Theiler Regan N, Warring Simrit K, Young Maia C, Santos Janelle, Branda Megan E, Quinton Reade A, Enninga Elizabeth Ann L
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
Fellows in the Department of Obstetrics and Gynecology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Placenta. 2025 Jan;159:180-186. doi: 10.1016/j.placenta.2024.12.017. Epub 2024 Dec 25.
The reported gross and histopathologic changes in the placenta associated with SARS-CoV-2 infection are heterogeneous. We sought to summarize placental histopathologic findings from pregnancies affected by SARS-CoV-2 infection according to timing of infection and symptom severity.
We conducted a retrospective cohort study of patients with SARS-CoV-2 infection during pregnancy who had deliveries at Mayo Clinic, Rochester, Minnesota, from April 2020 through June 2021. Placental histopathologic findings and clinical characteristics were compared for infections before vs after 28 weeks' gestation and according to COVID-19 symptom severity.
We analyzed 93 cases of SARS-CoV-2 infection during pregnancy, with 51 % of infections occurring before 28 weeks' gestation. Infections were categorized as asymptomatic (14 %), mild (77 %), moderate (6 %), and severe (3 %) according to World Health Organization criteria. An increased risk of small placental weight (<10th percentile) was associated with maternal infection at all gestational ages (30 %, P < .001). Histopathologic lesions consistent with maternal vascular malperfusion occurred more often for infections before than after 28 weeks' gestation (18/46, 38 % vs 9/47, 19 %; P = .047) and did not differ in frequency according to symptom severity. Inflammatory changes were present in 50 % of the placentas examined but did not differ by group, except that acute fetal vasculitis occurred more frequently after asymptomatic vs symptomatic maternal infection (23 % vs 5 %; risk ratio, 4.62; 95 % CI, 1.16-18.30).
COVID-19 at any gestational age or severity increases the risk of small placental weight and the presence of placental inflammatory lesions.
与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染相关的胎盘大体和组织病理学变化报道不一。我们试图根据感染时间和症状严重程度总结SARS-CoV-2感染孕妇的胎盘组织病理学发现。
我们对2020年4月至2021年6月在明尼苏达州罗切斯特市梅奥诊所分娩的SARS-CoV-2感染孕妇进行了一项回顾性队列研究。比较妊娠28周前和28周后感染的胎盘组织病理学发现及临床特征，并根据新冠病毒病（COVID-19）症状严重程度进行比较。
我们分析了93例孕期SARS-CoV-2感染病例，其中51%的感染发生在妊娠28周前。根据世界卫生组织标准，感染分为无症状（14%）、轻度（77%）、中度（6%）和重度（3%）。所有孕周的孕妇感染均与胎盘重量小（<第10百分位数）风险增加相关（30%，P<0.001）。与母体血管灌注不良一致的组织病理学病变在妊娠28周前感染中比28周后感染中更常见（18/46，38%对9/47，19%；P=0.047），且根据症状严重程度频率无差异。在所检查的胎盘中，50%存在炎症变化，但各亚组间无差异，但无症状与有症状母体感染后急性胎儿血管炎的发生频率更高（23%对5%；风险比，4.62；95%置信区间，1.16-18.30）。
任何孕周或严重程度的COVID-19都会增加胎盘重量小和胎盘炎症病变出现的风险。
