Post by Nadica (She/Her) on Nov 11, 2024 1:14:23 GMT
Association between situs inversus and maternal SARS-CoV-2 infection at gestational age 4–6 weeks - Published Nov 8, 2024
Context and significance
A striking increase in situs inversus cases, diagnosed by ultrasound, was observed several months following removal of zero-COVID-19 policies in China, which coincided with a surge in SARS-CoV-2 infection. The rare clinical evidence presented here reveals a previously unobserved possible fetal consequence of maternal SARS-CoV-2 infection specifically during gestational weeks 4–6. To date, visceral lateralization has never been definitively linked to a specific developmental time in humans due to the rarity of such fetal samples. This study advances our current understanding of gastrulation-stage development and possibly provides the most robust support yet linking an environmental factor to occurrence of situs inversus, opening new research directions into mechanisms of visceral lateralization in humans and consequences of SARS-CoV-2 infection in pregnancy.
Highlights
• Situs inversus is associated with SARS-CoV-2 infection at gestational weeks (GWs) 4–6
• Results herein support previously undefined visceral lateralization at GWs 4–6 in humans
• SARS-CoV-2 infection at GWs 4–6 is well supported as an environmental risk factor for situs inversus
Summary
Background
A dramatic increase in fetal situs inversus diagnoses by ultrasound in the months following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surge of December 2022 in China led us to investigate whether maternal SARS-CoV-2 exposure could be associated with elevated risk of fetal situs inversus.
Methods
In this multi-institutional, hospital-based, matched case-control study, we investigated pregnant women who underwent ultrasonographic fetal biometric assessment at gestational weeks 20–24 at our hospitals. Each pregnant woman carrying a situs inversus fetus was randomly matched with four controls based on the date of confinement. Relevant information, including SARS-CoV-2 infection, and other potential risk factors were collected. Conditional logistic regression was used to test possible associations between fetal situs inversus and SARS-CoV-2 infection at different gestational weeks as well as individual risk factors.
Findings
A total of 52 pregnant women diagnosed with fetal situs inversus between January 1 and October 31, 2023 and 208 matched controls with normal fetuses were enrolled. We found no association between an increased risk of fetal situs inversus with gestational SARS-CoV-2 infection or with other risk factors. However, fetal situs inversus was significantly associated with SARS-CoV-2 infection specifically in gestational weeks 4–6 (adjusted odds ratio [aOR] 6.54 [95% confidence interval 1.76–24.34]), but not with infection at other gestational ages, after adjusting for covariates.
Conclusions
Increased risk of fetal situs inversus is significantly associated with maternal SARS-CoV-2 infection at gestational weeks 4–6, corresponding to the fetal developmental window for visceral lateralization in humans.
Context and significance
A striking increase in situs inversus cases, diagnosed by ultrasound, was observed several months following removal of zero-COVID-19 policies in China, which coincided with a surge in SARS-CoV-2 infection. The rare clinical evidence presented here reveals a previously unobserved possible fetal consequence of maternal SARS-CoV-2 infection specifically during gestational weeks 4–6. To date, visceral lateralization has never been definitively linked to a specific developmental time in humans due to the rarity of such fetal samples. This study advances our current understanding of gastrulation-stage development and possibly provides the most robust support yet linking an environmental factor to occurrence of situs inversus, opening new research directions into mechanisms of visceral lateralization in humans and consequences of SARS-CoV-2 infection in pregnancy.
Highlights
• Situs inversus is associated with SARS-CoV-2 infection at gestational weeks (GWs) 4–6
• Results herein support previously undefined visceral lateralization at GWs 4–6 in humans
• SARS-CoV-2 infection at GWs 4–6 is well supported as an environmental risk factor for situs inversus
Summary
Background
A dramatic increase in fetal situs inversus diagnoses by ultrasound in the months following the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surge of December 2022 in China led us to investigate whether maternal SARS-CoV-2 exposure could be associated with elevated risk of fetal situs inversus.
Methods
In this multi-institutional, hospital-based, matched case-control study, we investigated pregnant women who underwent ultrasonographic fetal biometric assessment at gestational weeks 20–24 at our hospitals. Each pregnant woman carrying a situs inversus fetus was randomly matched with four controls based on the date of confinement. Relevant information, including SARS-CoV-2 infection, and other potential risk factors were collected. Conditional logistic regression was used to test possible associations between fetal situs inversus and SARS-CoV-2 infection at different gestational weeks as well as individual risk factors.
Findings
A total of 52 pregnant women diagnosed with fetal situs inversus between January 1 and October 31, 2023 and 208 matched controls with normal fetuses were enrolled. We found no association between an increased risk of fetal situs inversus with gestational SARS-CoV-2 infection or with other risk factors. However, fetal situs inversus was significantly associated with SARS-CoV-2 infection specifically in gestational weeks 4–6 (adjusted odds ratio [aOR] 6.54 [95% confidence interval 1.76–24.34]), but not with infection at other gestational ages, after adjusting for covariates.
Conclusions
Increased risk of fetal situs inversus is significantly associated with maternal SARS-CoV-2 infection at gestational weeks 4–6, corresponding to the fetal developmental window for visceral lateralization in humans.