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Underestimation of SARS-CoV-2 infection in placental samples

      COVID-19, caused by SARS-CoV-2, has emerged as one of the most serious global public health problems in recent history. Data from the Centers for Disease Control and Prevention suggest that approximately 86,000 pregnant women in the United States have been infected so far.
      Centers for Disease Control and Prevention
      Pregnant and recently pregnant people at increased risk for severe illness from COVID-19.
      SARS-CoV-2 infects cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. However, viral cell entry is dependent on the spike protein cleavage by the transmembrane serine protease 2 (TMPRSS2).
      • Hoffmann M.
      • Kleine-Weber H.
      • Schroeder S.
      • et al.
      SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.
      ,
      • Hanna N.
      • Hanna M.
      • Sharma S.
      Is pregnancy an immunological contributor to severe or controlled COVID-19 disease?.
      Some reports demonstrated placental tissue expression of both ACE2 and TMPRSS2, suggesting a potential mechanism for viral cell entry and an ability to infect the placenta.
      • Hoffmann M.
      • Kleine-Weber H.
      • Schroeder S.
      • et al.
      SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.
      ,
      • Hanna N.
      • Hanna M.
      • Sharma S.
      Is pregnancy an immunological contributor to severe or controlled COVID-19 disease?.
      However, it is unclear why placental SARS-CoV-2 infection is rarely demonstrated using reverse transcription polymerase chain reaction (RT-PCR) testing.
      • Sharps M.C.
      • Hayes D.J.L.
      • Lee S.
      • et al.
      A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection.
      ,
      • Hecht J.L.
      • Quade B.
      • Deshpande V.
      • et al.
      SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID-19-positive mothers.
      We report on 2 cases of pregnant women infected with SARS-CoV-2 and demonstrate the variability in the detection of SARS-CoV-2 in placental tissues using RT-PCR.
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      References

        • Centers for Disease Control and Prevention
        Pregnant and recently pregnant people at increased risk for severe illness from COVID-19.
        (Available at:) (Accessed June 7, 2021)
        • Hoffmann M.
        • Kleine-Weber H.
        • Schroeder S.
        • et al.
        SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.
        Cell. 2020; 181: 271-280.e8
        • Hanna N.
        • Hanna M.
        • Sharma S.
        Is pregnancy an immunological contributor to severe or controlled COVID-19 disease?.
        Am J Reprod Immunol. 2020; 84: e13317
        • Sharps M.C.
        • Hayes D.J.L.
        • Lee S.
        • et al.
        A structured review of placental morphology and histopathological lesions associated with SARS-CoV-2 infection.
        Placenta. 2020; 101: 13-29
        • Hecht J.L.
        • Quade B.
        • Deshpande V.
        • et al.
        SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID-19-positive mothers.
        Mod Pathol. 2020; 33: 2092-2103