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

Date:
March 17, 2022
Source:
Northwestern University
Summary:
A small preliminary study has shown that a blood test may identify
risk of stillbirth and placentitis in pregnant individuals who have
had COVID- 19. The finding builds on another study with similar
results and could have implications in how physicians screen for
and address high-risk pregnancies.



FULL STORY ==========================================================================
A small preliminary study from Northwestern Medicine has shown that a
blood test may identify risk of stillbirth and placentitis in pregnant individuals who have had COVID-19. The finding builds on another study
with similar results and could have implications in how physicians screen
for and address high-risk pregnancies.


========================================================================== Research has shown pregnant people with COVID-19 have a higher risk
of stillbirths and other pregnancy complications. Anecdotal reports
have also reported potentially higher cases of stillbirths caused
by certain variants, leading to increased concern in the scientific
community. Scientists identified a link between COVID placentitis,
in which the virus infects the placenta, and these 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, illuminates
a link between placentitis and circulating SARS-CoV-2 virus.

"Right now, we don't know if there's placentitis until after the fact,"
said Northwestern's Dr. Leena Mithal, the paper's first author. "We're
laying groundwork for further studies so that in the future, people
who are diagnosed with COVID during pregnancy may be able to get a
test that will help identify pregnancies that may be at higher risk
of stillbirth or fetal distress." Mithal is an assistant professor of pediatric infectious diseases at Northwestern University Feinberg School
of Medicine and an attending physician at Ann & Robert H. Lurie Children's Hospital of Chicago. Dr. Jeffery Goldstein, the director of perinatal
pathology at Feinberg, led the study and is the corresponding author.

Placentitis affects between 1% and 2% of pregnant people infected with
COVID- 19. Unlike many pregnancy complications, the risk of placentitis
and stillbirth isn't linked to the severity of the virus. Dr. Elisheva
Shanes, a co- investigator of the study and assistant professor of
perinatal and autopsy pathology at Feinberg, said that makes predicting
which placentas are at risk next to impossible, because an asymptomatic infection could just as easily have complications as a very sick person.



========================================================================== Using a biorepository of blood taken from pregnant people during the
pandemic in 2020, the scientists looked at the blood of participants
who had tested positive for COVID-19 during pregnancy -- six who were
positive for placentitis and 12 controls who were not. Then, scientists
at the Center for Pathogen Genomics and Microbial Evolution looked for
RNA of the virus in maternal blood using the same PCR-based test 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 the people
with viremia had a stillbirth, and the other had a well infant; all participants who tested negative for the marker delivered healthy babies.

"The part of the placenta infected by the virus is also the part that's
in contact with maternal blood," Shanes said. "So if there's infection
in these cells, the virus may also be found in the blood. If a pregnant
person had COVID and no placentitis, we wouldn't expect to find virus
in the blood." Most pregnant patients with COVID-19 will go on to have
normal pregnancies.

Improved versions of this test and additional studies to validate the
finding could help obstetricians develop plans for those who are at
a high risk of placentitis and stillbirth, Shanes said. Investigators
plan to conduct follow- up studies with larger pools of participants and
hope other labs will build on the small body of literature to further
validate the findings.

The best way to protect both the parent and baby is to get vaccinated,
the authors said. In their observations, stillbirths have been more
common in unvaccinated patients.

"We don't know why viremia does or doesn't affect some people, but the
vaccine does seem to protect against severe complications," Mithal said.

The all-Northwestern team also includes Sebastian Otero, Lacy Simons,
Judd Hultquist, Emily Miller and Egon Ozer.

The study, "Low-level SARS-CoV-2 viremia coincident with COVID placentitis
and stillbirth," received support from Friends of Prentice, the Stanley
Manne Children's Research Institute and from institutional resources
supported by 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 Institute of Health (R21 AI163912, U19 AI135964).


========================================================================== Story Source: Materials provided by Northwestern_University. Original
written by Win Reynolds. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Leena B. Mithal, Sebastian Otero, Lacy M. Simons, Judd F. Hultquist,
Emily S. Miller, Egon A. Ozer, Elisheva D. Shanes, Jeffery
A. Goldstein.

Low-level SARS-CoV-2 viremia coincident with COVID
placentitis and stillbirth. Placenta, 2022; 121: 79 DOI:
10.1016/j.placenta.2022.03.003 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/03/220316173257.htm

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