A University of Miami case study published today in Pediatrics suggests that SARS-CoV-2 breached the placenta, causing brain damage in two newborns.
The infants, born to COVID-19–positive mothers, had seizures on the day of their birth, microcephaly (small head size), and substantial developmental delays over time. Repeated magnetic resonance imaging (MRI) demonstrated severe brain damage. Both mothers were infected in the second trimester, and one was reinfected in the third trimester.
While neither newborn was COVID-positive at birth, both had SARS-CoV-2 antibodies and elevated levels of blood inflammatory markers. The placentas showed abnormalities such as inadequate blood flow to the fetus and increased inflammatory markers. One infant died unexpectedly at 13 months, the brain showing evidence of SARS-CoV-2 infection.
Cases are rare
The clinical findings, placental abnormalities, and inflammatory findings strongly suggest that second-trimester maternal COVID-19 infection triggered an inflammatory response and oxidative stress injury to the fetus and placenta that damaged the fetal brain, the researchers said.
"The demonstration of SARS-CoV-2 in the deceased infant's brain also raises the possibility that SARS-CoV-2 infection of the fetal brain directly contributed to ongoing brain injury," they wrote. "Our cases also highlight the shortcomings of current fetal monitoring for assessment of fetal well-being, especially when the target of injury is the fetal brain."
The researchers, however, emphasize that these cases, the first of their kind to be reported, are rare. "We're trying to understand what made these two pregnancies different, so we can direct research towards protecting vulnerable babies," senior author Shahnaz Duara, MD, said in a University of Miami news release.
The authors recommend that women get vaccinated against COVID-19 before or during pregnancy, breastfeed and, if infected, wear a mask to prevent transmission to the newborn.