COVID-19 in pregnancy: What do we really know?

Abstract

Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to escalate worldwide and has become a pressing global health concern. This article comprehensively reviews the current knowledge on the impact of COVID-19 over pregnant women and neonates, as well as current recommendations for their management. We also analyse previous evidences from viral respiratory diseases such as SARS, Middle East respiratory syndrome, and influenza that may help to guide clinical practice during the current pandemic. We collected 23 case reports, case series, and case-control studies (18 from China) comprising 174 pregnant women with COVID-19. The majority of mothers showed a clinical presentation of the disease similar to that of non-infected adults. Preliminary evidences point towards a potentially increased risk of pregnancy adverse outcomes in women with COVID-19, with preterm delivery the most frequently observed (16.7%) followed by fetal distress (9.77%). The most commonly reported adverse neonatal outcomes included respiratory symptoms (7.95%) and low birth weight (6.81%). A few studies reported other maternal comorbidities that can influence these outcomes. Mothers with other comorbidities may be at higher risk of infection. Mother-to-child transmission of SARS-CoV-2 appears unlikely, with no study observing intrauterine transmission, and a few cases of neonatal infection reported a few hours after birth. Although the WHO and other health authorities have published interim recommendations for care and management of pregnant women and infants during COVID-19 pandemic, many questions remain open. Pregnant women should be considered in prevention and control efforts, including the development of drugs and vaccines against SARS-CoV-2. Further research is needed to confirm the exact impact of COVID-19 infection during pregnancy. To fully quantify this impact, we urgently need to integrate the current knowledge about viral characteristics, epidemiology, disease immunopathology, and potential therapeutic strategies with data from the clinical practice.

Knowledge, Attitudes, and Practices towards COVID-19 of Pregnant Women at a Primary Health Care Facility in South Africa

“…It is also known that pregnant women are vulnerable to infectious diseases that can cause both maternal and foetal adverse outcomes, compared to their non-pregnant counterparts [6]. The recent reports showed that the clinical presentation of COVID-19 among pregnant women is similar to the general population with an increased risk of pregnancy and foetal adverse outcomes such as preterm delivery, foetal distress and low birth weight [7]. The reports from recent studies have found an increased incidence of neonatal pneumonia, cases of vertical transmission to the foetus, and postpartum infections to mothers and their babies [8]- [12].…”

COVID-19 during the Third Semester of Pregnancy: Maternal Characteristic, Possibility of Intrauterine Transmission and Neonatal Outcome in Aceh, Indonesia

“…However, placentas from women with confirmed SARS-CoV during the third trimester show increased intervillous or subchorionic fibrin, which is associated with impaired placental blood flow due to respiratory disease associated with hypoxia [15]. Infant outcomes of convalescent women infected with SARS-CoV during the third trimester include fetal growth restriction and small gestational age [16]. Therefore, there is concern regarding adverse pregnancy and infant outcomes due to intrauterine transmission of infection to the fetus from mothers with confirmed COVID-19.…”

The therapeutic potential of regulatory T cells in reducing cardiovascular complications in patients with severe COVID-19

“…This virus has a genome that is about 30,000 nucleotides (27–32 kb) and encodes structural and accessory proteins [42] . SARS-CoV preserves 79% and 50% of its genetic sequence with MERS and SARS-CoV-1, two other coronaviridae viruses, respectively, and attaches to ACE2 as the receptor for cell infection [43] . According to a large body of evidence, COVID-19 infection causes multi-organ dysfunction in the lung, heart, brain, large intestine, kidneys, and spleen compared to other coronaviruses that are only concerned with respiratory infections express the ACE2 receptor [43] , [44] , [45] , [46] , [47] , [48] .…”