Pregnancy and COVID-19

Abstract

There are many unknowns for pregnant women during the COVID-19 pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g. SARS and MERS, has led to pregnant woman being considered potentially vulnerable to severe SARS-CoV-2 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function and coagulation. These may have positive or negative effects on COVID-19 disease progression. The impact of SARS-CoV-2 in pregnancy remains to be determined and a concerted, global effort is required to determine effects on implantation, fetal growth and development, labour and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention and management. As well as direct impacts of the disease, a plethora of indirect consequences of the pandemic will adversely affect maternal health including reduced access to reproductive health services, increased mental health strain and increased socioeconomic deprivation. In this review we explore the current knowledge of COVID-19 in pregnancy and signpost areas for further research to minimise its impact for women and their children.

Pregnancy as a risk factor for severe coronavirus disease 2019 using standardized clinical criteria

“… 24 , 25 Following infection and replication within cells infected with SARS-CoV-2, pyroptosis (inflammation-mediated programmed cell death in response to a pathogenic stimulus) occurs, releasing damage-associated molecular proteins and stimulating a pro-inflammatory response. 26 T cells are attracted to the site of infection; however, as the response is modulated in the context of pregnancy, altered clearance of infected cells may favor severe disease.…”

Sero-surveillance for IgG to SARS-CoV-2 at antenatal care clinics in two Kenyan referral hospitals

“…The impact of pregnancy on susceptibility to SARS-CoV-2 infection is unclear 22 ; however, comparisons of infected pregnant women with non-pregnant women of the same age suggests that a similar proportion of infections become symptomatic 23 . This would suggest a similar proportion of pregnant and non-pregnant women mount a protective antibody response and seroprevalence estimates are generalisable to non-pregnant women of the same age.…”

“…In high income countries, a number of seroprevalence studies have indicated that the proportion of pregnant women who have been infected by SARS-CoV-2 is much greater than the cumulative prevalence identified by PCR testing of symptomatic individuals; seroprevalence estimates range from 5-20% but samples differ in time since the virus first emerged [15][16][17][18][19][20][21] . It remains unclear whether pregnancy alters susceptibility to SARS-CoV-2 infection 22 ; however, a large systematic review has found no difference in risk of becoming symptomatic when comparing pregnant women with confirmed SARS-CoV-2 infection with women of the same age 23 .…”

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

“…An analysis of the WAPM study on COVID-19 reported that early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection ( 300 ). However, significant neonatal respiratory diseases appear to be rare in presence of SARS-CoV-2 positivity ( 301 ). In this context, the key question is whether SARS-CoV-2 can be transmitted to fetuses from a woman infected with COVID-19.…”