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Acknowledgments The authors acknowledge the Cellex Foundation for providing research facilities and equipment. The study was undertaken with the support of a COVID-19 Direccio General de Recerca i Innovacio en Salut grant (Generalitat de Catalunya) , the Fundacion Asociacion Espanola contra el Cancer (AECC) , the Ramon Areces Foundation, the Instituto de Salud Carlos III, the Fondo de Investigaciones Sanitarias (PI19/00318) , and the Juande la Cierva formacion fellowship (to CRP) . AT was supported by the Botnar Research Centre for Child Health (BRCCH) at the University of Basel.

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Rubio-Perez, CarlotaAuthorAnton, AndresAuthor

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Article

Severe SARS-CoV-2 placenta infection can impact neonatal outcome in the absence of vertical transmission

Publicated to:Journal Of Clinical Investigation. 131 (6): e145427- - 2021-03-15 131(6), DOI: 10.1172/JCI145427

Authors: Cribiu, Fulvia Milena; Erra, Roberta; Pugni, Lorenza; Rubio-Perez, Carlota; Alonso, Lidia; Simonetti, Sara; Croci, Giorgio Alberto; Serna, Garazi; Ronchi, Andrea; Pietrasanta, Carlo; Lunghi, Giovanna; Fagnani, Anna Maria; Pinana, Maria; Matter, Matthias; Tzankov, Alexandar; Terracciano, Luigi; Anton, Andres; Ferrazzi, Enrico; Ferrero, Stefano; Iurlaro, Enrico; Seoane, Joan; Nuciforo, Paolo

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Abstract

The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pathophysiology of the placenta and its impact on pregnancy outcome has not yet been fully elucidated. Here, we present a comprehensive clinical, morphological, and molecular analysis of placental tissues from pregnant women with and without SARS-CoV-2 infection. SARS-CoV-2 could be detected in half of placental tissues from SARS-CoV-2-positive women. The presence of the virus was not associated with any distinctive pathological, maternal, or neonatal outcome features. SARS-CoV-2 tissue load was low in all but one patient who exhibited severe placental damage leading to neonatal neurological manifestations. The placental transcriptional response induced by high viral load of SARS-CoV-2 showed an immunopathology phenotype similar to autopsy lung tissues from patients with severe coronavirus disease 2019. This finding contrasted with the lack of inflammatory response in placental tissues from SARS-CoV-2-positive women with low viral tissue load and from SARS-CoV-2-negative women. Importantly, no evidence of vertical transmission of SARS-CoV-2 was found in any newborns, suggesting that the placenta may be an effective maternal-neonatal barrier against the virus even in the presence of severe infection. Our observations suggest that severe placental damage induced by the virus may be detrimental for the neonate independently of vertical transmission.

Keywords

AdultCohort studiesCovid-19Embryonic developmentFemaleGene expression profilingHumansInfant, newbornInfectious disease transmission, verticalMolecular pathologyObstetrics/gynecologyPandemicsPlacentaPlacenta diseasesPregnancyPregnancy complications, infectiousPregnancy outcomeReproductive biologyRna, viralSars-cov-2Young adult

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Clinical Investigation due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position 2/139, thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine, Research & Experimental. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 4.38. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 38.24 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-05, the following number of citations:

  • WoS: 66
  • Scopus: 74
  • Europe PMC: 65
  • OpenCitations: 69

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-05:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 181.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 181 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 171.7.
  • The number of mentions on the social network X (formerly Twitter): 19 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Italy; Switzerland.