COVID‐19 and preeclampsia: The unique and the mutually nonexclusive clinical manifestations

Abstract

Preeclampsia (PE) is a serious, unpredictable hypertensive disorder of pregnancy present in around 8–10% of all pregnancies resulting in high rate of maternal and fetal morbidity and mortality. With the pathophysiology partially known, delivery is the only cure for PE. The disease sets due to multiple pathologic processes involving endothelial cell activation, inflammation, multiorgan damage and syncytiotrophoblast stress. Though the primary target organ is lungs in COVID‐19, other systemic manifestations which include endothelial dysfunction, dysregulated angiogenesis, thrombosis, liver injury, thrombocytopenia, hypertension and kidney damage overlap with PE. COVID‐19 patients show a higher incidence of PE as compared to their noninfected counterparts and vice versa. Similar pathophysiology and clinical features make differential diagnosis challenging. For effective and specific management, it is important to differentiate actual PE from COVID‐19 with PE like features. There are contradictory reports about the accuracy of diagnostic tools in distinguishing PE from severe COVID‐19 with PE like features. With the available data, it can only be stated that PE is a common adverse pregnancy event, which may be exacerbated by, or may exacerbate, COVID‐19. Future research should focus on cohesive understanding of the pathophysiology of the clinical manifestations, and preventive strategies during pregnancy.

SARS-CoV-2 Infection and Preeclampsia—How an Infection Can Help Us to Know More about an Obstetric Condition

“…The key host protease responsible for initiating this process and facilitating viral entry is TMPRSS2, a type II transmembrane serine protease [ 30 , 31 ]. In addition to ACE2, SARS-CoV-2 impacts other elements of the renin-angiotensin system (RAS), including ADAM17, which primarily controls the levels of ACE2 on the cell membrane and consequently reduces its expression [ 32 ]. ACE2, a membrane-bound exopeptidase primarily found in the kidney, lungs, and heart, is a critical component of the RAS, which regulates the conversion of angiotensin II (Ang II) to angiotensin 1–7 (Ang 1–7) and the conversion of angiotensina I (Ang I) to angiotensina 1–9 (Ang 1–9).…”

“…In pregnancy, the RAS system plays a crucial role in placental function, controlling trophoblast proliferation, angiogenesis, and blood flow. It significantly influences utero-placental blood flow through the modulation of vasoconstrictor and vasodilator pathways [ 30 , 32 ].…”

“…Histopathological studies conducted on patients with COVID-19 have revealed an increase in the expression of ACE2 protein in lung tissues, in contrast to non-infected patients. This abnormal regulation of ACE2 levels serves as a significant shared biomarker for both PE and COVID-19 [ 32 ].…”