Is pregnancy an immunological contributor to severe or controlled COVID‐19 disease?

Abstract

Since its emergence in Wuhan as a novel coronavirus disease, it has taken only a few months since January 2020 for it to be recognized as a widespread COVID-19 pandemic which has contributed to global health devastation. As pointed out by health experts, it is a once in a century pandemic of our times. Clinical observations so far indicate that the older population and immune compromised individuals, particularly in African American and Hispanic/Latino communities, are at much higher risk for infection with this novel coronavirus. In this regard, pregnancy offers an altered immunity scenario which may allow severe COVID-19 disease. The literature is so far highly conflicting on this issue. This review will offer a conceptual basis for severe or controlled disease and address trepidations for pregnant women associated with COVID-19 pandemic, particularly in the comparative context of clinical consequences of other coronaviruses such as SARS and MERS. We will highlight the possible consequences of COVID-19 on the general health of pregnant women as well as its possible effects at the maternal-fetal interface. For the placenta-related pathology, we will focus our discussion on the temporal expression of ACE2 throughout gestation for possible propagation of SARS-CoV-2 in the placenta in infected women and ensuing consequences.

An Immunological Perspective: What Happened to Pregnant Women After Recovering From COVID-19?

“…An elevated number of Tfh17 may play a role in maintaining humoral immune memory. Exhausted CD8 + T cells (CD3 + CD8 + PD-1 + ) showed an elevated tendency after recovery, which may be a hint left during infection that T-cell exhaustion curtailed T-cell responses leading to slow, subacute propagation of COVID-19 ( 9 ).…”

Risk Factors Contributing in Increased Susceptibility and Severity of COVID-19 Infection during Pregnancy

“…In fact, SARS-CoV-2 enters the cell via the angiotensin-converting enzyme 2 (ACE2) receptor, which is upregulated in normal pregnancy [25]. For the placenta-related pathology, we will focus our discussion on the temporal expression of ACE2 throughout gestation for possible propagation of SARS-CoV-2 in the placenta in infected women and ensuing consequences [26].…”

Special issue on COVID‐19 and pregnancy: Consequences for maternal and neonatal health

“…One major factor that has baffled clinicians and scientists is that this pandemic has spread in a sustained manner without a significant reduction in transmissibility. Among the vulnerable populations, pregnant women and their fetuses have traditionally represented a high‐risk population during viral pandemics; however, this pandemic demonstrated altered maternal immunity 2,3 and effect on gametogenesis 4 and organogenesis, 5 and placental function 6,7 . To date, the outcomes of several cohorts of pregnant women have been reported, with no definite evidence of mortality and vertical transmission 8‐10 .…”

“…In this Special Issue, we have compiled a collection of twelve manuscripts that cover most of the important issues relating to COVID‐19 and pregnancy. The manuscripts cover themes on immunology, placenta, receptor biology, risk factors to infection progression, and most importantly clinical consequences 2‐8,11‐14 . Each review is authored by experts on the specific topic of their respective research and/or clinical work.…”