Placental pathology, neonatal birth weight, and Apgar score in acute and distant SARS-CoV-2 infection

Marie C. Smithgall^{1 *}, Elisabeth A. Murphy¹, Sophie Rand¹, Ashley Sukhu², Sunidhi Singh⁵, Nina Schatz-Siemers¹, Cathleen Matrai¹, Jiangling Tu¹, Christine M. Salvatore³, Malavika Prabhu⁴, Sallie Permar³, Laura E. Riley⁴, Brian D. Robinson¹, Rebecca N. Baergen¹, Yawei J. Yang^{1 *}

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¹ Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States

² New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, United States

³ Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065, United States

⁴ Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, United States

⁵ Weill Medical College, Weill Cornell Medicine, New York, NY 10065, United States

JCTR 2022, 8(5), 351–359; https://doi.org/10.18053/jctres.08.202205.005

Submitted: 30 August 2022 | Accepted: 31 August 2022 | Published: 7 September 2022

© 2022 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )

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Abstract

Background: Most research on SARS-CoV-2 infection during pregnancy has been on acute infections with limited data on the effect of distant infection.

Aim: We examined placental pathology and neonatal outcomes in distant SARS-CoV-2 infection earlier in pregnancy compared to acute infections late in pregnancy/at birth and to non-SARS-CoV-2 infected patients with other placental pathologies/clinical presentations.

Methods: Placentas birthed to unvaccinated patients with SARS-CoV-2 RT-PCR testing and serology testing results from time of delivery were included in this study. A total of 514 singleton placentas between 4/18/2020 and 7/26/2021 were included: 77 acute SARS-CoV-2 infection (RT-PCR positive and serology negative); 222 distant SARS-CoV-2 infection (RT-PCR negative but serology IgG-positive); and 215 non-SARS-Cov-2 infected (RT-PCR negative, serology negative, and history negative) with other placental pathologies: preeclampsia/hypertension, intrauterine growth restriction (IUGR), diabetes, chorioamnionitis and meconium. Placental pathology findings, Apgar scores, and neonatal birth weights were compared.

Results: Placentas from the acute group had significantly more villous agglutination (10.4%, p=0.015) and eosinophilic T-cell vasculitis (5.2%, p=0.004) compared to placentas from the distant group (2.7% and 0%) and non-SARS-CoV-2 placentas (1.9% and 0.9%). One acute case showed SARS-CoV-2 placentitis and resulted in preterm delivery at 25 weeks. Both the preeclampsia/hypertension and the IUGR groups showed significantly more maternal vascular malperfusion findings compared to the acute (6.5%, 6.5% and 1.3%) and distant (7.7%, 7.7%, 3.2%) groups. Fetal vascular malperfusion findings such as thrombosis of fetal vessels (17.4% p=0.042) and intramural fibrin deposition (21.7% p=0.026) were significantly higher in the IUGR group compared to acute (7.8%; 2.6%) and distant (3.6%; 8.1%) infection. Many neonates born to patients infected with SARS-CoV-2 had birthweights outside of 95% confidence range of observed birthweights. There was no association of Apgar scores with infection status or placental pathology.

Conclusion: Acute and distant SARS-CoV-2 infections present differing placental pathology.

Relevance for patients: SARS-CoV-2 infection during pregnancy has demonstrable effects on the placenta with potential significant impacts for maternal and fetal health. Prevention of maternal SARS-CoV-2 infection, primarily through vaccination, remains the best mitigation strategy to prevent sequelae of maternal SARS-CoV-2 infection.

Keywords

COVID

placenta

serology

villous agglutination

eosinophilic T-cell vasculitis

Conflict of interest

The authors declare that there are no conflicts of interest that could be perceived as prejudicing the impartiality of the research reported.

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