Impact of Co-Occurrence of Obesity and SARS-CoV-2 Infection during Pregnancy on Placental Pathologies and Adverse Birth Outcomes: A Systematic Review and Narrative Synthesis

Abstract

Obesity is a risk factor for severe COVID-19 disease during pregnancy. We hypothesized that the co-occurrence of high maternal body mass index (BMI) and gestational SARS-CoV-2 infection are detrimental to fetoplacental development. We conducted a systematic review following PRISMA/SWiM guidelines and 13 studies were eligible. In the case series studies (n = 7), the most frequent placental lesions reported in SARS-CoV-2(+) pregnancies with high maternal BMI were chronic inflammation (71.4%, 5/7 studies), fetal vascular malperfusion (FVM) (71.4%, 5/7 studies), maternal vascular malperfusion (MVM) (85.7%, 6/7 studies) and fibrinoids (100%, 7/7 studies). In the cohort studies (n = 4), three studies reported higher rates of chronic inflammation, MVM, FVM and fibrinoids in SARS-CoV-2(+) pregnancies with high maternal BMI (72%, n = 107/149; mean BMI of 30 kg/m2) compared to SARS-CoV-2(−) pregnancies with high BMI (7.4%, n = 10/135). In the fourth cohort study, common lesions observed in placentae from SARS-CoV-2(+) pregnancies with high BMI (n = 187 pregnancies; mean BMI of 30 kg/m2) were chronic inflammation (99%, 186/187), MVM (40%, n = 74/187) and FVM (26%, n = 48/187). BMI and SARS-CoV-2 infection had no effect on birth anthropometry. SARS-CoV-2 infection during pregnancy associates with increased prevalence of placental pathologies, and high BMI in these pregnancies could further affect fetoplacental trajectories.

Stress of Prematurity in the Experience of the COVID-19 Pandemic—Current State of Knowledge

“…Pregnant women are also more susceptible to developing pneumonia and acute respiratory distress syndrome, which carries the risk of severe oxygen deprivation for both the mother and the fetus. Severe COVID-19 infection can also serve as an indication for the premature termination of pregnancy for the health of the mother and the fetus, thus warranting iatrogenic preterm delivery [ 11 , 12 , 13 , 14 , 15 , 16 ].…”

“…Severe COVID-19 infection can also serve as an indication for the premature termination of pregnancy for the health of the mother and the fetus, thus warranting iatrogenic preterm delivery [ 12 , 13 , 14 , 15 , 16 ]. Van den Bergh et al in an international cohort study discovered that maternal and neonatal complications were significantly more common in women diagnosed with COVID-19.…”

“…Life 2023, 13, 1757 2 of 16 Moreover, lockdown during the COVID-19 pandemic could have caused modifications in environmental and behavioral life, such as reduction of physical activity, employment, social support and the most common in this group, reduction of access to healthcare-especially gynecological and obstetric [6]. Hedermann et al research presented a slightly increased number of very premature births, with no significant differences in rates of moderate premature, term or post-term births during the COVID-19 pandemic [7].…”

Impact of Obesity and Diabetes in Pregnant Women on Their Immunity and Vaccination

“…The global prevalence of overweight and obesity among pregnant women is increasing, and viral infections in this population can significantly impact the health of both mother and child. In pregnant women with an elevated body mass index (BMI ≥ 25.0 kg/m 2 ), SARS-CoV-2 infection may be associated with placental pathologies such as chronic inflammation, fetal vascular malperfusion, maternal vascular malperfusion, fibrinoid lesions, and myxoid lesions [ 78 ].…”