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Article

Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms

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Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
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Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Department of Pathology, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
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Department of Viroscience, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
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Department of Pediatric Infectiology, Immunology and Rheumatology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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Department of Obstetrics and Gynaecology, Ikazia Hospital, 3083 AN Rotterdam, The Netherlands
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Department of Obstetrics and Gynaecology, Franciscus en Vlietland Hospital, 3045 PM Rotterdam, The Netherlands
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Department of Obstetrics and Gynaecology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Department of Neonatology, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
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Authors to whom correspondence should be addressed.
Academic Editor: Giorgio Palù
Viruses 2021, 13(8), 1670; https://doi.org/10.3390/v13081670
Received: 16 July 2021 / Revised: 19 August 2021 / Accepted: 19 August 2021 / Published: 23 August 2021
Background: Although the risk for transplacental transmission of SARS-CoV-2 is rare, placental infections with adverse functional consequences have been reported. This study aims to analyse histological placental findings in pregnancies complicated by SARS-CoV-2 infection and investigate its correlation with clinical symptoms and perinatal outcomes. We want to determine which pregnancies are at-risk to prevent adverse pregnancy outcomes related to COVID-19 in the future. Methods: A prospective, longitudinal, multicentre, cohort study. All pregnant women presenting between April 2020 and March 2021 with a nasopharyngeal RT-PCR-confirmed SARS-CoV-2 infection were included. Around delivery, maternal, foetal and placental PCR samples were collected. Placental pathology was correlated with clinical maternal characteristics of COVID-19. Results: Thirty-six patients were included, 33 singleton pregnancies (n = 33, 92%) and three twin pregnancies (n = 3, 8%). Twenty-four (62%) placentas showed at least one abnormality. Four placentas (4/39, 10%) showed placental staining positive for the presence of SARS-CoV-2 accompanied by a unique combination of diffuse, severe inflammatory placental changes with massive perivillous fibrin depositions, necrosis of syncytiotrophoblast, diffuse chronic intervillositis, and a specific, unprecedented CD20+ B-cell infiltration. This SARS-CoV-2 placental signature seems to correlate with foetal distress (75% vs. 15.6%, p = 0.007) but not with the severity of maternal COVID-19 disease. Conclusion: We describe a unique placental signature in pregnant patients with COVID-19, which has not been reported in a historical cohort. We show that the foetal environment can be seriously compromised by disruption of placental function due to local, devastating SARS-CoV-2 infection. Maternal clinical symptoms did not predict the severity of the SARS-CoV-2-related placental signature, resulting in a lack of adequate identification of maternal criteria for pregnancies at risk. Close foetal monitoring and pregnancy termination in case of foetal distress can prevent adverse pregnancy outcomes due to COVID-19 related placental disease. View Full-Text
Keywords: placenta; SARS-CoV-2; pregnancy; foetal outcome placenta; SARS-CoV-2; pregnancy; foetal outcome
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MDPI and ACS Style

Husen, M.F.; van der Meeren, L.E.; Verdijk, R.M.; Fraaij, P.L.A.; van der Eijk, A.A.; Koopmans, M.P.G.; Freeman, L.; Bogers, H.; Trietsch, M.D.; Reiss, I.K.M.; DeKoninck, P.L.J.; Schoenmakers, S. Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms. Viruses 2021, 13, 1670. https://doi.org/10.3390/v13081670

AMA Style

Husen MF, van der Meeren LE, Verdijk RM, Fraaij PLA, van der Eijk AA, Koopmans MPG, Freeman L, Bogers H, Trietsch MD, Reiss IKM, DeKoninck PLJ, Schoenmakers S. Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms. Viruses. 2021; 13(8):1670. https://doi.org/10.3390/v13081670

Chicago/Turabian Style

Husen, Marjolein F., Lotte E. van der Meeren, Robert M. Verdijk, Pieter L. A. Fraaij, Annemiek A. van der Eijk, Marion P. G. Koopmans, Liv Freeman, Hein Bogers, Marjolijn D. Trietsch, Irwin K. M. Reiss, Philip L. J. DeKoninck, and Sam Schoenmakers. 2021. "Unique Severe COVID-19 Placental Signature Independent of Severity of Clinical Maternal Symptoms" Viruses 13, no. 8: 1670. https://doi.org/10.3390/v13081670

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