An Immunological Perspective: What Happened to Pregnant Women After Recovering From COVID-19?

The coronavirus disease 2019 (COVID-19) pandemic has been raging around the world since January 2020. Pregnancy places the women in a unique immune scenario which may allow severe COVID‐19 disease. In this regard, the potential unknown effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on mothers and fetuses have attracted considerable attention. There is no clear consistent evidence of the changes in the immune status of pregnant women after recovery from COVID-19. In this study, we use multiparameter flow cytometry and Luminex assay to determine the immune cell subsets and cytokines, respectively, in the peripheral blood and umbilical cord blood from pregnant women recovering from COVID-19 about 3 months (n=5). Our results showed decreased percentages of Tc2, Tfh17, memory B cells, virus-specific NK cells, and increased percentages of naive B cells in the peripheral blood. Serum levels of IL-1ra and MCP-1 showed a decreased tendency in late recovery stage (LRS) patients. Meanwhile, there was no significant difference in immune cell subsets in the umbilical cord blood. The placentas from LRS patients showed increased CD68+ macrophages infiltration and mild hypoxic features. The inflammatory damage of the placenta may be related to the antiviral response. Since the receptors, ACE2 and TMPRSS2, utilized by SARS-CoV-2 are not co-expressed in the placenta, so it is extremely rare for SARS-CoV-2 to cause infection through this route and the impact on the fetus is negligible.

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P68 Proportion of iNKT cells in pregnant women with preeclampsia: an evaluation in peripheral blood, placenta and umbilical cord blood

Pregnancy Hypertension ◽

10.1016/s2210-7789(10)60234-6 ◽

2010 ◽

Vol 1 ◽

pp. S60

Author(s):

Leandro DeOliveira ◽

Marcos Cenedeze ◽

Rafael Larocca ◽

Nelson Sass ◽

Niels Olsen Câmara

Keyword(s):

Cord Blood ◽

Pregnant Women ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Peripheral Blood ◽

Inkt Cells

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Delayed Umbilical Cord Clamping at <32 Weeks' Gestation: Implementation and Outcomes

American Journal of Perinatology ◽

10.1055/s-0037-1603591 ◽

2017 ◽

Vol 34 (11) ◽

pp. 1048-1053

Author(s):

Tatiana Bierut ◽

Shayna Conner ◽

Methodius Tuuli ◽

Zachary Vesoulis ◽

George Macones ◽

...

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Blood Gases ◽

Maternal Outcomes ◽

Blood Gas ◽

Cord Clamping ◽

Significant Difference ◽

Umbilical Cord Clamping ◽

The Impact

Objectives This study aims to evaluate the implementation of a delayed umbilical cord clamping (DCC) protocol for neonates <32 weeks. Secondarily, to evaluate the impact of DCC on maternal outcomes and on the ability to obtain umbilical cord blood gases. Study Design Retrospective cohort study from November 2014 to March 2016 of patients delivered by 316/7 weeks. In 2014, an institutional protocol for DCC at <32 weeks was implemented. We assessed adherence to the protocol and compared adverse maternal outcomes (utilizing a hemorrhage composite). We evaluated the impact of DCC on the ability to obtain adequate umbilical cord blood gas specimens. Results Of the 185 patients included in the study, 90 underwent DCC, and 72% of potentially eligible patients appropriately received DCC. There was no significant difference in the maternal hemorrhage composite outcome between DCC and immediate cord clamping (23.3 vs. 36.8%, adjusted odds ratio = 0.64, 95% confidence interval = 0.33, 1.26). There was also no significant difference in the ability to obtain a single or paired umbilical cord blood gas result. Conclusion Implementation of a DCC protocol for preterm neonates is feasible and was successful. We did not find an increase in maternal risk or a decrease in the ability to obtain umbilical cord blood gases following DCC.

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Proportion of Invariant NKT Cells in Normal Pregnant Women at Term: an Evaluation in Peripheral Blood, Placenta and Umbilical Cord Blood

American Journal of Reproductive Immunology ◽

10.1111/j.1600-0897.2010.00915.x ◽

2010 ◽

Vol 65 (1) ◽

pp. 11-12 ◽

Cited By ~ 4

Author(s):

Leandro De Oliveira ◽

Rafael Larocca ◽

Nelson Sass ◽

Niels Olsen S. Câmara

Keyword(s):

Cord Blood ◽

Pregnant Women ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Peripheral Blood ◽

Nkt Cells ◽

Invariant Nkt Cells

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IN−UTERO MOTHER−TO−CHILD SARS−CoV−2 TRANSMISSION: viral detection and fetal immune response

10.1101/2020.07.09.20149591 ◽

2020 ◽

Cited By ~ 1

Author(s):

Claudio Fenizia ◽

Mara Biasin ◽

Irene Cetin ◽

Patrizia Vergani ◽

Davide Mileto ◽

...

Keyword(s):

Inflammatory Response ◽

Cord Blood ◽

Pregnant Women ◽

Umbilical Cord ◽

Vertical Transmission ◽

Umbilical Cord Blood ◽

In Utero ◽

Vaginal Mucosa ◽

Cord Plasma ◽

The Impact

Pregnancy is known to increase the risk of severe illnesses in response to viral infections. Therefore, the impact of SARS−CoV−2 infection during gestational ages might be detrimental and the potential vertical transmission should be thoroughly studied. Herein, we investigated whether SARS−CoV−2 vertical transmission is possible and, in case, whether this results in a fetal involvement. Additionally, we analyzed the role of the antibody and the inflammatory responses in placenta and plasma from SARS−CoV−2−positive pregnant women and fetuses. 31 SARS−CoV−2 pregnant women were enrolled. Real−time PCR was performed to detect the virus on maternal and newborns nasopharyngeal swabs, vaginal swabs, maternal and umbilical cord plasma, placenta and umbilical cord biopsies, amniotic fluids and milk. Maternal and umbilical cord plasma, and milk were tested for specific anti−SARS−CoV−2 antibodies. RNA expression quantification of genes involved in the inflammatory response was performed on four selected placentas. On maternal and umbilical cord plasma of the same subjects, secreted cytokines/chemokines were quantified. SARS−CoV−2 is found in at-term placentae and in the umbilical cord blood, in the vaginal mucosa of pregnant women and in milk. Furthermore, we report the presence of specific anti−SARS−CoV-2 IgM and IgG antibodies in the umbilical cord blood of pregnant women, as well as in milk specimens. Finally, a specific inflammatory response is triggered by SARS−CoV−2 infection in pregnant women at both systemic and placental level, and in umbilical cord blood plasma. Our data strongly support the hypothesis that in−utero vertical transmission is possible in SARS−CoV−2 positive pregnant women. This is essential for defining proper obstetric management of COVID−19 pregnant women, or putative indications for mode and timing of delivery.

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In-Utero Mother-to-Child SARS-CoV-2 Transmission: Viral Detection and Fetal Immune Response

10.21203/rs.3.rs-45729/v1 ◽

2020 ◽

Author(s):

Claudio Fenizia ◽

Mara Biasin ◽

Irene Cetin ◽

Patrizia Vergani ◽

Davide Mileto ◽

...

Keyword(s):

Inflammatory Response ◽

Cord Blood ◽

Pregnant Women ◽

Umbilical Cord ◽

Vertical Transmission ◽

Umbilical Cord Blood ◽

In Utero ◽

Vaginal Mucosa ◽

Cord Plasma ◽

The Impact

Abstract Pregnancy is known to increase the risk of severe illnesses in response to viral infections. Therefore, the impact of SARS-CoV-2 infection during gestational ages might be detrimental and the potential vertical transmission should be thoroughly studied.Herein, we investigated whether SARS-CoV-2 vertical transmission is possible and, in case, whether this results in a fetal involvement. Additionally, we analyzed the role of the antibody and the inflammatory responses in placenta and plasma from SARS-CoV-2-positive pregnant women and fetuses.31 SARS-CoV-2 pregnant women were enrolled. Real-time PCR was performed to detect the virus on maternal and newborns’ nasopharyngeal swabs, vaginal swabs, maternal and umbilical cord plasma, placenta and umbilical cord biopsies, amniotic fluids and milk. Maternal and umbilical cord plasma, and milk were tested for specific anti-SARS-CoV-2 antibodies. RNA expression quantification of genes involved in the inflammatory response was performed on four selected placentas. On maternal and umbilical cord plasma of the same subjects, secreted cytokines/chemokines were quantified.SARS-CoV-2 is found in at-term placentae and in the umbilical cord blood, in the vaginal mucosa of pregnant women and in milk. Furthermore, we report the presence of specific anti-SARS-CoV-2 IgM and IgG antibodies in the umbilical cord blood of pregnant women, as well as in milk specimens. Finally, a specific inflammatory response is triggered by SARS-CoV-2 infection in pregnant women at both systemic and placental level, and in umbilical cord blood plasma.Our data strongly support the hypothesis that in-utero vertical transmission is possible in SARS-CoV-2 positive pregnant women. This is essential for defining proper obstetric management of COVID-19 pregnant women, or putative indications for mode and timing of delivery.

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Biomarkers for a histological chorioamnionitis diagnosis in pregnant women with or without group B streptococcus infection: a case-control study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03731-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jie Ren ◽

Zhe Qiang ◽

Yuan-yuan Li ◽

Jun-na Zhang

Keyword(s):

Cord Blood ◽

Pregnant Women ◽

Peripheral Blood ◽

Group B Streptococcus ◽

Diagnostic Value ◽

Adverse Outcomes ◽

Intercellular Adhesion Molecule ◽

Tnf Α ◽

Group B ◽

The Impact

Abstract Background Chorioamnionitis may cause serious perinatal and neonatal adverse outcomes, and group B streptococcus (GBS) is one of the most common bacteria isolated from human chorioamnionitis. The present study analyzed the impact of GBS infection and histological chorioamnionitis (HCA) on pregnancy outcomes and the diagnostic value of various biomarkers. Methods Pregnant women were grouped according to GBS infection and HCA detection. Perinatal and neonatal adverse outcomes were recorded with a follow-up period of 6 weeks. The white blood cell count (WBC), neutrophil ratio, and C-reactive protein (CRP) level from peripheral blood and soluble intercellular adhesion molecule-1 (sICAM-1), interleukin 8 (IL-8), and tumor necrosis factor α (TNF-α) levels from cord blood were assessed. Results A total of 371 pregnant women were included. Pregnant women with GBS infection or HCA had a higher risk of pathological jaundice and premature rupture of membranes and higher levels of sICAM-1, IL-8, and TNF-α in umbilical cord blood. Univariate and multivariate regression analysis revealed that sICMA-1, IL-8, TNF-α, WBC, and CRP were significantly related to an increased HCA risk. For all included pregnant women, TNF-α had the largest receiver operating characteristic (ROC) area (area: 0.841; 95% CI: 0.778–0.904) of the biomarkers analyzed. TNF-α still had the largest area under the ROC curve (area: 0.898; 95% CI: 0.814–0.982) for non-GBS-infected pregnant women, who also exhibited a higher neutrophil ratio (area: 0.815; 95% CI: 0.645–0.985) and WBC (area: 0.849; 95% CI: 0.72–0.978), but all biomarkers had lower value in the diagnosis of HCA in GBS-infected pregnant women. Conclusion GBS infection and HCA correlated with several perinatal and neonatal adverse outcomes. TNF-α in cord blood and WBCs in peripheral blood had diagnostic value for HCA in non-GBS-infected pregnant women but not GBS-infected pregnant women.

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