Transplacental transmission of SARS-CoV-2 infection

Abstract

SARS-CoV-2 outbreak is the first pandemic of the century. SARS-CoV-2 infection is transmitted through droplets; other transmission routes are hypothesized but not confirmed. So far, it is unclear whether and how SARS-CoV-2 can be transmitted from the mother to the fetus. We demonstrate the transplacental transmission of SARS-CoV-2 in a neonate born to a mother infected in the last trimester and presenting with neurological compromise. The transmission is confirmed by comprehensive virological and pathological investigations. In detail, SARS-CoV-2 causes: (1) maternal viremia, (2) placental infection demonstrated by immunohistochemistry and very high viral load; placental inflammation, as shown by histological examination and immunohistochemistry, and (3) neonatal viremia following placental infection. The neonate is studied clinically, through imaging, and followed up. The neonate presented with neurological manifestations, similar to those described in adult patients.

Vivanti A.J., Vauloup-Fellous C., Prevot S., et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020; 11 (1): 3572. DOI: https://doi.org/10.1038/s41467-020-17436-6

References

1. Zeng H., et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020; 323: 1848-9.

2. Dong L., et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020; 323: 1846-8.

3. Zeng L., et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr. 2020. DOI: https://doi.org/10.1001/jamapediatrics.2020.0878

4. Zhu H., et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020; 9: 51-60.

5. Yu N., et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, singlecentre, descriptive study. Lancet Infect Dis. 2020; 20: 559-64.

6. Alzamora, M.C., et al. Severe COVID-19 during Pregnancy and possible vertical transmission. Am J Perinatol. 2020. DOI: https://doi.org/10.1055/s-0040-1710050

7. American College of Obstetricians and Gynecologists. Practice bulletin no.106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009; 114: 192-202.

8. Perlman J.M., et al. Part 7: neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (Reprint). Pediatrics. 2015; 136: 120-66.

9. Singh Y., et al. International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24: 65.

10. De Luca D., et al. Role of distinct phospholipases A2 and their modulators in meconium aspiration syndrome in human neonates. Intensiv Care Med. 2011; 37: 1158-65.

11. Zamaniyan M., et al. Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diag. 2020. DOI: https://doi.org/10.1002/pd.5713.

12. Lorenz N., et al. Neonatal early-onset infection with SARS-CoV-2 in a newborn presenting with encephalitic symptoms. Pediat Infect Dis J. 2020. DOI: https://doi.org/10.1097/INF.0000000000002735

13. Shah P.S., Diambomba Y., Acharya G., Morris S.K., Bitnun A. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand. 2020; 99: 565-8.

14. Kirtsman M., et al. Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection. CMAJ. 2020. DOI: https://doi.org/10.1503/cmaj.200821

15. Algarroba G.N., et al. Visualization of SARS-CoV-2 virus invading the human placenta using electron microscopy. Am. J Obstet Gynecol. 2020. DOI: https://doi.org/10.1016/j.ajog.2020.05.023

16. Ng W.F., et al. The placentas of patients with severe acute respiratory syndrome: a pathophysiological evaluation. Pathology. 2006; 38: 210-8.

17. Li M., Chen L., Zhang J., Xiong C., Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study. PLoS ONE. 2020; 15: e0230295.

18. Mao L., et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77: 1-9.

19. Needham E.J., Chou S.H.-Y., Coles A.J., Menon, D.K. Neurological implications of COVID-19 infections. Neurocrit Care. 2020; 32: 667-71.

20. Poyiadji N., et al. COVID-19-associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology. 2020; 201187. DOI: https://doi.org/10.1148/radiol.2020201187.

21. Moriguchi T., et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020; 94: 55-8.

22. De Blic J., et al. Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society. Eur Resp J. 2000; 15: 217-31.

23. Uhteg, K., et al. Comparing the analytical performance of three SARS-CoV-2 molecular diagnostic assays. J Clin Virol. 2020; 127: 104384.

24. Khong T.Y., et al. Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016; 140: 698-713.

25. Riley D.S., et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017; 89, 218-35.

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CHIEF EDITOR
CHIEF EDITOR
Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

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