{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:31:29Z","timestamp":1777890689435,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NPM"],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:p>BACKGROUND: Our objectives were to determine 1) the prevalence and description of placental pathologic lesions in pregnancies complicated by SARS-CoV-2 infection compared to healthy controls and 2) whether the prevalence and\/ or pattern of placental pathologic lesions differed in the few neonates who tested positive for SARS-CoV-2 in the first 48\u200ahours of life at a busy urban county hospital. METHODS: This study included all pregnant mothers who tested positive for SARS-CoV-2 and delivered at our institution from March 2020 to June 2021, while control placentas were collected from term pregnancies without complications. RESULTS: Approximately 90% (n\u200a=\u200a380\/425) of placentas from pregnancies complicated by SARS-CoV-2 infections had placental pathologic lesions, compared to 32% (n\u200a=\u200a16\/50) of controls. The predominant lesions were acute histologic chorioamnionitis with or without fetal response (n\u200a=\u200a209\/380, 55%), maternal vascular malperfusion (n\u200a=\u200a180\/380, 47%), and other inflammatory lesions (n\u200a=\u200a148\/380, 39%). Only 14 (2.5%) infants tested positive for SARS-CoV-2 within the first 48\u200ahours of life. There were no significant differences in placental histopathology between infants who tested positive vs. those that were negative for SARS-CoV-2. Placental lesions in mothers who tested positive for SARS-CoV-2 during the first vs. second vs. third pregnancy trimesters, were significantly different in the incidence of inflammatory placental pathologic lesions (n\u200a=\u200a9\/19, 53% vs. n\u200a=\u200a37\/98, 49% vs. n\u200a=\u200a102\/439, 31%, respectively; p\u200a&lt;\u200a0.01). CONCLUSION: A significant proportion of women with SARS-CoV-2 infection during pregnancy at a single county hospital have inflammatory and vascular placental lesions at birth, raising questions regarding their downstream effects and clinical consequences.<\/jats:p>","DOI":"10.3233\/npm-230177","type":"journal-article","created":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T11:22:51Z","timestamp":1728991371000},"page":"623-636","source":"Crossref","is-referenced-by-count":3,"title":["Placental pathology in SARS-CoV-2 infected pregnancies: A single-institution retrospective cohort analysis"],"prefix":"10.1177","volume":"17","author":[{"given":"T.","family":"Le","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.S.","family":"Brown","sequence":"additional","affiliation":[{"name":"Parkland Health and Hospital System, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.W.","family":"Payton","sequence":"additional","affiliation":[{"name":"Parkland Health and Hospital System, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Sepulveda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Sisman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. L.","family":"Leon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.F.","family":"Chalak","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.N.","family":"Mir","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"key":"10.3233\/NPM-230177_ref1","unstructured":"CDC. COVID Data Tracker 2021 [Available from: https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fspecial-populations%2Fpregnancy-data-on-covid-19.html#pregnant-population."},{"issue":"4","key":"10.3233\/NPM-230177_ref2","doi-asserted-by":"crossref","first-page":"e217523","DOI":"10.1001\/jamanetworkopen.2021.7523","article-title":"Association of maternal perinatal SARS-CoV-2 infection with neonatal outcomes during the COVID-19 pandemic in Massachusetts","volume":"4","author":"Angelidou","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"4","key":"10.3233\/NPM-230177_ref3","doi-asserted-by":"crossref","first-page":"100329","DOI":"10.1016\/j.ajogmf.2021.100329","article-title":"Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): The World Association of Perinatal Medicine working group on coronavirus disease 2019","volume":"3","author":"D\u2019Antonio","year":"2021","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"1","key":"10.3233\/NPM-230177_ref4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1515\/jpm-2020-0539","article-title":"Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): A secondary analysis of the WAPM study on COVID-19","volume":"49","author":"Di Mascio","year":"2020","journal-title":"J Perinat Med"},{"issue":"2","key":"10.3233\/NPM-230177_ref5","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1002\/uog.23575","article-title":"Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx)","volume":"57","author":"Martinez-Portilla","year":"2021","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"3","key":"10.3233\/NPM-230177_ref6","doi-asserted-by":"crossref","first-page":"100319","DOI":"10.1016\/j.ajogmf.2021.100319","article-title":"Pregnancy as a risk factor for severe coronavirus disease 2019 using standardized clinical criteria","volume":"3","author":"Oakes","year":"2021","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"9","key":"10.3233\/NPM-230177_ref7","doi-asserted-by":"crossref","first-page":"e265","DOI":"10.1097\/INF.0000000000002815","article-title":"Intrauterine transmission of SARS-COV-2 infection in a preterm infant","volume":"39","author":"Sisman","year":"2020","journal-title":"Pediatr Infect Dis J"},{"issue":"11","key":"10.3233\/NPM-230177_ref8","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1038\/s41379-020-0639-4","article-title":"SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: A series of 19 placentas from COVID-19-positive mothers","volume":"33","author":"Hecht","year":"2020","journal-title":"Mod Pathol"},{"issue":"1","key":"10.3233\/NPM-230177_ref9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.52054\/FVVO.13.1.001","article-title":"Retrospective observational RT-PCR analyses on 688 babies born to 843 SARS-CoV-2 positive mothers, placental analyses and diagnostic analyses limitations suggest vertical transmission is possible","volume":"13","author":"Bahadur","year":"2021","journal-title":"Facts Views Vis Obgyn"},{"issue":"6","key":"10.3233\/NPM-230177_ref10","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1111\/jog.14784","article-title":"Maternal and perinatal outcomes and placental pathologic examination of 29 SARS-CoV-2 infected patients in the third trimester of gestation","volume":"47","author":"Blasco Santana","year":"2021","journal-title":"J Obstet Gynaecol Res"},{"issue":"8","key":"10.3233\/NPM-230177_ref11","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.3390\/cells9081777","article-title":"A message from the human placenta: Structural and immunomodulatory defense against SARS-CoV-2","volume":"9","author":"Kreis","year":"2020","journal-title":"Cells"},{"key":"10.3233\/NPM-230177_ref12","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.placenta.2020.08.018","article-title":"A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection","volume":"101","author":"Sharps","year":"2020","journal-title":"Placenta"},{"issue":"4","key":"10.3233\/NPM-230177_ref13","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s00428-021-03097-3","article-title":"Placenta histopathology in SARS-CoV-2 infection: analysis of a consecutive series and comparison with control cohorts","volume":"479","author":"Bertero","year":"2021","journal-title":"Virchows Arch"},{"key":"10.3233\/NPM-230177_ref14","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.humpath.2020.12.004","article-title":"Trophoblast damage with acute and chronic intervillositis: Disruption of the placental barrier by severe acute respiratory syndrome coronavirus 2","volume":"109","author":"Debelenko","year":"2021","journal-title":"Hum Pathol"},{"issue":"6","key":"10.3233\/NPM-230177_ref15","doi-asserted-by":"crossref","first-page":"100468","DOI":"10.1016\/j.ajogmf.2021.100468","article-title":"Placental histopathology after SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis","volume":"3","author":"Di Girolamo","year":"2021","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"1","key":"10.3233\/NPM-230177_ref16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13000-021-01067-6","article-title":"Placental pathology of the third trimester pregnant women from COVID-19","volume":"16","author":"Gao","year":"2021","journal-title":"Diagn Pathol"},{"issue":"1","key":"10.3233\/NPM-230177_ref17","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/PAS.0000000000001772","article-title":"SARS-CoV-2 and placental pathology: Malperfusion patterns are dependent on timing of infection during pregnancy","volume":"46","author":"Glynn","year":"2022","journal-title":"Am J Surg Pathol"},{"issue":"4","key":"10.3233\/NPM-230177_ref18","doi-asserted-by":"crossref","first-page":"100211","DOI":"10.1016\/j.ajogmf.2020.100211","article-title":"Histopathologic evaluation of placentas after diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection","volume":"2","author":"Gulersen","year":"2020","journal-title":"Am J Obstet Gynecol MFM"},{"key":"10.3233\/NPM-230177_ref19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ejogrb.2021.01.049","article-title":"COVID-19 as an independent risk factor for subclinical placental dysfunction","volume":"259","author":"Jaiswal","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"1","key":"10.3233\/NPM-230177_ref20","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1159\/000511324","article-title":"Placental Pathology Findings during and after SARS-CoV-2 Infection: Features of Villitis and Malperfusion","volume":"88","author":"Menter","year":"2021","journal-title":"Pathobiology"},{"key":"10.3233\/NPM-230177_ref21","doi-asserted-by":"crossref","first-page":"676870","DOI":"10.3389\/fmed.2021.676870","article-title":"SARS-CoV-2 Infection in pregnancy: Clinical Signs, placental pathology, and neonatal outcome-implications for clinical care","volume":"8","author":"Moresi","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"10.3233\/NPM-230177_ref22","doi-asserted-by":"crossref","first-page":"743022","DOI":"10.3389\/fimmu.2021.743022","article-title":"The effects of COVID-19 on the placenta during pregnancy","volume":"12","author":"Rad","year":"2021","journal-title":"Front Immunol"},{"issue":"5","key":"10.3233\/NPM-230177_ref23","doi-asserted-by":"crossref","first-page":"723","DOI":"10.3390\/v13050723","article-title":"SARS-CoV-2 and placenta: New insights and perspectives","volume":"13","author":"Resta","year":"2021","journal-title":"Viruses"},{"issue":"1","key":"10.3233\/NPM-230177_ref24","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1093\/ajcp\/aqaa089","article-title":"Placental pathology in COVID-19","volume":"154","author":"Shanes","year":"2020","journal-title":"Am J Clin Pathol"},{"key":"10.3233\/NPM-230177_ref25","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.placenta.2021.04.002","article-title":"Placental pathology in COVID-19 affected pregnant women: A prospective case-control study","volume":"110","author":"Tasca","year":"2021","journal-title":"Placenta"},{"issue":"7","key":"10.3233\/NPM-230177_ref26","doi-asserted-by":"crossref","first-page":"698","DOI":"10.5858\/arpa.2015-0225-CC","article-title":"Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement","volume":"140","author":"Khong","year":"2016","journal-title":"Arch Pathol Lab Med"},{"key":"10.3233\/NPM-230177_ref27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.placenta.2018.07.006","article-title":"Fetal-placental crosstalk occurs through fetal cytokine synthesis and placental clearance","volume":"69","author":"Mir","year":"2018","journal-title":"Placenta"},{"issue":"7","key":"10.3233\/NPM-230177_ref28","first-page":"533","article-title":"An immunologic basis for placental insufficiency in fetal growth restriction","volume":"29","author":"Greer","year":"2012","journal-title":"Am J Perinatol"},{"issue":"6","key":"10.3233\/NPM-230177_ref29","doi-asserted-by":"crossref","first-page":"849 e1","DOI":"10.1016\/j.ajog.2015.09.072","article-title":"Placental pathology is associated with severity of neonatal encephalopathy and adverse developmental outcomes following hypothermia","volume":"213","author":"Mir","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"7","key":"10.3233\/NPM-230177_ref30","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/S0046-8177(85)80159-3","article-title":"Clinical and pathologic aspects of recurrent placental villitis","volume":"16","author":"Redline","year":"1985","journal-title":"Hum Pathol"},{"issue":"Suppl A","key":"10.3233\/NPM-230177_ref31","doi-asserted-by":"crossref","first-page":"S114","DOI":"10.1016\/j.placenta.2005.02.009","article-title":"Placental diagnostic criteria and clinical correlation\u2013a workshop report","volume":"26","author":"Redline","year":"2005","journal-title":"Placenta"},{"key":"10.3233\/NPM-230177_ref32","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.placenta.2021.01.012","article-title":"SARS-CoV-2 placentitis: An uncommon complication of maternal COVID-19","volume":"104","author":"Linehan","year":"2021","journal-title":"Placenta"},{"issue":"5","key":"10.3233\/NPM-230177_ref33","doi-asserted-by":"crossref","first-page":"517","DOI":"10.5858\/arpa.2020-0771-SA","article-title":"Chronic histiocytic intervillositis with trophoblast necrosis is a risk factor associated with placental infection from coronavirus disease 2019 (COVID-19) and intrauterine maternal-fetal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in live-born and stillborn infants","volume":"145","author":"Schwartz","year":"2021","journal-title":"Arch Pathol Lab Med"},{"issue":"4","key":"10.3233\/NPM-230177_ref34","doi-asserted-by":"crossref","first-page":"382e1","DOI":"10.1016\/j.ajog.2020.10.020","article-title":"Coronavirus disease 2019 infection and placental histopathology in women delivering at term","volume":"224","author":"Patberg","year":"2021","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"10.3233\/NPM-230177_ref35","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.ajog.2020.05.023","article-title":"Visualization of severe acute respiratory syndrome coronavirus 2 invading the human placenta using electron microscopy","volume":"223","author":"Algarroba","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"10.3233\/NPM-230177_ref36","doi-asserted-by":"crossref","first-page":"648","DOI":"10.5858\/arpa.2020-0793-SA","article-title":"Histologic and immunohistochemical evaluation of 65 placentas from women with polymerase chain reaction-proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection","volume":"145","author":"Levitan","year":"2021","journal-title":"Arch Pathol Lab Med"},{"issue":"6","key":"10.3233\/NPM-230177_ref37","doi-asserted-by":"crossref","first-page":"e145427","DOI":"10.1172\/JCI145427","article-title":"Severe SARS-CoV-2 placenta infection can impact neonatal outcome in the absence of vertical transmission","volume":"131","author":"Cribi\u00f9","year":"2021","journal-title":"J Clin Invest"},{"issue":"12","key":"10.3233\/NPM-230177_ref38","doi-asserted-by":"crossref","first-page":"e2030455","DOI":"10.1001\/jamanetworkopen.2020.30455","article-title":"Assessment of maternal and neonatal SARS-CoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19 pandemic","volume":"3","author":"Edlow","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"5","key":"10.3233\/NPM-230177_ref39","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1002\/jmv.26857","article-title":"Being pregnant in the COVID-19 pandemic: Effects on the placenta in all aspects","volume":"93","author":"Seymen","year":"2021","journal-title":"J Med Virol"},{"key":"10.3233\/NPM-230177_ref40","doi-asserted-by":"crossref","first-page":"118676","DOI":"10.1016\/j.lfs.2020.118676","article-title":"Is highly expressed ACE 2 in pregnant women \u201ca curse\u201d in times of COVID-19 pandemic?","volume":"264","author":"Dhaundiyal","year":"2021","journal-title":"Life Sci"},{"issue":"3","key":"10.3233\/NPM-230177_ref41","doi-asserted-by":"crossref","first-page":"e14726","DOI":"10.14814\/phy2.14726","article-title":"SARS CoV-2 related microvascular damage and symptoms during and after COVID-19: Consequences of capillary transit-time changes, tissue hypoxia and inflammation","volume":"9","author":"\u00d8stergaard","year":"2021","journal-title":"Physiol Rep"},{"issue":"10234","key":"10.3233\/NPM-230177_ref42","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"}],"container-title":["Journal of Neonatal-Perinatal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/NPM-230177","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:43:44Z","timestamp":1777614224000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.medra.org\/servlet\/aliasResolver?alias=iospress&doi=10.3233\/NPM-230177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,15]]},"references-count":42,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3233\/npm-230177","relation":{},"ISSN":["1934-5798","1878-4429"],"issn-type":[{"value":"1934-5798","type":"print"},{"value":"1878-4429","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,15]]}}}