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SARS-CoV-2 Variant-Related Abnormalities Detected by Prenatal MRI: A Prospective Case-Control Study

24 Pages Posted: 25 Oct 2022

See all articles by Patric Kienast

Patric Kienast

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy

Daniela Prayer

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy

Julia Binder

Medical University of Vienna - Division of Obstetrics and Feto-maternal Medicine

Florian Prayer

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy

Sabine Dekan

Medical University of Vienna - Department of Pathology

Eva Langthaler

Medical University of Vienna - Department of Pathology

Benjamin Sigl

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy

Sabine Eichinger

Medical University of Vienna - Department of Pathology

Nicole Perkmann-Nagele

Medical University of Vienna - Department of Pathology

Ingrid Stuempflen

Klinik Floridsdorf - Department of Obstetrics & Gynecology

Marlene Stuempflen

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy

Nawa Schirwani

Medical University of Vienna - Division of Obstetrics and Feto-maternal Medicine

Petra Pateisky

Medical University of Vienna - Division of Obstetrics and Feto-maternal Medicine

Christian Mitter

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy

Gregor Kasprian

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy

More...

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 investigate the effects of SARS-CoV-2 variants on the placenta and fetus, we aimed to investigate 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.Forty-three prenatal MRI examinations were included after confirmed infection with SARS-CoV-2 and matched 1:1 with 43 control cases with respect to sex, MRI field strength, and gestational age (average deviation 1·7 ± 1·6 days).Where available, the pathohistological examination 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 43 included cases after SARS-CoV-2 infection, 25 (58%) were infected with pre-Omicron variants and 18 (42%) with Omicron. Prenatal MRIs were performed on an average of 144 ± 70·7 days after the first positive PCR test.Both pre-Omicron (P=·002) 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 (Mean Diff. 7·32mm, 95% CI 2·05 to 12·59, P=·009), and showed significantly more frequent lobules (P=·031), and hemorrhages (P=·003).Fetal growth restriction (FGR) was observed in 28% (P=·004) 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 Information: Vienna Science and Technology Fund.

Declaration of Interests: The authors declare no conflict of interest.

Ethics Approval Statement: The institutional review board of the Medical University of Vienna approved this prospective study (Ethics Committee number 2306/2020). Written informed consent was obtained before study inclusion.

Keywords: COVID-19, SARS-CoV-2, COVID-19 during pregnancy, Omicron, variants, prenatal MRI, placenta, vascular

Suggested Citation

Kienast, Patric and Prayer, Daniela and Binder, Julia and Prayer, Florian and Dekan, Sabine and Langthaler, Eva and Sigl, Benjamin and Eichinger, Sabine and Perkmann-Nagele, Nicole and Stuempflen, Ingrid and Stuempflen, Marlene and Schirwani, Nawa and Pateisky, Petra and Mitter, Christian and Kasprian, Gregor, SARS-CoV-2 Variant-Related Abnormalities Detected by Prenatal MRI: A Prospective Case-Control Study. Available at SSRN: https://ssrn.com/abstract=4257647 or http://dx.doi.org/10.2139/ssrn.4257647

Patric Kienast

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy ( email )

Daniela Prayer

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy ( email )

Julia Binder

Medical University of Vienna - Division of Obstetrics and Feto-maternal Medicine ( email )

Florian Prayer

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy ( email )

Sabine Dekan

Medical University of Vienna - Department of Pathology ( email )

Eva Langthaler

Medical University of Vienna - Department of Pathology ( email )

Benjamin Sigl

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy ( email )

Sabine Eichinger

Medical University of Vienna - Department of Pathology ( email )

Nicole Perkmann-Nagele

Medical University of Vienna - Department of Pathology ( email )

Ingrid Stuempflen

Klinik Floridsdorf - Department of Obstetrics & Gynecology ( email )

Marlene Stuempflen

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy ( email )

Nawa Schirwani

Medical University of Vienna - Division of Obstetrics and Feto-maternal Medicine ( email )

Petra Pateisky

Medical University of Vienna - Division of Obstetrics and Feto-maternal Medicine ( email )

Christian Mitter

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy ( email )

Gregor Kasprian (Contact Author)

Medical University of Vienna - Department of Biomedical Imaging and Image-guided Therapy ( email )

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