The extent to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at different points in the pregnancy timeline may affect maternal and fetal outcomes remains unknown. We sought to characterize the impact of SARS-CoV-2 infection proximate and remote from delivery on placental pathology. We performed a secondary analysis of placental pathology from a prospective cohort of universally tested SARS-CoV-2 positive women >20 weeks gestation at 1 institution. Subjects were categorized as having acute or nonacute SARS-CoV-2 based on infection <14 or ≥14 days from delivery admission, respectively, determined by nasopharyngeal swab, symptom history, and serologies, when available. A subset of SARS-CoV-2 negative women represented negative controls. Placental pathology was available for 90/97 (92.8%) of SARS-CoV-2 positive women, of which 26 were from women with acute SARS-CoV-2 infection and 64 were from women with nonacute SARS-CoV-2. Fetal vascular malperfusion lesions were significantly more frequent among the acute SARS-CoV-2 group compared with the nonacute SARS-CoV-2 group (53.8% vs. 18.8%; P=0.002), while frequency of maternal vascular malperfusion lesions did not differ by timing of infection (30.8% vs. 29.7%; P>0.99). When including 188 SARS-CoV-2 negative placentas, significant differences in frequency of fetal vascular malperfusion lesions remained between acute, nonacute and control cases (53.8% vs. 18.8% vs. 13.2%, respectively; P<0.001). No differences were noted in obstetric or neonatal outcomes between acutely and nonacutely infected women. Our findings indicate timing of infection in relation to delivery may alter placental pathology, with potential clinical implications for risk of thromboembolic events and impact on fetal health.

中文翻译：

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SARS-CoV-2 和胎盘病理学：灌注不良模式取决于怀孕期间的感染时间。

妊娠期间不同时间点的严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染对母婴结局的影响程度仍不清楚。我们试图描述临近分娩和远离分娩的 SARS-CoV-2 感染对胎盘病理学的影响。我们对 1 个机构中妊娠 20 周以上的 SARS-CoV-2 阳性女性的前瞻性队列进行了胎盘病理学的二次分析。根据入院后 14 天或≥14 天的感染情况，根据鼻咽拭子、症状史和血清学（如果有）确定，受试者被分为急性或非急性 SARS-CoV-2。一部分 SARS-CoV-2 阴性女性代表阴性对照。90/97 (92.8%) 的 SARS-CoV-2 阳性女性可获得胎盘病理学检查，其中 26 名来自患有急性 SARS-CoV-2 感染的女性，64 名来自患有非急性 SARS-CoV-2 的女性。与非急性 SARS-CoV-2 组相比，急性 SARS-CoV-2 组胎儿血管灌注不良病变的发生率显着更高（53.8% vs. 18.8%；P=0.002），而母体血管灌注不良病变的发生率没有差异按感染时间划分（30.8% vs. 29.7%；P>0.99）。当纳入 188 个 SARS-CoV-2 阴性胎盘时，急性、非急性和对照病例之间胎儿血管灌注不良病变的发生率仍存在显着差异（分别为 53.8% vs. 18.8% vs. 13.2%；P<0.001）。急性和非急性感染妇女的产科或新生儿结局没有差异。我们的研究结果表明，与分娩相关的感染时间可能会改变胎盘病理学，对血栓栓塞事件的风险和对胎儿健康的影响具有潜在的临床意义。