Chronic Histiocytic Intervillositis With Trophoblast Necrosis Is a Risk Factor Associated With Placental Infection From Coronavirus Disease 2019 (COVID-19) and Intrauterine Maternal-Fetal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission in Live-Born and Stillborn Infants
Chronic Histiocytic Intervillositis With Trophoblast Necrosis Is a Risk Factor Associated With Placental Infection From Coronavirus Disease 2019 (COVID-19) and Intrauterine Maternal-Fetal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission in Live-Born and Stillborn Infants
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DOI：
10.5858/arpa.2020-0771-sa
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发表时间：
2021-05-01
影响因子：
4.6
通讯作者：
Vivanti, Alexandre J.
中科院分区：
文献类型：
--
作者：
Schwartz, David A.;Baldewijns, Marcella;Vivanti, Alexandre J.
背景：严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染的新生儿数量正在增加，少数有宫内感染的报告。目的：描述因母体感染 SARS-CoV-2 而经胎盘传播的预选新生儿队列的胎盘病理学结果，并确定胎盘和胎儿感染的病理学危险因素。设计：由多国小组进行的基于病例的回顾性分析。 19 名围产期专家对 2 组 SARS-CoV-2 检测呈阳性的母亲所生婴儿的胎盘病理学结果进行了研究：通过胎盘传播感染的活产新生儿在分娩后检测出 SARS-CoV-2 呈阳性，并通过分子病理学在胎盘胎儿室的细胞中鉴定出 SARS-CoV-2，以及合体滋养层 SARS-CoV-2 呈阳性的死产婴儿。结果。-在所有胎盘中6 名活产新生儿通过胎盘传播感染 SARS-CoV-2，使用免疫组织化学、RNA 原位杂交或两者检测，合体滋养层冠状病毒呈阳性。所有6个胎盘均患有慢性组织细胞绒毛间炎和合体滋养层坏死。 5 名死产/终止婴儿的胎盘病理学结果相似，包括合体滋养层 SARS-CoV-2 感染、慢性组织细胞绒毛间炎和合体滋养层坏死。结论。-在活产和死产中，慢性组织细胞绒毛间炎和合体滋养层坏死伴随合体滋养层 SARS-CoV-2 感染婴儿。这两项发现在出生前感染的活产婴儿的所有胎盘中同时存在，表明它们构成了经胎盘胎儿感染的病理学危险因素。讨论了胎盘和胎儿感染 SARS-CoV-2 的潜在机制以及未来可能的研究。
Context.-The number of neonates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection.Objective.-To characterize the placental pathology findings in a preselected cohort of neonates infected by transplacental transmission arising from maternal infection with SARS-CoV-2, and to identify pathology risk factors for placental and fetal infection.Design.-Case-based retrospective analysis by a multinational group of 19 perinatal specialists of the placental pathology findings from 2 cohorts of infants delivered to mothers testing positive for SARS-CoV-2: live-born neonates infected via transplacental transmission who tested positive for SARS-CoV-2 after delivery and had SARS-CoV-2 identified in cells of the placental fetal compartment by molecular pathology, and stillborn infants with syncytiotrophoblast positive for SARS-CoV-2.Results.-In placentas from all 6 live-born neonates acquiring SARS-CoV-2 via transplacental transmission, the syncytiotrophoblast was positive for coronavirus using immunohistochemistry, RNA in situ hybridization, or both. All 6 placentas had chronic histiocytic intervillositis and necrosis of the syncytiotrophoblast. The 5 stillborn/terminated infants had placental pathology findings that were similar, including SARS-CoV-2 infection of the syncytiotrophoblast, chronic histiocytic intervillositis, and syncytiotrophoblast necrosis.Conclusions.-Chronic histiocytic intervillositis together with syncytiotrophoblast necrosis accompanies SARS-CoV-2 infection of syncytiotrophoblast in live-born and stillborn infants. The coexistence of these 2 findings in all placentas from live-born infants acquiring their infection prior to delivery indicates that they constitute a pathology risk factor for transplacental fetal infection. Potential mechanisms of infection of the placenta and fetus with SARS-CoV-2, and potential future studies, are discussed.