Linn Rebecca L, Forkpa Markolline, Leite Rita, Guerrero Jessenia C, Reyes Maria C, Schwartz Lauren E, Simmons Rebecca A, Parry Samuel, Golden Thea N
Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Pathol. 2025 Aug;195(8):1457-1466. doi: 10.1016/j.ajpath.2025.04.009. Epub 2025 Apr 30.
The relationship among timing and severity of coronavirus disease 2019 (COVID-19) during pregnancy, placental pathology, and adverse pregnancy outcomes is not well understood. A prospective cohort study of 497 pregnant patients with COVID-19 whose placentas underwent systematic pathologic examination was conducted. The main exposure was timing of COVID-19 during pregnancy (first/second versus third trimester). The primary outcome was composite placental pathology that included high-grade maternal vascular malperfusion or >25% perivillous fibrin deposition. Sixty three patients had the composite placental pathology outcome. In adjusted analyses that controlled for maternal age, parity, active infection at delivery, interval from time of diagnosis to delivery, and COVID-19 variant, timing of COVID-19 during pregnancy was not associated with risk of the composite placental pathology outcome. Among the secondary COVID-19-related exposures investigated, severity of disease and treatment for COVID-19 were associated with risk of the composite placental pathology outcome. In addition, patients with COVID-19 in the first 9 months of the pandemic had the highest rate of the composite placental pathology outcome. In this large cohort, placental vascular pathology was common among COVID-19 cases but was unrelated to the timing of COVID-19 during pregnancy or adverse pregnancy outcomes. These findings suggest that uncomplicated COVID-19 during pregnancy does not require intensive fetal surveillance or detailed pathologic examination of the placenta after delivery.
2019冠状病毒病（COVID-19）在孕期的发病时间、严重程度与胎盘病理学及不良妊娠结局之间的关系尚未完全明确。对497例感染COVID-19且胎盘接受了系统病理检查的孕妇进行了一项前瞻性队列研究。主要暴露因素为孕期COVID-19的发病时间（孕早期/孕中期与孕晚期）。主要结局为复合胎盘病理学改变，包括重度母体血管灌注不良或绒毛周围纤维蛋白沉积>25%。63例患者出现了复合胎盘病理学改变结局。在控制了产妇年龄、产次、分娩时的活动性感染、诊断至分娩的间隔时间以及COVID-19变异株的校正分析中，孕期COVID-19的发病时间与复合胎盘病理学改变结局的风险无关。在调查的与COVID-19相关的次要暴露因素中，疾病严重程度和COVID-19治疗与复合胎盘病理学改变结局的风险相关。此外，在疫情的前9个月感染COVID-19的患者中，复合胎盘病理学改变结局的发生率最高。在这个大型队列中，胎盘血管病理学改变在COVID-19病例中很常见，但与孕期COVID-19的发病时间或不良妊娠结局无关。这些发现表明，孕期无并发症的COVID-19不需要进行强化胎儿监测或产后对胎盘进行详细病理检查。
