Carmo Francisca, Ramalho Carla, Guimarães Susana, Martel Fátima
Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, 4200-135 Porto, Portugal.
Viruses. 2025 Jul 18;17(7):1013. doi: 10.3390/v17071013.
Obesity during pregnancy is associated with an elevated risk of severe COVID-19, including higher rates of maternal complications, intensive care admission, and adverse neonatal outcomes. The impact of combination of SARS-CoV-2 infection and maternal obesity in placental pathology has not been properly investigated.
To compare the histopathological changes in the placenta induced by active SARS-CoV-2 infection in obese and non-obese patients.
This retrospective cohort study included human placentas from non-obese women and pre-gestationally obese women with active SARS-CoV-2 infection (SARS and OB+SARS, respectively), and placentas from non-obese women and pre-gestationally obese women without SARS-CoV-2 infection (control and OB, collected in the post- and pre-pandemic periods, respectively).
A higher (50%) occurrence of ischemic injury and subchorionic fibrin deposits and a 15× higher risk of occurrence of these lesions were found in the OB+SARS group, in relation to control. In contrast, a 10% lower risk of developing chorangiosis in the OB+SARS group than the OB group was observed.
An increased risk of lesions related to both maternal and fetal malperfusion and ischemic injury and a lower risk for chorangiosis exist in placentas from obese women affected by SARS-CoV-2 infection. Importantly, these differences were not observed in placentas from non-obese women.
孕期肥胖与严重新型冠状病毒肺炎（COVID-19）风险升高相关，包括孕产妇并发症、重症监护病房收治率及不良新生儿结局发生率更高。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染与孕产妇肥胖合并存在对胎盘病理学的影响尚未得到充分研究。
比较肥胖和非肥胖患者中由活动性SARS-CoV-2感染引起的胎盘组织病理学变化。
这项回顾性队列研究纳入了来自非肥胖女性和孕前肥胖且患有活动性SARS-CoV-2感染的女性的人胎盘（分别为SARS组和OB+SARS组），以及来自非肥胖女性和未感染SARS-CoV-2的孕前肥胖女性的胎盘（分别为对照组和OB组，分别在疫情后和疫情前收集）。
与对照组相比，OB+SARS组缺血性损伤和绒毛膜下纤维蛋白沉积的发生率更高（50%），且出现这些病变的风险高15倍。相比之下，观察到OB+SARS组发生绒毛膜血管病的风险比OB组低10%。
受SARS-CoV-2感染的肥胖女性的胎盘发生与母婴灌注不良和缺血性损伤相关病变的风险增加，而发生绒毛膜血管病的风险降低。重要的是，在非肥胖女性的胎盘中未观察到这些差异。
