVID-19 testing throughout pregnancy. This article is protected by copyright. All rights reserved.
Keywords: Coronavirus < Virus classification; Public policy < Social Science; SARS coronavirus < Virus classification.