The impact of maternal stress on placental pathology at delivery in COVID-19 patients

ABSTRACT

Objectives: The COVID-19 pandemic has placed unprecedented stress on many populations, particularly pregnant women. Maternal adversity has been shown to impact fetal development by way of placental perturbations. The aim of this study is to characterize the impact of maternal stress from the COVID-19 pandemic on placental pathology at delivery and on perinatal outcomes. Method(s) We recruited women with singleton pregnancies in a prospective, observational study on the impact of the COVID-19 pandemic on maternal-fetal wellness. Pregnant women completed a series of validated mental health questionnaires, namely the Speilberger State-Trait Anxiety Inventory (SSAI-S, state anxiety, SSTAI-T, trait anxiety) and the Perceived Stress Scale (PSS). Standardized placental pathologic examinations were performed and assessed using the Amsterdam classification scheme. Maternal mental health assessments and placental weight were analyzed using linear regression and group differences were assessed using student's t-test. Result(s) Thirty-one pregnant women with singleton pregnancies were recruited at a mean gestational age (28.48 +/- 13.34 weeks);of these, 5 (16%) had documented COVID-19 infection in pregnancy. Mean GA at birth was 39.45 +/- 1.49 weeks;14 (45%) of infants were male. Maternal mental health questionnaires were available for 24 women. Maternal anxiety state was significantly associated with increased placental weight at delivery, while anxiety trait and stress did not reach statistical significance (placental weight vs. STAI-S p = 0.04, vs. STAI-T p = 0.07, vs. PSS p = 0.398);Figure 1A-C. Pregnant women with COVID-19 had greater placental weight compared to pregnant women without COVID-19 exposures (p = 0.025);Figure 1D. Conclusion(s) In this cohort, maternal anxiety and positive COVID-19 status have been associated with increased placental weight. Previous studies of increased placental weight have been associated with altered nutritional and endocrinologic functions of the placenta and subsequent fetal programming. The impact of maternal mental distress and disrupted placental growth on short-and long-term infant outcomes are currently underway. Optimizing maternal and fetal care, as well as perinatal outcomes, during the COVID-19 pandemic will require establishing stronger associations between pandemic stress, SARS-CoV-2 infections, and placental pathology.