Fetal and placental infection with SARS‐CoV‐2 in early pregnancy

To date, mother‐to‐fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), responsible for the coronavirus disease 2019 (COVID‐19) pandemic, remains controversial. Although placental COVID‐19 infection has been documented in some cases during the second‐ and third‐trimest...

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Published in:Journal of Medical Virology 2021-07, Vol.93 (7), p.4480-4487
Main Authors: Valdespino‐Vázquez, María Y., Helguera‐Repetto, Cecilia A., León‐Juárez, Moises, Villavicencio‐Carrisoza, Oscar, Flores‐Pliego, Arturo, Moreno‐Verduzco, Elsa R., Díaz‐Pérez, Diana L., Villegas‐Mota, Isabel, Carrasco‐Ramírez, Elba, López‐Martínez, Irma E., Giraldo‐Gómez, David M., Lira, Rosalia, Yocupicio‐Monroy, Martha, Rodríguez‐Bosch, Mario, Sevilla‐Reyes, Edgar E., Cortés‐Bonilla, Manuel, Acevedo‐Gallegos, Sandra, Merchant‐Larios, Horacio, Cardona‐Pérez, Jorge Arturo, Irles, Claudine
Format: Article
Language:English
Subjects:
Coronaviruses
COVID-19
Disease transmission
Double-stranded RNA
Electron microscopy
fetus
Fetuses
first trimester
Immunofluorescence
Immunohistochemistry
Infections
miscarriage
Nucleocapsids
Organs
Pandemics
Placenta
Polymerase chain reaction
Pregnancy
Proteins
Respiratory diseases
Reverse transcription
Ribonucleic acid
RNA
Severe acute respiratory syndrome
Severe acute respiratory syndrome coronavirus 2
Viral diseases
Virology
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Summary:To date, mother‐to‐fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), responsible for the coronavirus disease 2019 (COVID‐19) pandemic, remains controversial. Although placental COVID‐19 infection has been documented in some cases during the second‐ and third‐trimesters, no reports are available for the first trimester of pregnancy, and no SARS‐CoV‐2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarriage in a COVID‐19 maternal infection by immunohistochemical, reverse transcription quantitative real‐time polymerase chain reaction, immunofluorescence, and electron microscopy methods. SARS‐CoV‐2 nucleocapsid protein, viral RNA, and particles consistent with coronavirus were found in the placenta and fetal tissues, accompanied by RNA replication revealed by double‐stranded RNA (dsRNA) positive immunostain. Prominent damage of the placenta and fetal organs were associated with a hyperinflammatory process identified by histological examination and immunohistochemistry. The findings provided in this study document that congenital SARS‐CoV‐2 infection is possible during the first trimester of pregnancy and that fetal organs, such as lung and kidney, are targets for coronavirus. The infection and multi‐organic fetal inflammation produced by SARS‐CoV‐2 during early pregnancy should alert clinicians in the assessment and management of pregnant women for possible fetal consequences and adverse perinatal outcomes.
ISSN:0146-6615
1096-9071
DOI:10.1002/jmv.26965