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Valdespino-Vázquez MY, Helguera-Repetto CA, León-Juárez M, Villavicencio-Carrisoza O, Flores-Pliego A, Moreno-Verduzco ER, Díaz-Pérez DL, Villegas-Mota I, Carrasco-Ramírez E, López-Martínez IE, Giraldo-Gómez DM, Lira R, Yocupicio-Monroy M, Rodríguez-Bosch M, Sevilla-Reyes EE, Cortés-Bonilla M, Acevedo-Gallegos S, Merchant-Larios H, Cardona-Pérez A, Irles C. Fetal and placental infection with SARS-CoV-2 in early pregnancy. J Med Virol. 2021 Mar 25. doi: 10.1002/jmv.26965. Epub ahead of print. PMID: 33764543.

To date, mother-to-fetus transmission of SARS-CoV-2, responsible for the COVID-19 pandemic, remains controversial. Although placental COVID-19 infection has been documented in some cases during the second- and third-trimesters, no reports are available for the first trimester of pregnancy, and no SARS-CoV-2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarriage in a COVID-19 maternal infection by immunohistochemical, RT-qPCR, immunofluorescence, and electron microscopy methods. SARS-CoV-2 nucleocapsid protein, viral RNA, and particles consistent with coronavirus were found in the placenta and fetal tissues, accompanied by RNA replication revealed by double-stranded RNA positive immunostain. Prominent damage of placenta and fetal organs were associated with a hyperinflammatory process identified by histological examination and immunohistochemistry. The findings provided in this study document that congenital SARS-CoV-2 infection is possible during the first trimester of pregnancy and that fetal organs, such as lung and kidney, are targets for coronavirus. The infection and multi-organic fetal inflammation produced by SARS-CoV-2 during early pregnancy should alert clinicians in the assessment and management of pregnant women for possible fetal consequences and adverse perinatal outcomes.

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