Analysis of placental pathology after COVID-19 by timing and severity of infection.
Analysis of placental pathology after COVID-19 by timing and severity of infection.
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DOI：
10.1016/j.ajogmf.2023.100981
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发表时间：
2023-07
影响因子：
6.3
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中科院分区：
文献类型：
--
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怀孕期间的 COVID-19 会对妊娠结局产生严重影响。胎盘充当胎儿的感染屏障，可能会导致不良后果。与对照组相比，在 COVID-19 患者的胎盘中发现母体血管灌注不良的频率增加，但人们对感染的时间和严重程度如何影响胎盘病理学知之甚少。本研究旨在探讨 SARS-CoV-2 感染对胎盘病理学的影响，特别是 COVID-19 的发生时间和严重程度是否影响病理结果以及与围产期结局的关联。这是一项描述性回顾性队列研究，对象是 2020 年 4 月至 2021 年 9 月期间在 3 所大学医院分娩的被诊断患有 COVID-19 的孕妇。通过医疗记录审查收集人口统计、胎盘、分娩和新生儿结局。记录了 SARS-CoV-2 感染的时间，并根据美国国立卫生研究院指南对 COVID-19 的严重程度进行了分类。所有鼻咽逆转录聚合酶链反应 COVID-19 检测呈阳性的患者的胎盘在分娩时均被送去进行肉眼和显微镜组织病理学检查。非盲病理学家根据阿姆斯特丹标准对组织病理学病变进行分类。使用单变量线性回归和卡方分析来评估 SARS-CoV-2 感染的时间和严重程度如何影响胎盘病理结果。这项研究包括 131 名怀孕患者和 138 个胎盘，其中大多数患者在加州大学洛杉矶分校 (n=65) 分娩，其次是加州大学旧金山分校 (n=38) 和扎克伯格旧金山总医院 (n=28)。大多数患者在妊娠晚期 (69%) 被诊断出患有 COVID-19，并且大多数感染程度较轻 (60%)。根据 COVID-19 的发生时间或严重程度，没有特定的胎盘病理特征。与妊娠 20 周后感染引起的胎盘感染反应相关的胎盘特征频率更高 (P=.001)。母体血管灌注不良因感染时间的不同而没有差异；然而，严重母体血管灌注不良的特征仅在妊娠中期和晚期的SARS-CoV-2感染患者的胎盘中发现，而在妊娠前三个月的COVID-19患者的胎盘中没有发现。无论疾病发生的时间或严重程度如何，来自 COVID-19 患者的胎盘均未显示出特定的病理特征。妊娠早期 COVID-19 检测呈阳性的患者的胎盘比例较高，有胎盘感染相关特征的证据。未来的研究应侧重于了解 SARS-CoV-2 感染中的这些胎盘特征如何继续影响妊娠结局。
COVID-19 during pregnancy can have serious effects on pregnancy outcomes. The placenta acts as an infection barrier to the fetus and may mediate adverse outcomes. Increased frequency of maternal vascular malperfusion has been detected in the placentas of patients with COVID-19 compared with controls, but little is known about how the timing and severity of infection affect placental pathology. This study aimed to examine the effects of SARS-CoV-2 infection on placental pathology, specifically whether the timing and severity of COVID-19 affect pathologic findings and associations with perinatal outcomes. This was a descriptive retrospective cohort study of pregnant people diagnosed with COVID-19 who delivered between April 2020 and September 2021 at 3 university hospitals. Demographic, placental, delivery, and neonatal outcomes were collected through medical record review. The timing of SARS-CoV-2 infection was noted, and the severity of COVID-19 was categorized on the basis of the National Institutes of Health guidelines. The placentas of all patients with positive nasopharyngeal reverse transcription-polymerase chain reaction COVID-19 testing were sent for gross and microscopic histopathologic examinations at the time of delivery. Nonblinded pathologists categorized histopathologic lesions according to the Amsterdam criteria. Univariate linear regression and chi-square analyses were used to assess how the timing and severity of SARS-CoV-2 infection affected placental pathologic findings. This study included 131 pregnant patients and 138 placentas, with most patients delivered at the University of California, Los Angeles (n=65), followed by the University of California, San Francisco (n=38) and Zuckerberg San Francisco General Hospital (n=28). Most patients were diagnosed with COVID-19 in the third trimester of pregnancy (69%), and most infections were mild (60%). There was no specific placental pathologic feature based on the timing or severity of COVID-19. There was a higher frequency of placental features associated with response to infection in the placentas from infections before 20 weeks of gestation than that from infections after 20 weeks of gestation (P=.001). There was no difference in maternal vascular malperfusion by the timing of infection; however, features of severe maternal vascular malperfusion were only found in the placentas of patients with SARS-CoV-2 infection in the second and third trimesters of pregnancy, not in the placentas of patients with COVID-19 in the first trimester of pregnancy. Placentas from patients with COVID-19 showed no specific pathologic feature, regardless of the timing or severity of the disease. There was a higher proportion of placentas from patients with COVID-19–positive tests in earlier gestations with evidence of placental infection–associated features. Future studies should focus on understanding how these placental features in SARS-CoV-2 infections go on to affect pregnancy outcomes.
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