Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

Elisheva D. Shanes; Emily S. Miller; Sebastian Otero; Rebecca Ebbott; Raveena Aggarwal; Antonia S. Willnow; Egon A. Ozer; Leena B. Mithal; Jeffery A. Goldstein

doi:10.1177/10668969221102534

Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

Elisheva D. Shanes, Emily S. Miller, Sebastian Otero, Rebecca Ebbott, Raveena Aggarwal, Antonia S. Willnow, Egon A. Ozer, Leena B. Mithal, Jeffery A. Goldstein^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

25 Scopus citations

Abstract

Objectives.The goal of this study is to describe placental pathology after infection with SARS-CoV-2 before the predominance of variants of concern (pre-VOC) and during eras of predominant transmission of the Alpha & Gamma (co-circulating), Delta, and Omicron variants. Methods. We used county-level variant data to establish population-level variant proportions, SARS-CoV-2 PCR to identify cases, and IgG serology to exclude latent infections from controls and histopathologic examination to identify placental pathology. Results. We report findings in 870 placentas from pregnancies complicated by SARS-CoV-2 including 90 with infection in the Alpha/Gamma era, 60 from the Delta era and 56 from the Omicron era. Features of maternal vascular malperfusion (MVM), including decidual arteriopathy, were significantly more frequent after SARS-CoV-2 infection. The risk of these findings varied over time, with the highest rates in the Delta era. Increased COVID-19 severity and the presence of comorbidities strengthened these associations. Conclusion. MVM is a feature of SARS-CoV-2 infection in pregnancy. Lesion frequency changed with the predominant circulating virus and should be considered with new variants.

Original language	English (US)
Pages (from-to)	387-397
Number of pages	11
Journal	International Journal of Surgical Pathology
Volume	31
Issue number	4
DOIs	https://doi.org/10.1177/10668969221102534
State	Published - Jun 2023

Funding

This study was supported by a grant from the Friends of Prentice (to JAG) and from the Stanley Manne Children's Research Fund Springboard Award (to LBM). JAG is supported by the National Institute of Biomedical Imaging and Bioengineering K08EB030120. LBM is supported by the National Institute of Allergy and Infectious Diseases K23AI139337. The authors wish to thank the staff of the Northwestern Prentice Women's Hospital Obstetric COVID Unit, the Northwestern Memorial Hospital Blood Bank, Chemistry Lab, and Pathology Gross Room, for going above and beyond for over a year to continue to make this study possible. Additional clinical data collection was performed by Ashwin Sunderraj, Allison Sakowicz, and Allaa Fadl-Alla. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute of Allergy and Infectious Diseases, Stanley Manne Children’s Research Fund Springboard Award, Friends of Prentice, National Institute of Biomedical Imaging and Bioengineering, (grant number K23AI139337, 2020, K08EB030120). This study was supported by a grant from the Friends of Prentice (to JAG) and from the Stanley Manne Children's Research Fund Springboard Award (to LBM). JAG is supported by the National Institute of Biomedical Imaging and Bioengineering K08EB030120. LBM is supported by the National Institute of Allergy and Infectious Diseases K23AI139337. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute of Allergy and Infectious Diseases, Stanley Manne Children’s Research Fund Springboard Award, Friends of Prentice, National Institute of Biomedical Imaging and Bioengineering, (grant number K23AI139337, 2020, K08EB030120).

Keywords

COVID-19
SARS-CoV-2
decidual arteriopathy
maternal vascular malperfusion
placenta
variants of concern

ASJC Scopus subject areas

Surgery
Anatomy
Pathology and Forensic Medicine

Access to Document

10.1177/10668969221102534

Cite this

@article{a493ce8301314a46a8d1838cdc9d94b8,

title = "Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras",

abstract = "Objectives.The goal of this study is to describe placental pathology after infection with SARS-CoV-2 before the predominance of variants of concern (pre-VOC) and during eras of predominant transmission of the Alpha & Gamma (co-circulating), Delta, and Omicron variants. Methods. We used county-level variant data to establish population-level variant proportions, SARS-CoV-2 PCR to identify cases, and IgG serology to exclude latent infections from controls and histopathologic examination to identify placental pathology. Results. We report findings in 870 placentas from pregnancies complicated by SARS-CoV-2 including 90 with infection in the Alpha/Gamma era, 60 from the Delta era and 56 from the Omicron era. Features of maternal vascular malperfusion (MVM), including decidual arteriopathy, were significantly more frequent after SARS-CoV-2 infection. The risk of these findings varied over time, with the highest rates in the Delta era. Increased COVID-19 severity and the presence of comorbidities strengthened these associations. Conclusion. MVM is a feature of SARS-CoV-2 infection in pregnancy. Lesion frequency changed with the predominant circulating virus and should be considered with new variants.",

keywords = "COVID-19, SARS-CoV-2, decidual arteriopathy, maternal vascular malperfusion, placenta, variants of concern",

author = "Shanes, {Elisheva D.} and Miller, {Emily S.} and Sebastian Otero and Rebecca Ebbott and Raveena Aggarwal and Willnow, {Antonia S.} and Ozer, {Egon A.} and Mithal, {Leena B.} and Goldstein, {Jeffery A.}",

note = "Funding Information: This study was supported by a grant from the Friends of Prentice (to JAG) and from the Stanley Manne Children's Research Fund Springboard Award (to LBM). JAG is supported by the National Institute of Biomedical Imaging and Bioengineering K08EB030120. LBM is supported by the National Institute of Allergy and Infectious Diseases K23AI139337. The authors wish to thank the staff of the Northwestern Prentice Women's Hospital Obstetric COVID Unit, the Northwestern Memorial Hospital Blood Bank, Chemistry Lab, and Pathology Gross Room, for going above and beyond for over a year to continue to make this study possible. Additional clinical data collection was performed by Ashwin Sunderraj, Allison Sakowicz, and Allaa Fadl-Alla. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute of Allergy and Infectious Diseases, Stanley Manne Children{\textquoteright}s Research Fund Springboard Award, Friends of Prentice, National Institute of Biomedical Imaging and Bioengineering, (grant number K23AI139337, 2020, K08EB030120). Funding Information: This study was supported by a grant from the Friends of Prentice (to JAG) and from the Stanley Manne Children's Research Fund Springboard Award (to LBM). JAG is supported by the National Institute of Biomedical Imaging and Bioengineering K08EB030120. LBM is supported by the National Institute of Allergy and Infectious Diseases K23AI139337. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute of Allergy and Infectious Diseases, Stanley Manne Children{\textquoteright}s Research Fund Springboard Award, Friends of Prentice, National Institute of Biomedical Imaging and Bioengineering, (grant number K23AI139337, 2020, K08EB030120). Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2023",

month = jun,

doi = "10.1177/10668969221102534",

language = "English (US)",

volume = "31",

pages = "387--397",

journal = "International Journal of Surgical Pathology",

issn = "1066-8969",

publisher = "SAGE Publications Inc.",

number = "4",

}

TY - JOUR

T1 - Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

AU - Shanes, Elisheva D.

AU - Miller, Emily S.

AU - Otero, Sebastian

AU - Ebbott, Rebecca

AU - Aggarwal, Raveena

AU - Willnow, Antonia S.

AU - Ozer, Egon A.

AU - Mithal, Leena B.

AU - Goldstein, Jeffery A.

N1 - Funding Information: This study was supported by a grant from the Friends of Prentice (to JAG) and from the Stanley Manne Children's Research Fund Springboard Award (to LBM). JAG is supported by the National Institute of Biomedical Imaging and Bioengineering K08EB030120. LBM is supported by the National Institute of Allergy and Infectious Diseases K23AI139337. The authors wish to thank the staff of the Northwestern Prentice Women's Hospital Obstetric COVID Unit, the Northwestern Memorial Hospital Blood Bank, Chemistry Lab, and Pathology Gross Room, for going above and beyond for over a year to continue to make this study possible. Additional clinical data collection was performed by Ashwin Sunderraj, Allison Sakowicz, and Allaa Fadl-Alla. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute of Allergy and Infectious Diseases, Stanley Manne Children’s Research Fund Springboard Award, Friends of Prentice, National Institute of Biomedical Imaging and Bioengineering, (grant number K23AI139337, 2020, K08EB030120). Funding Information: This study was supported by a grant from the Friends of Prentice (to JAG) and from the Stanley Manne Children's Research Fund Springboard Award (to LBM). JAG is supported by the National Institute of Biomedical Imaging and Bioengineering K08EB030120. LBM is supported by the National Institute of Allergy and Infectious Diseases K23AI139337. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute of Allergy and Infectious Diseases, Stanley Manne Children’s Research Fund Springboard Award, Friends of Prentice, National Institute of Biomedical Imaging and Bioengineering, (grant number K23AI139337, 2020, K08EB030120). Publisher Copyright: © The Author(s) 2022.

PY - 2023/6

Y1 - 2023/6

N2 - Objectives.The goal of this study is to describe placental pathology after infection with SARS-CoV-2 before the predominance of variants of concern (pre-VOC) and during eras of predominant transmission of the Alpha & Gamma (co-circulating), Delta, and Omicron variants. Methods. We used county-level variant data to establish population-level variant proportions, SARS-CoV-2 PCR to identify cases, and IgG serology to exclude latent infections from controls and histopathologic examination to identify placental pathology. Results. We report findings in 870 placentas from pregnancies complicated by SARS-CoV-2 including 90 with infection in the Alpha/Gamma era, 60 from the Delta era and 56 from the Omicron era. Features of maternal vascular malperfusion (MVM), including decidual arteriopathy, were significantly more frequent after SARS-CoV-2 infection. The risk of these findings varied over time, with the highest rates in the Delta era. Increased COVID-19 severity and the presence of comorbidities strengthened these associations. Conclusion. MVM is a feature of SARS-CoV-2 infection in pregnancy. Lesion frequency changed with the predominant circulating virus and should be considered with new variants.

AB - Objectives.The goal of this study is to describe placental pathology after infection with SARS-CoV-2 before the predominance of variants of concern (pre-VOC) and during eras of predominant transmission of the Alpha & Gamma (co-circulating), Delta, and Omicron variants. Methods. We used county-level variant data to establish population-level variant proportions, SARS-CoV-2 PCR to identify cases, and IgG serology to exclude latent infections from controls and histopathologic examination to identify placental pathology. Results. We report findings in 870 placentas from pregnancies complicated by SARS-CoV-2 including 90 with infection in the Alpha/Gamma era, 60 from the Delta era and 56 from the Omicron era. Features of maternal vascular malperfusion (MVM), including decidual arteriopathy, were significantly more frequent after SARS-CoV-2 infection. The risk of these findings varied over time, with the highest rates in the Delta era. Increased COVID-19 severity and the presence of comorbidities strengthened these associations. Conclusion. MVM is a feature of SARS-CoV-2 infection in pregnancy. Lesion frequency changed with the predominant circulating virus and should be considered with new variants.

KW - COVID-19

KW - SARS-CoV-2

KW - decidual arteriopathy

KW - maternal vascular malperfusion

KW - placenta

KW - variants of concern

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SN - 1066-8969

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EP - 397

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JF - International Journal of Surgical Pathology

IS - 4

ER -

Placental Pathology After SARS-CoV-2 Infection in the Pre-Variant of Concern, Alpha / Gamma, Delta, or Omicron Eras

Abstract

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