Blood test may indicate higher risk pregnancies in patients with COVID-19: Once developed, test could improve care of COVID-19 in pregnancies

A small preliminary study from Northwestern Medicine has shown that a blood test can identify an increased risk of stillbirth and placentitis in pregnant individuals who have had COVID-19. The finding is based on another study with similar results and could have implications for how clinicians screen for and address high-risk pregnancies.

Research has shown that pregnant people with COVID-19 have a higher risk of stillbirth and other pregnancy complications. Anecdotal reports have also reported potentially higher cases of stillbirths caused by certain types, raising concern in the scientific community. Scientists have identified a link between COVID placentitis, in which the virus infects the placenta, and poor outcomes, but can only diagnose instances of placentitis after delivery by examining the placenta.

The new paper, published this week in the journal PLACENTA, sheds light on a link between placentitis and the circulating SARS-CoV-2 virus.

“Right now, we don’t know whether there is placentitis until after the fact,” said Northwestern’s Dr. Lena Mithal, the paper’s first author. “We are laying the groundwork for further studies so that in the future, people who have been diagnosed with COVID during pregnancy may be able to receive a test that will help identify pregnancies that are stillbirths.” Or the fetus may be at higher risk of distress.”

Mittal is an assistant professor of pediatric infectious diseases at Northwestern University Feinberg School of Medicine and the Ann and Robert H. Lurie is an attending physician at Children’s Hospital. Dr. Jeffrey Goldstein, director of perinatal pathology at Feinberg, led the study and is the corresponding author.

Placenitis affects 1% to 2% of pregnant people infected with COVID-19. Unlike many complications of pregnancy, the risk of placentitis and stillbirth is not associated with the severity of the virus. Study co-investigator and assistant professor of perinatal and autopsy pathology at Feinberg, Dr. Elisheva Shanes said that making predicting which placentas are at risk is next to impossible, because an asymptomatic infection can very easily lead to complications in the form of a very sick person.

Using a biorepository of blood taken from people who were pregnant during the pandemic in 2020, scientists looked at the blood of participants who had tested positive for COVID-19 during pregnancy – six who were positive for the placenta and 12 controls that were not. Then, scientists from the Center for Pathogen Genomics and Microbial Evolution looked for the virus’s RNA in maternal blood using the same PCR-based test that is usually performed on nasal swabs.

Of those who had placentitis, two had low levels of viral RNA (called viremia) in their blood; None of the controls did. One of those with viremia was born stillborn, and the other had a healthy baby; All participants who tested negative for the marker went on to give birth to healthy babies.

“The virus-infected part of the placenta is also the part that is in contact with maternal blood,” Shen said. “So if there is an infection in these cells, the virus can be found in the blood as well. If a pregnant person has covid and does not have placentitis, we would not expect to find the virus in the blood.”

Most pregnant patients with COVID-19 will have a normal pregnancy. An improved version of this test and additional studies to validate the finding could help obstetricians develop plans for people who are at high risk of placentitis and stillbirth, Shen said. The investigators plan to conduct follow-up studies with larger pools of participants and hope that other laboratories will build on the smaller body of literature to further validate the findings.

The authors said the best way to protect both the parent and the child is through vaccination. In his observations, stillbirth has been more common in unvaccinated patients.

“We don’t know why viremia affects some people or not, but the vaccine protects against serious complications,” Mithal said.

The All-Northwestern team also includes Sebastian Otero, Lacey Simmons, Judd Haltquist, Emily Miller and Egon Ozer.

The study, “Low-Level SARS-CoV-2 Viremia Combining COVID with Placentitis and Stillbirth,” received support from institutional resources supported by Friends of Prentice, the Stanley Mann Children’s Research Institute and the National Center for Advancing Translational Sciences (UL1TR001422). , The team is also supported by the National Institute of Biomedical Imaging and Bioengineering (K08EB030120), the National Institute of Allergy and Infectious Diseases (K23AI139337), and the National Institutes of Health (R21 AI163912, U19 AI135964).

Story Source:

Material provided by Northwestern University, Original written by Vin Reynolds. Note: Content can be edited for style and length.

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