Objective
To evaluate the impact of COVID-19 disease and vaccination on the maternal fetal unit through assessment of placental pathology.
Study Design
This is a prospective study that recruited patients on admission for delivery who consented to sample collection for a biorepository. Participants were categorized as either COVID negative (no history of COVID disease or vaccine), COVID vaccine recipient, or COVID disease (by PCR diagnosis) during pregnancy. Primary outcome was placental maternal vascular malperfusion, as this has previously been associated with COVID disease. Secondary outcomes included delivery outcomes, other placental pathological findings, and whether aspirin therapy influenced pathological impact of COVID-19 disease.
Results
A total of 304 participants were included. Those with COVID disease history were more likely to be Hispanic and have a higher BMI (TABLE). COVID disease was associated witih placental maternal vascular malperfusion compared to COVID negative, even after adjusting for age and BMI (aOR4.2 (2.1-8.3, p< 0.001)); COVID vaccination was not (TABLE). COVID disease was also associated with an increased rate of preterm birth (15% vs 7%, OR 2.5 (1.03-6.30, p=0.04). Among those with COVID disease, 22 were taking aspirin. Those on aspirin had a lower rate of maternal vascular malperfusion on placental pathology, although this did not reach statistical significance (41% vs 55%, OR 0.56 (0.19-4.6),p=0.29).
Conclusion
Although the large majority of cases of COVID-19 were mild,COVID-19 exposure was still strongly associated with placental vascular pathology. COVID-19 vaccine did not have similar impact on perinatal outcomes or placental pathology, supporting the safety of the vaccine in pregnancy. Further study is needed on whether aspirin reduces the vascular pathology related to COVID-19 in pregnancy.
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