Maternal COVID-19 infection may lead to brain injury in fetal brain: Case report

USA: The study published in the Journal of the American Academy of Pediatrics reported two cases of infants born to mothers with COVID-19 who showed early-onset seizures, acquired microcephaly, and significant developmental delay over time.

The COVID-19 pandemic has had a profound effect on global health and has resulted in unfavorable maternal and fetal outcomes. The study highlights the occurrence of severe neurological damage in two infants: one a preterm baby born at 32-week gestational age and the other a full-term baby born at 39-week gestational age. Notably, neither infant tested positive for the SARS-CoV-2 virus through RT-PCR.

The two infants were born without the virus but with detectable COVID-19 antibodies and increased blood inflammatory markers, had severe parenchymal atrophy and cystic encephalomalacia according to sequential MRI scans. Both infants suffered an ongoing neurologic injury and developmental deficits, with one experiencing sudden death at 13 months of age and extensive loss of brain white matter, gliosis, and vacuolization at autopsy.

The placental pathology of both mothers showed signs of SARS-CoV-2 infection, including the nucleocapsid protein and spike glycoprotein 1 in the syncytiotrophoblast and fetal vascular malperfusion, as well as increased inflammatory and oxidative stress markers.

The pre-term infant experienced sudden unexpected death at 13 months of age. The deceased infant's brain showed evidence of SARS-CoV-2. The researchers concluded that second-trimester maternal COVID-19 infection with placentitis triggered an inflammatory response and oxidative stress injury to the fetoplacental unit that affected the fetal brain. 

The study's lead author Dr. Merline Benny added that the findings highlight “The need for further research on the potential long-term effects of COVID-19 on fetal brain development. The researchers emphasized the importance of pregnant women getting vaccinated against COVID-19 to prevent infection and protect the health of their unborn babies.”

These findings also underline the importance of continuing to follow COVID-19 safety measures such as wearing masks, social distancing, and avoiding large gatherings, especially for pregnant women.

Reference:

Benny, M., Bandstra, E. S., Saad, A. G., Lopez-Alberola, R., Saigal, G., Paidas, M. J., Jayakumar, A. R., & Duara, S. (2023, April 6). Maternal SARS-CoV-2, Placental Changes and Brain Injury in 2 Neonates. American Academy of Pediatrics. https://doi.org/10.1542/peds.2022-058271