COVID-19 during pregnancy. Analytical inspection
DOI:
https://doi.org/10.15574/PP.2021.85.74Keywords:
COVID-19, pregnancy, newborns, pregnancy complicationsAbstract
The cause of the current pandemic was the rapid spread of the coronavirus SARS-CoV-2 and the development of respiratory syndrome with significant morbidity and mortality. Pregnant women have the higher risk of morbidity and mortality than non-pregnant women. Pregnancy is the vulnerable condition that may contribute to a higher risk of infection due to the change in physiology during gestation. Physiologic, metabolic, and vascular changes in normal and high-risk pregnancies may affect risks for severe acute respiratory syndrome SARS-CoV-2 infection. The pathogenesis of COVID-19 during pregnancy explains the functioning of the renin-angiotensin-aldosterone system. SARS-CoV-2 uses angiotensin-converting enzyme-2 receptors to enter target cells. Its regulation during pregnancy may increase the risk of respiratory syndrome with COVID-19. The virus, by binding to receptors, causes decreasing its regulation and can lead to increasing angiotensin II, relative to angiotensin 1, 7, which is manifested by vasoconstriction and vascular dysfunction in preeclampsia. Coronavirus disease and preeclampsia have partially the same pathophysiological mechanism, which includes endothelial dysfunction and coagulation disorders. There is systemic inflammation or microcirculation disorders, which is characterized by vasoconstriction and ischemia, hypercoagulation. Thus, abnormalities that are characteristic of COVID-19 infection are similar to those that occur with preeclampsia during pregnancy. In addition, the known pathological mechanism of COVID-19 is an excessive anti-inflammatory response called the cytokine storm. The immune response is sufficiently altered during pregnancy, which can significantly alter the laboratory and clinical manifestations of COVID-19 during pregnancy. Therefore, the combination of these conditions can potentially lead to vascular damage. Currently, there are very limited data on the course, clinic and consequences of infection during pregnancy. This literature review combines various high-level studies that indicate higher rates of preeclampsia and other complications associated with pregnancy and SARS-CoV-2 infection. Studies to date have reported higher risks of pregnancy complications, including preterm birth and preeclampsia, as well as higher rates of cesarean delivery. For the fetus were recorded isolated cases of stillbirth, which was less than <1%. Accordingly, this signals needs to increase attention to the course of infection during pregnancy, and the optimal treatment of COVID-19, as well as prevention strategies during pregnancy. Pharmacologic therapy is limited to medications with proven safety during pregnancy and lactation.
No conflict of interest was declared by the authors.
References
Boelig RC, Saccone G, Bellussi F, Berghella V. (2020). MFM Guidance for COVID-19. Am J Obstet Gynecol MFM. https://doi.org/10.1016/j.ajogmf.2020.100106; PMid:32363335 PMCid:PMC7195418
Breslin N, Baptiste C, Miller R et al. (2020). COVID-19 in pregnancy: early lessons. Am J Obstet Gynecol MFM. 2 (2): 100111. https://doi.org/10.1016/j.ajogmf.2020.100111; PMid:32518902 PMCid:PMC7271091
Brosnihan KB, Neves LA, Anton L et al. (2004). Enhanced expression of Ang-(1-7) during pregnancy. Braz J Med Biol Res. 37 (8): 1255-1262. https://doi.org/10.1590/S0100-879X2004000800017; PMid:15273828
Chen H, Guo J, Wang C et al. (2020). Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 395 (10226): 809-815. https://doi.org/10.1016/S0140-6736(20)30360-3
Chen R, Zhang Y, Huang L. (2020). Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anesth. 67 (6): 655-663. https://doi.org/10.1007/s12630-020-01630-7; PMid:32180175 PMCid:PMC7090434
Chen S, Huang B, Luo DJ et al. (2020). Pregnant women with new corona-virus infection: a clinical characteristics and placental pathological analysis of three cases [in Chinese]. Zhonghua Bing Li Xue Za Zhi. 49 (5): 418-423.
Di Mascio D, Khalil A, Saccone G et al. (2020). Outcome of coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. https://doi.org/10.1016/j.ajogmf.2020.100107; PMid:32292902 PMCid:PMC7104131
Garovic VD, White WM, Vaughan L et al. (2020). Incidence and longterm outcomes of hypertensive disorders of pregnancy. J Am Coll Cardiol. 75 (18): 2323-2334. https://doi.org/10.1016/j.jacc.2020.03.028; PMid:32381164
Glowacka I, Bertram S, Herzog P et al. (2010). Differential downregulation of ACE2 by the spike proteins of severe acute respiratory syndrome coronavirus and human coronavirus NL63. J Virol. 84 (2): 1198-1205. https://doi.org/10.1128/JVI.01248-09; PMid:19864379 PMCid:PMC2798380
Gorbalenya AE, Baker SC, Baric RS et al. (2020). The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 5 (4): 536-544. https://doi.org/10.1038/s41564-020-0695-z; PMid:32123347 PMCid:PMC7095448
Halscott T, MS, Vaught J. (2020). Management considerations for pregnant patients with COVID-19 developed with guidance from Torre Halscott, MS and Jason Vaught, MD. Society for Maternal-Fetal Medicine. URL: https://s3.amazonaws.com/cdn.smfm.org/media/2334/SMFM_COVID_Management_of_COVID_pos_preg_patients_4_29_20_final.pdf.
Hegewald MJ, Crapo RO. (2011). Respiratory physiology in pregnancy. Clin Chest Med. 32 (1): 1-13. https://doi.org/10.1016/j.ccm.2010.11.001; PMid:21277444
Juusela A, Nazir M, Gimovsky M. (2020). Two cases of coronavirus 2019erelated cardiomyopathy in pregnancy. Am J Obstet Gynecol MFM. https://doi.org/10.1016/j.ajogmf.2020.100113; PMid:32363336 PMCid:PMC7194868
Kelly JC, Dombrowksi M, O'Neil Callahan M et al. (2020). False-negative COVID-19 testing: considerations in obstetrical care. Am J Obstet Gynecol MFM. doi: org/10.1016/j.ajogmf.2020.100130.
Klok FA, Kruip MJHA, van der Meer NJM et al. (2020). Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. https://doi.org/10.1016/j.thromres.2020.04.013; PMid:32291094 PMCid:PMC7146714
Li N, Han L, Peng M et al. (2020). Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case_control study. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa352; PMid:32249918 PMCid:PMC7184430
Li Y, Zhao R, Zheng S et al. (2020). Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis. 26 (6): 1335-1336. https://doi.org/10.3201/eid2606.200287; PMid:32134381 PMCid:PMC7258467
Lippi G, Plebani M, Henry BM. (2020). Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta. 506: 145-148. https://doi.org/10.1016/j.cca.2020.03.022; PMid:32178975 PMCid:PMC7102663
Liu D, Li L, Wu X et al. (2020). Pregnancy and perinatal outcomes of women with coronavirus disease (COVID-19) pneumonia: a preliminary analysis. AJR Am J Roentgenol. doi: org/10.2214/AJR.20.23072. https://doi.org/10.2139/ssrn.3548758
Liu H, Wang LL, Zhao SJ et al. (2020). Why are pregnant women susceptible to COVID-19? An immunological viewpoint. J Reprod Immunol. 139: 103122. https://doi.org/10.1016/j.jri.2020.103122; PMid:32244166 PMCid:PMC7156163
Liu Y, Chen H, Tang K, Guo Y. (2020). Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. https://doi.org/10.1016/j.jinf.2020.02.028; PMCid:PMC7133645
Loeffelholz MJ, Tang YW. (2020). Laboratory diagnosis of emerging human coronavirus infections: the state of the art. Emerg Microbes Infect. 9 (1): 747-756. https://doi.org/10.1080/22221751.2020.1745095; PMid:32196430 PMCid:PMC7172701
Lumbers ER, Delforce SJ, Arthurs AL et al. (2019). Pringle KG.Causes and consequences of the dysregulated maternal renin-angiotensin system in preeclampsia. Front Endocrinol (Lausanne). 10: 563. https://doi.org/10.3389/fendo.2019.00563; PMid:31551925 PMCid:PMC6746881
Mao L, Jin H, Wang M et al. (2020). Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. https://doi.org/10.1001/jamaneurol.2020.1127; PMid:32275288 PMCid:PMC7149362
Merrill DC, Karoly M, Chen K, Ferrario CM, Brosnihan KB. (2020). Angiotensin-(1-7) in normal and preeclamptic pregnancy. Endocrine. 18 (3): 239-245. https://doi.org/10.1385/ENDO:18:3:239
Mor G, Aldo P, Alvero AB. (2017). The unique immunological and microbial aspects of pregnancy. Nat Rev Immunol. 17 (08): 469-482. https://doi.org/10.1038/nri.2017.64; PMid:28627518
Narang K, Ibirogba ER, Elrefaei A et al. (2020). SARS-CoV-2 in pregnancy: a comprehensive summary of current guidelines. J Clin Med. 9 (5): 1521. https://doi.org/10.3390/jcm9051521; PMid:32443538 PMCid:PMC7291307
Narang Kavita, L E. (2020). Enninga, Madugodaralalage DSK Gunaratne. SARS-CoV-2 Infection and COVID-19 During Pregnancy: A Multidisciplinary Review Mayo Clin Proc. 95 (8): 1750-1765. Published online 2020 May 30. https://doi.org/10.1016/j.mayocp.2020.05.011; PMid:32753148 PMCid:PMC7260486
Penfield CA, Brubaker SG, Limaye MA et al. (2020). Detection of SARS-COV-2 in placental and fetal membrane samples. Am J Obstet Gynecol MFM. https://doi.org/10.1016/j.ajogmf.2020.100133
Pierce Williams RAM, Burd J, Felder L et al. (2020). Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study. Am J Obstet Gynecol MFM. doi: org/10.1016/j.ajogmf.2020.100134.
Rasmussen SA, Jamieson DJ, Macfarlane K et al. (2009). Pandemic Influenza and Pregnancy Working Group. Pandemic influenza and pregnant women:summary of a meeting of experts. Am J Public Health. 99 (2): S248-S254. https://doi.org/10.2105/AJPH.2008.152900; PMid:19461110 PMCid:PMC4504360
Royal College of Obstetricians and Gynaecologists. (2021). Coronavirus (COVID-19) infection in pregnancy: information for healthcare professionals: 13. URL: https://www.rcog.org.uk/coronavirus-pregnancy.
Schwartz DA. (2020). An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol LabMed. https://doi.org/10.5858/arpa.2020-0901-SA; PMid:32180426
Shah PS, Diambomba Y, Acharya G et al. (2020). Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand. 99 (5): 565-568. https://doi.org/10.1111/aogs.13870; PMid:32277845 PMCid:PMC7262318
Varga Z, Flammer AJ, Steiger P et al. (2020). Endothelial cell infection and endotheliitis in COVID-19. Lancet. 395 (10234): 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5
Wang X, Zhou Z, Zhang J et al. (2020). Case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa200; PMid:32119083 PMCid:PMC7108126
Wen R, Sun Y, Xing Q S. (2020). A patient with SARS-CoV-2 infection during pregnancy in Qingdao, China. J Microbiol Immunol Infect. https://doi.org/10.1016/j.jmii.2020.03.004; PMid:32198004 PMCid:PMC7128446
West CA, Sasser JM, Baylis C et al. (2016). The enigma of continual plasma volume expansion in pregnancy: critical role of the reninangiotensin-aldosterone system. Am J Physiol Renal Physiol. 311 (6): 1125-1134. https://doi.org/10.1152/ajprenal.00129.2016; PMid:27707703 PMCid:PMC6189751
Wu X, Sun R, Chen J et al. (2020). Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia. Int J Gynecol Obst. https://doi.org/10.1002/ijgo.13165; PMid:32270479
Xia H, Zhao S, Wu Z. (2020). Emergency Caesarean delivery in a patient with confirmed COVID-19 under spinal anaesthesia. Br J Anaesth. 124 (5): e216-e218. https://doi.org/10.1016/j.bja.2020.02.016; PMid:32192711 PMCid:PMC7118662
Xie Y, Wang X, Yang P, Zhang S. (2020). COVID-19 complicated by acute pulmonary embolism. Radiol Cardiothorac Imag. 2 (2): e200067. https://doi.org/10.1148/ryct.2020200067; PMid:33778561 PMCid:PMC7233431
Yu N, Li W, Kang Q et al. (2020). Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 20 (5): 559-564. https://doi.org/10.1016/S1473-3099(20)30176-6
Zaigham M, Andersson O. (2020). Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. https://doi.org/10.1111/aogs.13867; PMid:32259279 PMCid:PMC7262097
Zamaniyan M, Ebadi A, Aghajanpoor Mir S et al. (2020). Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diagn, https://doi.org/10.1002/pd.5713; PMid:32304114 PMCid:PMC7264605
Zhang C, Shi L, Wang FS. (2020). Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 5 (5): 428-430. https://doi.org/10.1016/S2468-1253(20)30057-1
Zhang L, Jiang Y, Wei M et al. (2020). Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province. Zhonghua Fu Chan Ke Za Zhi. 55 (3): 166-171.
Zhou P, Yang XL, Wang XG et al. (2020). A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature Mar. 579 (7798): 270-273.
Zhu H, Wang L, Fang C et al. (2020). Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 9 (1): 51-60. https://doi.org/10.21037/tp.2020.02.06; PMid:32154135 PMCid:PMC7036645
Downloads
Published
Issue
Section
License
The policy of the Journal “Ukrainian Journal of Perinatology and Pediatrics” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
