ABSTRACT
Objective: Studies have shown that the antibodies developed in pregnant mothers who have been infected with severe acute respiratory syndrome coronavirus (SARS-COV-2) are able to cross the placenta;though, there is a decreased efficiency ratio of cord to maternal anti-receptor-binding domain IgG titers. Viral mediated placental injury may explain this finding. The objective of this study is to examine the relationship between transplacental antibody transfer and abnormal placental pathology in pregnant patients following infection with SARS-COV-2. Study Design: Pregnant patients with COVID-19 delivering at Grady Memorial Hospital were identified and enrolled into a prospective cohort study. Maternal and cord blood samples were collected at the time of delivery, and concentrations of anti- SARS-COV-2 IgG spike protein quantified using an enzyme-linked immunosorbent assay (ELISA). Placentas were sent for pathologic examination at the discretion of the obstetric provider and examined by trained pathologists for size, presence of infarcts, and other histologic findings. Results: A total of 12 women were included in the study. Demographic characteristics and clinical outcomes are reported in Table 1. There was no statistically significant difference in the mean transplacental antibody ratio for patients with and without placental infarcts, with the mean (SD) maternal:cord antibody IgG ratio for patients with infarcts at 0.67 (0.47) and without was 0.73 (0.35) (p=0.81). Maternal hypertensive disorder and the presence of symptoms at time of infection were not associated with infarct in this small sample. Conclusion: Results demonstrate that in this limited sample, placental infarcts were not associated with difference in transplacental antibody transfer. Further studies are needed to understand mechanisms underlying transplacental antibody transfer. [Formula presented] [Formula presented]
ABSTRACT
Objective: Prior studies have shown maternal viral infections are associated with fetal growth restriction (FGR);however, the relationship between FGR and Sars-CoV-2 (SCOV2) infection during pregnancy remains unclear. In this study, we investigate the association between FGR & parental SCOV2 infection at a county hospital in Atlanta, Georgia. Study Design: A prospective cohort study was created by matching patients who had positive SCOV2 (PSCOV2) and negative SCOV2 (NSCOV2) PCR tests between 1/2020-4/2021 utilizing an institutional database. Cohorts were drawn from patients who received a 3rd trimester ultrasound (3TUS) & were matched by gestational age & month SCVO2 testing was performed. FGR was present when estimated fetal weight (EFW) was ≤10% or abdominal circumference (AC) ≤10% at time of either late 2nd or 3rd trimester ultrasound. Sample size calculations were performed to investigate a 15% difference in FGR rate requiring 74 subjects per group. Univariate analyses, chi-square tests and logistic regression were performed. Regression models were adjusted for comorbidities including preeclampsia, gestational diabetes, chronic hypertension, gestational hypertension, and maternal race. Results: 157 subjects were in the analyses (n=78 PSCOV2 and n=79 NSCVO2). 83.4% (n =131) self-identified as African American. FGR rates were 15.3% and 16.4% among PSCOV2 and NSCOV2 respectively. After adjusting for confounders, no difference in FGR was observed between the groups (adjusted OR: 1.12, 95% CI 0.46-2.73). Absolute EFW at time of FGR diagnosis was lower in PSCOV2 vs NSCOV2 (1,250 grams vs.1,337 grams, p= 0.015), a relationship that remained after adjusting for confounders (p=0.015). Conclusion: Our data suggest that despite a high background FGR rate (15.2%), there was no significant association between FGR and SCOV2. Also, EFW was lower in PSCOV2 cohort vs NSCOV2 cohort. Therefore, unlike other viral illnesses, while SCOV2 may not clinically drive FGR, further studies are necessary to investigate the effects of maternal SCVO2 on fetal growth & examine whether growth exams improve outcomes in this setting.