SPECIAL REPORT: A standardized definition of placental infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a consensus statement from the National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH/NICHD) SARS-CoV-2 placental infection workshop

Roberts, Drucilla J.; Edlow, Andrea G.; Romero, Roberto J.; Coyne, Carolyn B.; Ting, David T.; Hornick, Jason L.; Zaki, Sherif R.; Adhikari, Upasana Das; Serghides, Lena; Gaw, Stephanie L.; Metz, Torri D.

Pregnant individuals infected with SARS-CoV-2 have higher rates of ICU admission, oxygen requirement, need for mechanical ventilation and death than non-pregnant individuals. Increased COVID-19 disease severity may be associated with increased risk for viremia and placental infection. Maternal SARS-CoV-2 infection is also associated with pregnancy complications such as preeclampsia and preterm birth, that can be either placentally-mediated or reflected in the placenta. Maternal viremia followed by placental infection may lead to maternal-fetal transmission (vertical), which affects 1-3% of exposed newborns. However, there is no agreed-upon or standard definition of placental infection. NIH/NICHD convened a group of experts to propose a working definition of placental infection to inform ongoing studies of SARS-CoV-2 during pregnancy. Experts recommended that placental infection be defined using techniques that allow virus detection and localization in placental tissue by one or more of the following methods: in-situ hybridization with anti-sense probe (detects replication) and/or a sense probe (detects viral genome or immunohistochemistry to detect viral nucleocapsid (N) or spike (S) proteins. If the above methods are not possible, RT-PCR detection and/or quantification of viral RNA in placental homogenates, or electron microscopy are alternative approaches. A graded classification for the likelihood of placental infection as definitive, probable, possible, and unlikely was proposed. Manuscripts reporting placental infection should describe the sampling method (location and number of samples collected), method of preservation of tissue, and detection technique. Recommendations were made for the handling of the placenta, examination, and sampling, as well as the use of validated reagents and sample protocols (included as appendices).