Reply to “COVID-19 infection just before or during early pregnancy and the possible risk of placenta accreta spectrum or preeclampsia”

We would like to thank Dr Al-Lami for the interest in our study and the comments regarding our publication “Coronavirus disease 2019 infection and placental histopathology in women delivering at term.” Dr Al-Lami hypothesized that COVID-19 infection periconceptionally may increase the risk of placenta accreta spectrum (PAS) and/or preeclampsia. The biological mechanism by which this may occur is described by Dr Al-Lami who advocates for further research on the potential connections between them. We are aware of previous studies suggesting that women with COVID-19 infection in the second and third trimesters of pregnancy may be at increased risk for the development of preeclampsia.1, 2, 3 However, reliable data on periconception COVID-19 infection and the subsequent development of preeclampsia and/or PAS are very scarce, if any, at this time.

It should be emphasized that the COVID-19 cases in our study were identified by polymerase chain reaction screening in term patients (>37 weeks gestation) at the time of admission to labor and delivery. Therefore, it is highly unlikely that they would have contracted the virus before pregnancy or even in the first trimester. Because our study was conducted on women delivering at term and we excluded women with preeclampsia or PAS from our control group, we are unable to comment on any potential association. We agree with the author that more research is needed to determine whether there is an association between periconception COVID-19 infection and PAS and/or preeclampsia.