Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Placental Histopathological Changes and the Level of Anti-Spike Antibody After Covid-19 Vaccination During Pregnancy: A Case Series

Authors
Zohreh Heidary 1
Omid Kohandel Gargari 2
Majid Zaki-Dizaji 3
Arman Shafiee 2
Haniyeh Fathi
Roya Saeednejad 4
Marjan Ghaemi 1
Sedigheh Hantoushzadeh 1
1 Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
2 Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
3 Human Genetics Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
4 Irman Pathobiology Laboratory, Tehran, Iran
10.18502/jri.v25i3.17018
Abstract
Background: COVID-19 infection during pregnancy could be associated with placental histopathological changes such as vascular diseases and malperfusion. There are studies showing that mRNA vaccines are not associated with significant placental pathological changes. Our objective was to evaluate the placental histopathology in pregnant women who received Sinopharm, an inactivated virus vaccine, during pregnancy. Case Presentation: The study included placental samples collected from mothers who gave birth of living singletons through elective cesarean sections performed between March 2022 and May 2022 at Imam Khomeini Hospital Complex. The study included women who had no history of positive reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 during pregnancy, and had received at least one dose of COVID-19 vaccine during their pregnancy. Humoral levels of anti-SARS-CoV-2 spike IgG were measured in both the mothers and neonates. Results: The study included 20 mother-neonate pairs. The mean maternal age was 34±3.6 years, and all mothers received Sinopharm vaccine as their first and second doses. The last vaccine dose was administered during pregnancy, with 3 mothers receiving it in the first trimester, 9 in the second trimester, and 8 in the third trimester. The histopathological findings in the placental samples included decidual vasculopathy, subchorionic thrombosis, and chronic histiocytic intervillositis. All mothers and neonates, except one pair, were positive for anti-spike antibody. Conclusion: Multiple abnormal histopathological findings were reported in placenta of vaccinated mothers. However, similar to previous studies, these placental findings are considered mild lesions and have been observed in both vaccinated and unvaccinated mothers.
Keywords
COVID
19
placenta
SARS
CoV
2
sinopharm
Vaccine
Kumari K, Yadav R, Mittra S, Kumar A, Singh J, Bajpai PK, et al. Pregnancy consequences and vertical transmission potential of SARS-CoV-2 infection: seeking answers from a preliminary observation. J Reprod Infertil. 2021;22(2):144-7.
Heidary Z, Kohandel Gargari O, Fathi H, Zaki-Dizaji M, Ghaemi M, Hossein Rashidi B. Maternal and neonatal complications, outcomes and possibility of vertical transmission in Iranian women with COVID-19. Arch Iran Med. 2021;24(9):713-21.
Kumar D, Verma S, Mysorekar IU. COVID-19 and pregnancy: clinical outcomes; mechanisms, and vaccine efficacy. Transl Res. 2023;251:84-95.
Schwartz DA, Mulkey SB, Roberts DJ. SARS-CoV-2 placentitis, stillbirth, and maternal COVID-19 vaccination: clinical-pathologic correlations. Am J Obstet Gynecol. 2023;228(3):261-9.
Boelig RC, Aghai ZH, Chaudhury S, Kazan AS, Chan JSY, Bergmann-Leitner E. Impact of COVID-19 disease and COVID-19 vaccination on maternal or fetal inflammatory response, placental pathology, and perinatal outcomes. Am J Obstet Gynecol. 2022;227(4):652-6.
Leal CRV, Maciel RAM, Corrêa Júnior MD. SARS-CoV-2 infection and placental pathology. Rev Bras Ginecol Obstet. 2021;43(6):474-9.
Shanes ED, Otero S, Mithal LB, Mupanomunda CA, Miller ES, Goldstein JA. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in pregnancy: measures of immunity and placental histopathology. Obstet Gynecol. 2021;138(2):281-3.
Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebo T, Panagiotakopoulos L, et al. Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. N Engl J Med. 2021;384(24):2273-82.
Levine-Tiefenbrun M, Yelin I, Katz R, Herzel E, Golan Z, Schreiber L, et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med. 2021;27(5):790-2.
Mohamed K, Rzymski P, Islam MS, Makuku R, Mushtaq A, Khan A, et al. COVID-19 vaccinations: the unknowns, challenges, and hopes. J Med Virol. 2022;94(4):1336-49.
Shook LL, Atyeo CG, Yonker LM, Fasano A, Gray KJ, Alter G, et al. Durability of anti-spike antibodies in infants after maternal COVID-19 vaccination or natural infection. JAMA. 2022;327(11):1087-9.
Khong TY, Mooney EE, Ariel I, Balmus NC, Boyd TK, Brundler MA, et al. Sampling and definitions of placental lesions: amsterdam placental workshop group consensus statement. Arch Pathol Lab Med. 2016;140(7):698-713.
Arab M, Noei Teymoordash S, Talayeh M, Ghavami B, Javadi A, Nouri B. Evaluation of serologic changes of IgG and IgM antibodies associated with SARS-COV-2 in cancer patients: a cohort seroprevalence study. Asian Pac J Cancer Prev. 2021;22(6):1667-70.
Balou HA, Yaghubi Kalurazi T, Joukar F, Hassanipour S, Shenagari M, Khoshsorour M, et al. High seroprevalence of SARS-CoV-2 (COVID-19)-specific antibodies among healthcare workers: a cross-sectional study in Guilan, Iran. J Environ Public Health. 2021;2021:9081491.
Akhavan S, Borna S, Abdollahi A, Shariat M, Zamani N. Pathologic examination of the placenta and its benefits in treatment plan or follow-up of patients: a cross-sectional study. Eur J Med Res. 2022;27(1):113.
Singh N, Buckley T, Shertz W. Placental pathology in COVID-19: case series in a community hospital setting. Cureus. 2021;13(1):e12522.
Arcos Júnior GF, Francisco RPV, Kill B, Peres SV, Gibelli M, Ibidi SM, et al. Placental pathological findings in coronavirus disease 2019: perinatal outcomes. Placenta. 2022;128:23-8.
Al-Rawaf SA, Mousa ET, Kareem NM. Correlation between pregnancy outcome and olacental oathology in COVID-19 oregnant women. Infect Dis Obstet Gynecol. 2022;2022:8061112.
Gulersen M, Prasannan L, Tam Tam H, Metz CN, Rochelson B, Meirowitz N, et al. Histopathologic evaluation of placentas after diagnosis of maternal severe acute respiratory syndrome coronavirus 2 infection. Am J Obstet Gynecol MFM. 2020;2(4):100211.
Motwani R, Deshmukh V, Kumar A, Kumari C, Raza K, Krishna H. Pathological involvement of placenta in COVID-19: a systematic review. Infez Med. 2022;30(2):157-67.
Suhren JT, Meinardus A, Hussein K, Schaumann N. Meta-analysis on COVID-19-pregnancy-related placental pathologies shows no specific pattern. Placenta. 2022;117:72-7.
Prasad S, Kalafat E, Blakeway H, Townsend R, O'Brien P, Morris E, et al. Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy. Nat Commun. 2022;13(1):2414.
Jeewandara C, Jayampathi KCS, Ranasinghe T, Aberathna IS, Gunasekara B, Danasekara S, et al. Antibody responses to Sinopharm/BBIBP-CorV in pregnant mothers in Sri Lanka. PLOS Glob Public Health. 2022;2(7):e0000607.
Sunder A, Alqatari HM, Taha OE, Keshta MS, Bughamar FK, Darwish B. COVID-19 vaccinations in pregnancy: save mother and baby from COVID-19 pandemic. Int J Gynaecol Obstet. 2022;160(3):864-73.
Smithgall MC, Murphy EA, Schatz-Siemers N, Matrai C, Tu J, Baergen RN, et al. Placental pathology in women vaccinated and unvaccinated against SARS-CoV-2. Am J Obstet Gynecol. 2022;227(5):782-4.
Mohd Ariff NS, Abdul Halim Zaki I, Mohd Noordin Z, Md Hussin NS, Goh KW, Ming LC, et al. A review of the prevalence of thromboembolic complications among pregnant women infected with COVID-19. J Clin Med. 2022;11(19):5934.
Carbonnel M, Daclin C, Tourne M, Roux E, Le-Marchand M, Racowsky C, et al. Impact of COVID-19 on subclinical placental thrombosis and maternal thrombotic factors. J Clin Med. 2022;11(14):4067.
Fung TY, To KF, Sahota DS, Chan LW, Leung TY, Lau TK. Massive subchorionic thrombohematoma: a series of 10 cases. Acta Obstet Gynecol Scand. 2010;89(10):1357-61.
Miyagi M, Kinjo T, Mekaru K, Nitta H, Masamoto H, Aoki Y. Massive subchorionic thrombohematoma (Breus' Mole) associated with fetal growth restriction, oligohydramnios, and intrauterine fetal death. Case Rep Obstet Gynecol. 2019;2019:9510936.
Mattuizzi A, Sauvestre F, André G, Poingt M, Camberlein C, Carles D, et al. Adverse perinatal outcomes of chronic intervillositis of unknown etiology: an observational retrospective study of 122 cases. Sci Rep. 2020;10(1):12611.
Schwartz DA, Baldewijns M, Benachi A, Bugatti M, Collins RRJ, De Luca D, et al. 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. Arch Pathol Lab Med. 2021;145(5):517-28.
Rebutini PZ, Zanchettin AC, Stonoga ETS, Prá DMM, de Oliveira ALP, Dezidério FDS, et al. Association between COVID-19 pregnant women symptoms severity and placental morphologic features. Front Immunol. 2021;12:685919.
Marton T, Hargitai B, Hunter K, Pugh M, Murray P. Massive perivillous fibrin deposition and chronic histiocytic intervillositis a complication of SARS-CoV-2 infection. Pediatr Dev Pathol. 2021;24(5):450-4.
Romero R, Kim YM, Pacora P, Kim CJ, Benshalom-Tirosh N, Jaiman S, et al. The frequency and type of placental histologic lesions in term pregnancies with normal outcome. J Perinat Med. 2018;46(6):613-30.
Journal of Reproduction & Infertility
Volume 25, Issue 3
Summer 2024
Pages 231-237