ABSTRACT
Introduction: Viral infections in pregnant mothers can result in neurological disorders. Because of this, it is important to establish that there is fetal brain affectation due to COVID-19. Objective: To establish a direct and indirect relationship between SARS-CoV-2 infection during pregnancy, and adverse results on perinatalneurologicaldevelopment, as much as psychological long-term results. Material and methods: A narrative review of available evidence linked to the placenta and SARS-CoV-2 relationship, fetal brain physiopathology, and neuropsychiatric affectation was performed using PubMed, LILACS, and Google Scholar databases, on the time lapse between January 1997 to June 2022. Results: 66 studies with methodology, qualitative representability, and citation impact, according to the present research´s objective, were reviewed. Evidence review over COVID-19 and fetal central nervous system (CNS), establishes that chronic histiocytic intervillositis and trophoblast necrosis are risk factors for placental infection by SARS-CoV-2, viral vertical transmission, and breach of the maternal barrier-fetal. Fetal brain expression of protein S receptors suggests fetal brain incursion of SARS-CoV-2 in infected pregnancies, especially during the second and third trimesters of pregnancy. Infections during critical periods of early fetal neurodevelopment have been shown to increase the likelihood of neurodegenerative and neurobehavioral disorders, including autism or autism spectrum disorders (ASDs), and psychiatric illnesses in offspring. Conclusion: Evidence supports the possibility to establish a direct and indirect relationship between SARS-CoV-2 infection during pregnancy, and adverse results on perinatalneurologicaldevelopment, as much as psychological long-term results. © 2022 Academia Nacional de Medicina. All rights reserved.
ABSTRACT
COVID-19 infection is novel, so data on clinical presentation during pregnancy and perinatal outcomes are scarce. The types of cells in the placenta that express ECA2 are the syncytiotrophoblast and cytotrophoblast in chorionic villi, decidual stromal cells, perivascular decidual cells, and endothelial and vascular smooth muscle cells. Histopathological findings report placental involvement in all trimesters. Chronic histiocytic intervillositis and trophoblast necrosis are risk factors for placental infection by SARS-CoV-2, viral vertical transmission, and trespassing the maternal-fetal barrier. The success rate of transplacental viral infection (intrauterine transmission) to the fetus appears to be low. The fetal brain during the second and third trimesters of pregnancy may be vulnerable to SARS-CoV-2 infection. © 2022 Academia Nacional de Medicina. All rights reserved.
ABSTRACT
The novel coronavirus (SARS-CoV-2) pandemic infection during pregnancy brings potential bioethical issues in critical obstetrics, prenatal counseling, and making decisions over pregnancy termination and delivery. Maternal-fetal care using evidence-based medicine from the MFM health team, along with disciplines such as epigenetics and perinatal immunology, should use ethical values, guidelines, and protocols born of multidisciplinary consensus provided along with ethical committees assistance, where it is essential to apply the principles of beneficence and respect of autonomy, in addition to fetal consideration as a patient, particularly in presence of viability. Using enlightening discussion and reflexive prudent clinical judgment taking into consideration facts, values, and duties to make decisions is the ethical and human guideline to face the tremendous challenge represented by the pandemic during pregnancy in Latin America. © 2020 Academia Nacional de Medicina. All rights reserved.