SARS-CoV-2 variant-related abnormalities detected by prenatal MRI: a prospective case-control study

Patric Kienast; Daniela Prayer; Julia Binder; Florian Prayer; Sabine Dekan; Eva Langthaler; Benjamin Sigl; Sabine Eichinger; Nicole Perkmann-Nagele; Ingrid Stuempflen; Marlene Stuempflen; Nawa Schirwani; Petra Pateisky; Christian Mitter; Gregor Kasprian

doi:10.1016/j.lanepe.2023.100587

SARS-CoV-2 variant-related abnormalities detected by prenatal MRI: a prospective case-control study

Lancet Reg Health Eur. 2023 Mar:26:100587. doi: 10.1016/j.lanepe.2023.100587. Epub 2023 Jan 21.

Authors

Affiliations

¹ Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
² Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
³ Department of Pathology, Medical University of Vienna, Vienna, Austria.
⁴ Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.
⁵ Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
⁶ Department of Obstetrics & Gynecology, Klinik Floridsdorf, Vienna, Austria.

Abstract

Background: There are known complications for fetuses after infection with SARS-CoV-2 during pregnancy. However, previous studies of SARS-CoV-2 in pregnancy have largely been limited to histopathologic studies of placentas and prenatal studies on the effects of different SARS-CoV-2 variants are scarce to date. To examine the effects of SARS-CoV-2 variants on the placenta and fetus, we investigated fetal and extra-fetal structures using prenatal MRI.

Methods: For this prospective case-control study, two obstetric centers consecutively referred pregnant women for prenatal MRI after confirmed SARS-CoV-2 infection. Thirty-eight prenatal MRI examinations were included after confirmed infection with SARS-CoV-2 and matched 1:1 with 38 control cases with respect to sex, MRI field strength, and gestational age (average deviation 1.76 ± 1.65, median 1.5 days). Where available, the pathohistological examination and vaccination status of the placenta was included in the analysis. In prenatal MRI, the shape and thickness of the placenta, possible lobulation, and vascular lesions were quantified. Fetuses were scanned for organ or brain abnormalities.

Findings: Of the 38 included cases after SARS-CoV-2 infection, 20/38 (52.6%) were infected with pre-Omicron variants and 18/38 (47.4%) with Omicron. Prenatal MRIs were performed on an average of 83 days (±42.9, median 80) days after the first positive PCR test. Both pre-Omicron (P = .008) and Omicron (P = .016) groups showed abnormalities in form of a globular placenta compared to control cases. In addition, placentas in the pre-Omicron group were significantly thickened (6.35, 95% CI .02-12.65, P = .048), and showed significantly more frequent lobules (P = .046), and hemorrhages (P = .002). Fetal growth restriction (FGR) was observed in 25% (n = 5/20, P = .017) in the pre-Omicron group.

Interpretation: SARS-CoV-2 infections in pregnancy can lead to placental lesions based on vascular events, which can be well visualized on prenatal MRI. Pre-Omicron variants cause greater damage than Omicron sub-lineages in this regard.

Funding: Vienna Science and Technology Fund.

Keywords: COVID-19; COVID-19 during pregnancy; Omicron; Placenta; Prenatal MRI; SARS-CoV-2; Variants; Vascular.