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Abstract

Background

The impact of SARS-CoV-2 on pregnancy outcomes is unclear, but evidence suggests increased perinatal loss due to placental damage and fetal oxygen deprivation.

Objective

This study compared placental findings and fetal outcomes between pre-COVID-19 and COVID-19 periods to assess the association between COVID-19 and abnormal placental pathology and fetal complications. It was hypothesized that COVID-19-positive pregnancies would have higher rates of intrauterine fetal demise and fetal growth restriction due to virus-induced placental injury.

Study Design

A retrospective analysis of 34,102 deliveries compared placental and fetal outcomes across two periods: pre-COVID-19 (April 1, 2018–September 30, 2019) and COVID-19 (April 1, 2020–September 30, 2021), with a washout period in between. Placental abnormalities (chorangiosis, chorioamnionitis, and villitis) and fetal outcomes (fetal growth restriction and intrauterine fetal demise) were analyzed using chi-squared tests with odds ratios (ORs) and 95% confidence intervals (CIs).

Results

The COVID-19 period showed a significant increase in placental findings: chorangiosis, chorioamnionitis, villitis, and fetal growth restriction. Placentas from COVID-19-positive mothers had higher rates of these findings, though the increase in fetal growth restriction was not statistically significant. Intrauterine fetal demise rates were higher in COVID-19-negative pregnancies but did not differ between periods.

Conclusion

Routine antenatal fetal testing for COVID-19 positivity alone is not warranted. We agree a follow-up fetal growth ultrasound 4 weeks post-infection is advisable per Society for Maternal-Fetal Medicine guidelines. The role of maternal comorbidities in chorangiosis remains unclear, warranting further investigation.

Keywords

chorioamnionitis chorangiosis COVID-19 fetal growth restriction intrauterine fetal demise placental findings pregnancy pregnancy outcomes SARS-CoV-2 villitis

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The comparison of placental findings and pregnancy outcomes before and during COVID-19 pandemic