Placental Abnormalities Not Associated With Severe SARS-CoV-2 Infection

A large, single-institution study in Texas, found SARS-CoV-2 virus infections during pregnancy were not associated with adverse pregnancy outcomes. 

However, neonatal infections may be as high as 3 percent and may occur predominantly among asymptomatic or mildly symptomatic women. And, placental abnormalities were not associated with disease severity, and hospitalization frequency was similar to rates among nonpregnant women.

Published by JAMA on November 19, 2020, this study evaluated adverse outcomes associated with SARS-CoV-2 infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes.

This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System, a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. 

These Dallas, Texas-based women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity.

From March 18 through August 22, 2020, 3,374 pregnant women (mean age, 27 years) tested for SARS-CoV-2 delivered, including 252 who tested positive for SARS-CoV-2 and 3,122 who tested negative. 

The cohort included 2,520 Hispanic (75%), 619 Black (18%), and 125 White (4%) women. There were no differences in age, parity, body mass index, or diabetes among women with or without SARS-CoV-2. 

SARS-CoV-2 positivity was more common among Hispanic women (230 [91%] positive vs 2,290 [73%] negative; difference, 17.9%; 95% CI, 12.3%-23.5%; P < .001). 

There was no difference in the composite primary outcome (52 women [21%] vs 684 women [23%]; relative risk, 0.94; 95% CI, 0.73-1.21; P = .64). Early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. 

There were no placental pathologic differences by illness severity. Maternal illness at initial presentation was asymptomatic or mild in 239 women (95%), and 6 of those women (3%) developed a severe or critical illness. Fourteen women (6%) were hospitalized for the indication of COVID-19.

This study has limitations, such as it did not have the power to detect differences in individual adverse outcomes; thus, conclusions made from these comparisons may not be generalizable.

And, further study is needed to understand whether maternal infection with SARS-CoV-2 is associated with long-term maternal or infant health.

No conflict of interest disclosures were filed by these researchers.

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