These maternal infections caused seizures, developmental delays, and other health issues in two newborns.
Investigators at the University of Miami Health System and the University of Miami Miller School of Medicine confirmed 2 cases in which SARS-CoV-2 breached the mothers’ placentas and caused brain damage in both neonates.
Both infants had tested negative for SARS-CoV-2 at birth, but had significantly elevated virus antibodies detectable in their blood, indicating that either antibodies crossed the placenta, or passage of the virus occurred and the immune response was the baby’s. Both infants experienced seizures, small head sizes, and developmental delays. In one of the cases, the baby expired at 13 months of age.
“We’re trying to understand what made these two pregnancies different, so we can direct research towards protecting vulnerable babies.” said Shahnaz Duara, MD, professor of pediatrics at the University of Miami Miller School of Medicine, the medical director of the NICU at Holtz Children’s Hospital, and senior author on the study.
The investigators published their results in Pediatrics. According to the authors, this is the first study to confirm cross-placental SARS-CoV-2 transmission leading to brain injury in the newborn.
“Many women are affected by COVID-19 during pregnancy, but to see these kinds of problems in their infants at birth was clearly unusual,” Duara stated.
“We believe the extensive placental changes are sufficient to explain at least the initial neurologic presentation of both infants,” the authors wrote. “The placental histologic findings of thrombosis, loss of stromal vessels, and apoptosis are associated with maternal-fetal vascular malperfusion, placental ischemia, and insufficiency, which result in deterioration of placental function.”
“Our cases demonstrate that midtrimester maternal SARS-CoV- 2 infection can infect the placenta and fetal or infant brain and trigger a cascade of inflammatory events in both placenta and fetus,” the authors wrote. “This may be associated with major brain injury and progressive neurologic sequelae in infants beyond the neonatal period.”
With these findings, Duara says it is important to remain vigilant during pregnancy but she says it is equally as important to not create a panic in the general public. This is more a reminder that for pregnant mothers and their clinicians to take precautions.
“It’s important to get the message out that [COVID-19 infection] is not always benign,” Duara said in a press conference. “…Vaccinations will afford some protection for pregnancy, and there is an urgent need to develop therapeutics for out vulnerable populations like expectant mothers, children and elderly.”
For concerned parents, the authors recommend not only maternal pre- or pregnancy maternal COVID-19 vaccination as the first line of defense, but breastfeeding, as well as masking if actively infected.
In conclusion, they stressed the limitations of current monitoring and need to learn more about this phenomenon.
"Our cases also highlight the shortcomings of current fetal monitoring for assessment of fetal well-being, especially when the target of injury is the fetal brain. Future longitudinal studies are needed to study the impact of timing of in utero SARS-CoV-2 infection on placental inflammation, as well as the long-term consequences on the developing brain,” the authors wrote.