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Placental SARS-CoV-2 in a pregnant woman with mild COVID-19 disease.
J Med Virol. 2021 02; 93(2):1038-1044.JM

Abstract

The full impact of coronavirus disease 2019 (COVID-19) on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality. COVID-19 manifestations appear similar between pregnant and nonpregnant women. We present a case of placental severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in a woman with mild COVID-19 disease, then review the literature. Reverse transcriptase polymerase chain reaction 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. A 29-year-old multigravida presented at 40-4/7 weeks for labor induction. With myalgias 2 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. 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.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Reproductive Medicine and Fertility Center, University of Missouri-Columbia School of Medicine, Columbia, Missouri.MU Center for Research on Influenza Systems Biology (CRISB), University of Missouri, Columbia, Missouri. Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri. Bond Life Sciences Center, University of Missouri, Columbia, Missouri.Department of Pathology and Anatomical Sciences, University of Missouri-Columbia School of Medicine, Columbia, Missouri.Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Missouri-Columbia School of Medicine, Columbia, Missouri.Division of General Pediatrics, University of Missouri-Columbia School of Medicine, Columbia, Missouri.University of Missouri School of Medicine, Columbia, Missouri.University of Missouri School of Medicine, Columbia, Missouri.MU Center for Research on Influenza Systems Biology (CRISB), University of Missouri, Columbia, Missouri. Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri. Bond Life Sciences Center, University of Missouri, Columbia, Missouri. Department of Electrical Engineering and Computer Science, College of Engineering, University of Missouri, Columbia, Missouri.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

32749712

Citation

Hsu, Albert L., et al. "Placental SARS-CoV-2 in a Pregnant Woman With Mild COVID-19 Disease." Journal of Medical Virology, vol. 93, no. 2, 2021, pp. 1038-1044.
Hsu AL, Guan M, Johannesen E, et al. Placental SARS-CoV-2 in a pregnant woman with mild COVID-19 disease. J Med Virol. 2021;93(2):1038-1044.
Hsu, A. L., Guan, M., Johannesen, E., Stephens, A. J., Khaleel, N., Kagan, N., Tuhlei, B. C., & Wan, X. F. (2021). Placental SARS-CoV-2 in a pregnant woman with mild COVID-19 disease. Journal of Medical Virology, 93(2), 1038-1044. https://doi.org/10.1002/jmv.26386
Hsu AL, et al. Placental SARS-CoV-2 in a Pregnant Woman With Mild COVID-19 Disease. J Med Virol. 2021;93(2):1038-1044. PubMed PMID: 32749712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Placental SARS-CoV-2 in a pregnant woman with mild COVID-19 disease. AU - Hsu,Albert L, AU - Guan,Minhui, AU - Johannesen,Eric, AU - Stephens,Amanda J, AU - Khaleel,Nabila, AU - Kagan,Nikki, AU - Tuhlei,Breanna C, AU - Wan,Xiu-Feng, Y1 - 2020/11/10/ PY - 2020/07/22/received PY - 2020/07/30/accepted PY - 2020/8/5/pubmed PY - 2021/1/15/medline PY - 2020/8/5/entrez KW - Coronavirus KW - SARS coronavirus KW - public policy SP - 1038 EP - 1044 JF - Journal of medical virology JO - J Med Virol VL - 93 IS - 2 N2 - The full impact of coronavirus disease 2019 (COVID-19) on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality. COVID-19 manifestations appear similar between pregnant and nonpregnant women. We present a case of placental severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in a woman with mild COVID-19 disease, then review the literature. Reverse transcriptase polymerase chain reaction 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. A 29-year-old multigravida presented at 40-4/7 weeks for labor induction. With myalgias 2 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. 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. SN - 1096-9071 UR - https://www.unboundmedicine.com/medline/citation/32749712/Placental_SARS_CoV_2_in_a_pregnant_woman_with_mild_COVID_19_disease_ L2 - https://doi.org/10.1002/jmv.26386 DB - PRIME DP - Unbound Medicine ER -