Placental pathology associated with maternal age and maternal obesity in singleton pregnancy.

OBJECTIVE: Maternal age, maternal obesity and neonatal sex dimorphism are known to affect pregnancy and neonatal outcome. However, the effects of these factors on specific placental pathology are less well-documented. STUDY DESIGN: Clinical information, placental pathology and neonatal data from singleton delivery were collected at our hospital in March 2020 to October 2021 and correlation studies were performed. RESULTS: A total 3,119 singleton placentas were examined between March 2020 and October 2021 in conjunction with clinical information and neonatal birth data. Advanced maternal age (>35) was significantly associated with a variety of pregnancy complications and placental pathology including preeclampsia/pregnancy induced hypertension (Pre/PIH), gestational diabetes mellitus (GDM2), intrauterine growth restriction (IUGR), and increased maternal body mass index (BMI) at delivery. Maternal obesity (BMI >30 at the time of delivery) was significantly associated with a variety of clinical features and placental pathology including PRE/PIH, GDM2 and decidual vasculopathy (mural arterial hypertrophy). No specific placental pathology was associated with neonatal sex except for more maternal inflammatory response (MIR, chronic deciduitis) in neonates of male sex. CONCLUSION: Maternal age and maternal obesity were associated with not only clinical complications of pregnancy and neonatal birth weight but also specific placental pathology. Understanding the effects of maternal and environmental factors will help improve pregnancy outcome.

Maternal, neonatal and placental characteristics of SARS-CoV-2 positive mothers.

BACKGROUND: COVID19 is caused by a newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) that affects pregnant women equally to the general population. How SARS-CoV2 affects the mothers, the neonates and the placental pathology remain controversial. OBJECTIVE: To explore the effects of maternal SARS-CoV2 infection on the neonates and placental pathology in comparison to those from the normal pregnancies. STUDY DESIGN: Maternal, neonatal and placental pathology data were collected from medical records between March and August 2020 from New York Presbyterian- Brooklyn Methodist Hospital. The data from a total 142 neonates and 101 placentas from SARS-CoV2 positive mothers were compared with those from SARS-CoV2 negative mothers. RESULTS: There were 142 SARS-CoV2 positive mothers within the study group, and 43 (36%) of them showed various degrees of COVID19 related clinical symptoms including fever (13.8%), cough (5.7%), loss of taste/smell (anosmia)(5.6%), shortness of breath (2.4%), muscle ache (2.4%), headache (1.6%) and pneumonia (0.8%). A total 142 neonates were born to the SARS-CoV-2 positive mothers, and only 1 neonate tested positive for SARS-CoV2 in the first 24 h. Two additional neonates were initially tested negative in first 24 h, and later tested positive on day 7 and the 1 month visit, and all these neonates were asymptomatic and had no sequelae. There was no increase of pre-term labor and delivery or NICU admissions from SARS-CoV2 positive mothers. Examination of 101 placentas from SARS-CoV2 positive mothers and 121 placentas from SARS-CoV2 negative mothers revealed no increase of placental pathologic features. There were more vaginal deliveries and more meconium stain of fetal membranes from the SARS-CoV2 positive mothers. Previous reports of more maternal vascular malperfusion and fetal vascular malperfusion were not demonstrated in our current data. CONCLUSION: Although SARS-CoV2 is a significant risk to the pregnant women (mothers) and general population, there is no increased risk for neonates. Vertical transmission is rare, and perinatal transmission can also occur. There is no increased frequency of placental abnormalities in both maternal and fetal circulation.

Expectant Management of a Critically Ill Pregnant Patient with COVID-19 with Good Maternal and Neonatal Outcomes.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is responsible for a global pandemic that has significantly affected New York City. There is limited data about COVID-19 infection in pregnancy, especially in critically ill patients. CASE: A 30-year-old female who presented at 26 weeks gestation with acute severe respiratory distress that required intubation and intensive care unit (ICU) admission. We had a high suspicion of COVID-19 disease despite repeated negative SARS-CoV-2 PCR testing, with eventual positive COVID IgG antibody testing. Through an integration of obstetrical knowledge, critical care, and comparing outcomes from similar cases in the literature, we decided to expectantly manage her pregnancy and did not recommend administration of antenatal steroids. She was extubated after 23 days of mechanical ventilation and recovered from her respiratory illness. She had a full-term spontaneous vaginal delivery of a baby boy at 39 weeks gestation with excellent maternal and fetal outcomes at delivery. CONCLUSION: In the face of COVID-19, a new disease with unclear maternal and fetal outcomes to date, a collaboration of care teams is essential to navigate through the challenging decisions made, including timing of delivery, treatment options, and administration of steroids. Our paper is unique as there is no other published case report of a critically ill pregnant patient with COVID-19 in which delivery was deferred, and a full recovery was observed, with a vaginal delivery at term.

The association between placental histopathology and autism spectrum disorder.

INTRODUCTION: Research suggests that autism spectrum disorder (ASD) has its origins in utero. This study examines the association between evidence of placental histopathology and ASD. METHODS: Administrative claims data and medical records data were used to identify ASD cases (N = 55) and matched controls (N = 199) born at New York Methodist Hospital between 2007 and 2014 and subsequently seen in affiliated pediatrics clinics. Placentas from all births during this time period were reviewed as part of routine care. Data were analyzed using conditional logistic regression to account for the matched (gender, gestational age, and birth weight) design. RESULTS: Acute placental inflammation, regardless of type was associated with an increased risk of ASD (odds ratio [OR] = 3.14, 95% CI = 1.39, 6.95). Chronic uteroplacental vasculitis (OR = 7.13; 95% CI = 1.17, 43.38), the fetal inflammatory response in the chorionic plate vessels (OR = 5.12; 95% CI = 2.02, 12.96), and maternal vascular malperfusion pathology (OR = 12.29; 95% CI = 1.37, 110.69) were associated with an increased risk of ASD. Placental villous edema was associated with a decreased risk of ASD (OR = 0.05; 95% CI = 0.0005, 0.42). In subanalyses among male placentas acute inflammation overall, fetal inflammatory response in the chorionic plate vessels, and maternal vascular malperfusion pathology remained significantly associated with an increased risk of ASD whereas placental villous edema remained associated with a decreased risk of ASD. DISCUSSION: Histologic evidence of placental inflammation and maternal vascular malperfusion pathology are associated with ASD.