Placental SARS-CoV-2 Infection and Its Implications for Increased Risk of Adverse Pregnancy Outcomes

Bingbing Wang; Wei-Bin Shen; Karl E. Seif; Courtney Townsel; Lauren Baracco; James Logue; E. Albert Reece; Matthew B. Frieman; Sifa Turan; Peixin Yang

doi:10.1055/a-2323-0854

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(01): 052-059
DOI: 10.1055/a-2323-0854

Original Article

Placental SARS-CoV-2 Infection and Its Implications for Increased Risk of Adverse Pregnancy Outcomes

Authors

Bingbing Wang

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
Wei-Bin Shen

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
Karl E. Seif

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
Courtney Townsel

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
Lauren Baracco

²Department of Microbiology and Immunology, Center for Pathogen Research, University of Maryland School of Medicine, Baltimore, Maryland
James Logue

²Department of Microbiology and Immunology, Center for Pathogen Research, University of Maryland School of Medicine, Baltimore, Maryland
E. Albert Reece

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
Matthew B. Frieman

²Department of Microbiology and Immunology, Center for Pathogen Research, University of Maryland School of Medicine, Baltimore, Maryland
Sifa Turan

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
Peixin Yang

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland

Abstract

Objective Pregnant women are at increased risk of coronavirus disease 2019 (COVID-19). This could be explained through the prism of physiologic and immunologic changes in pregnancy. In addition, certain immunological reactions originate in the placenta in response to viral infections.

This study aimed to investigate whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can infect the human placenta and discuss its implications in the pathogenesis of adverse pregnancy outcomes.

Study Design We conducted a retrospective cohort study in which we collected placental specimens from pregnant women who had a laboratory-confirmed SARS-CoV-2 infection. We performed RNA in situ hybridization assay on formalin-fixed paraffin-embedded tissues to establish the in vivo evidence for placental infectivity by this corona virus. In addition, we infected trophoblast isolated from uninfected term human placenta with SARS-CoV-2 variants to further provide in vitro evidence for such an infectivity.

Results There was a total of 21 cases enrolled, which included 5 cases of spontaneous preterm birth (SPTB) and 2 intrauterine fetal demises (IUFDs). Positive staining of positive-sense strand of SARS-CoV-2 virions was detected in 15 placentas including 4 SPTB and both IUFDs. In vitro infection assay demonstrated that SARS-CoV-2 virions were highly capable of infecting both cytotrophoblast and syncytiotrophoblast.

Conclusion This study implies that placental SARS-CoV-2 infection may be associated with an increased risk of adverse obstetrical outcomes.

Key Points

SARS-CoV-2 can effectively infect human placenta.
Such infectivity is confirmed by in vitro experiments.
Placental SARS-CoV-2 corelates with adverse obstetrical outcomes.

Keywords

placenta - SARS-CoV-2 - adverse pregnancy outcomes - intrauterine fetal demise - preterm birth

Full Text

References

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