Details of Ethics Approval:
The study was approved by the Medical Ethics Committee of the Union
Hospital, TongJi Medical College of HuaZhong University of Science and
Technology [2020, NO. 0144]. Written informed consent was obtained
from the patients before enrolment and when data were collected.
Funding
Our study has been funded by the National Natural Science Foundation of
China, Hubei Provincial Natural Science Foundation of China.
References
1. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with
Pneumonia in China, 2019. N Engl J Med 2020.
2. Chen L, Li Q, Zheng D, et al. Clinical Characteristics of Pregnant
Women with Covid-19 in Wuhan, China. N Engl J Med 2020.
3. Sutton D, Fuchs K, D’Alton M, Goffman D. Universal Screening for
SARS-CoV-2 in Women Admitted for Delivery. N Engl J Med 2020;382 (22): 2163-4.
4. Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effects of
coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal
outcomes: a systematic review. Ultrasound Obstet Gynecol 2020.
5. Yan J, Guo J, Fan C, et al. Coronavirus disease 2019 (COVID-19) in
pregnant women: A report based on 116 cases. Am J Obstet Gynecol2020.
6. Dong L, Tian J, He S, et al. Possible Vertical Transmission of
SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA 2020.
7. Zeng H, Xu C, Fan J, et al. Antibodies in Infants Born to Mothers
With COVID-19 Pneumonia. JAMA 2020.
8. Kimberlin DW, Stagno S. Can SARS-CoV-2 Infection Be Acquired In
Utero?: More Definitive Evidence Is Needed. JAMA 2020.
9. Chen Shuo HB, Luo Danju, Li Xiang, Yang Fan, Zhao Yin, Nie Xiu, Huang
Bangxing. Pregnant women with new coronavirus infection: a clinical
characterics and placental pathological analysis of three cases.hin J Pathol, 2020,49:Epub ahead of print DOI:
103760/cmajcn112151-20200225-00138 .
10. Clinical management of severe acute respiratory infection when novel
coronavirus (2019-nCoV) infection is suspected: interim
guidance, 28 January 2020https://apps.who.int/iris/handle/10665/330893.
11. Chinese Clinical Guidance for Covid-19 Pneumonia Diagnosis and
Treatment 7th.
(http://www.gov.cn/zhengce/zhengceku/2020-03/04/5486705/files/ae61004f930d47598711a0d4cbf874a9.pdf).
12. Huang C, Wang Y, Li X, et al. Clinical features of patients infected
with 2019 novel coronavirus in Wuhan, China. Lancet 2020.
13. Laurini R, Laurin J, Marsal K. Placental histology and fetal blood
flow in intrauterine growth retardation. Acta Obstet Gynecol
Scand 1994; 73 (7): 529-34.
14. Ge XY, Li JL, Yang XL, et al. Isolation and characterization of a
bat SARS-like coronavirus that uses the ACE2 receptor. Nature2013; 503 (7477): 535-8.
15. Li Y, Zhou W, Yang L, You R. Physiological and pathological
regulation of ACE2, the SARS-CoV-2 receptor. Pharmacol Res 2020;157 : 104833.
16. Kai H, Kai M. Interactions of coronaviruses with ACE2, angiotensin
II, and RAS inhibitors-lessons from available evidence and insights into
COVID-19. Hypertens Res 2020.
17. Jing Y, Run-Qian L, Hao-Ran W, et al. Potential influence of
COVID-19/ACE2 on the female reproductive system. Mol Hum Reprod2020.
18. Lamers MM, Beumer J, van der Vaart J, et al. SARS-CoV-2 productively
infects human gut enterocytes. Science 2020.
19. Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2
expression of maternal-fetal interface and fetal organs by single-cell
transcriptome study. PLoS One 2020; 15 (4): e0230295.
20. Lamouroux A, Attie-Bitach T, Martinovic J, Leruez-Ville M, Ville Y.
Evidence for and against vertical transmission for SARS-CoV-2
(COVID-19). Am J Obstet Gynecol 2020.
21. Wang S, Guo L, Chen L, et al. A case report of neonatal COVID-19
infection in China. Clin Infect Dis 2020.
Figure Legend
Fig 1. Chest CT image of the cases.
A1, B1, C1 were the CT scanning images of pregnant women complicated
with COVID-19. Multiple or scattered membranous glass density
shadows/dense porphyry shadows surrounding the parenchyma of both lungs
could be seen at the onset of Covid-19, which indicated the possibility
of viral pneumonia is high. A2,C2 were the CT image which showed lesions
in lung were improved after being treated for 7 days. A3, B2, C3 were
the CT image at the time before delivery, no obvious abnormality was
observed.
Fig 2. Pathological findings of placental tissue
Case A : Pregnant woman of 24weeks complicated with Covid-19, and
delivered at 40 weeks. Placental chronic ischemia was shown : presence
of multiple placental calcifications (black arrow) and dense small villi
with increased syncytial knots (blue arrow) . (1: HE ×40, 2: ×100)
Case B: Pregnant woman of 26 weeks complicated with COVID-19, and
delivered at 35 weeks. Placental chronic infarct was seen at the
maternal side (40 times magnification) . In the middle part of the
placenta, normal villi structure could be seen. (100 times
magnification).
Case C: Pregnant woman of 6 weeks complicated with COVID-19, and the
pregnancy was terminated at 12 weeks. Part of the villous was edema and
fibrosis (Arrow) (40 times).” No definite thrombosis was found.
Case D: Pregnant women of 38 weeks who was serum IgG positive
asymptomatic case. Chronic placental ischemia infarction could be seen.
(1: HE ×40, 2: ×100).
Fig 3. Representative ACE2 Immunohistochemical staining in placenta.
ACE2 was positive in both villi and decidua, which was mainly expressed
in membrane and cytoplasm. It expressed stronger in 12 weeks (Case C) (×
100 times). ACE2 evaluation criteria: the area quartering method was 1,
2, 3 and 4 scores, and the staining intensity was 1 (weak), 2 (medium)
and 3 (strong), respectively. The total scores were area scores multiply
staining intensity scores.