Severe acute respiratory syndrome coronavirus-2 and the deduction effect of angiotensin-converting enzyme 2 in pregnancy

Abstract

The 2019 novel coronavirus (2019-nCoV, later named SARS-CoV-2) is a pandemic disease worldwide. The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is continuing at a rapid speed. Till May 4, 2020, there have been 3,407,747 confirmed cases and 238,198 deaths globally. The common symptoms in pregnant women are fever, cough, and dyspnea. Angiotensin-converting enzyme 2 (ACE2) has transient overexpression and increased activity during pregnancy, which is now confirmed as the receptor of SARS-CoV-2 and plays essential roles in human infection and transmission. There is no evidence that pregnant women are more susceptible to SARS-CoV-2. To date, there is no valid medication or vaccination. The immune suppression or modulation during pregnancy increases the risk of severe pneumonia. Remdesivir is an antiviral medication targeting ribonucleic acid (RNA) synthesis that has clinical improvement in the treatment of SARS-CoV-2. Chloroquine is controversial in its effectiveness and safety to treat SARS-CoV-2. Remdesivir is safe in pregnancy. Chloroquine has not been formally assigned to a pregnancy category by the Food and Drug Administration (FDA). The management strategy includes monitoring fetal heart rate and uterine contractions; early oxygenation if O 2 saturation is less than 95%; empiric antibiotics for prevention of secondary infection; corticosteroid to treat maternal SARS-CoV-2 disease routinely is not suggested, only for fetal lung maturation in selected cases; and consideration of delivery is according to the obstetric indication, gestational age, and severity of the disease. During epidemics, delivery at 32–34 weeks is considered. The indication for the Cesarean section should be flexible to minimize the risk of infection during the delivery. The newborn should be in isolation ward immediately after birth; breastfeeding is not contraindicated but should avoid direct transmission infection.

SARS-CoV-2 in Pregnant Women: Consequences of Vertical Transmission

“…In addition, a few studies illustrated that the SARS-CoV-2 virus almost consistently targeted the placenta for its replication, more specifically targeting the Syncytiotrophoblast cells for its replication ( Baud et al., 2020 ; Fenizia et al., 2020 ; Hosier et al., 2020 ; Pulinx et al., 2020 ; Vivanti et al., 2020b ). Furthermore, the ACE2 receptor, which is critical for SARS-CoV-2 entry into the host cells, was frequently expressed in the maternal-fetal interface cells, hence justifying why the Syncytiotrophoblast cells in the placenta were primarily targeted by SARS-CoV-2 for viral replication ( Fenizia et al., 2020 ; Golden and Simmons, 2020 ; Lai et al., 2020 ). Additionally, it was inferred that the presence of SARS-CoV-2 in these critical Syncytiotrophoblast cells may have led to intervillosis (miscarriage) in infected pregnant women ( Baud et al., 2020 ; Fenizia et al., 2020 ; Hosier et al., 2020 ; Pulinx et al., 2020 ; Vivanti et al., 2020b ) and occasional death in newborns as observed in several studies ( Knight et al., 2020 ; Pulinx et al., 2020 ; Zhu et al., 2020 )) since these cells played a significant role in the exchange of vital nutrients, antibodies, and Oxygen between the mother and child ( Aplin, 2010 ).…”

Letter to the editor: COVID-19 Vaccines and Breastfeeding

“…(Dashraath et al, 2020). To this must be added that the experience of SARS-CoV-2 in pregnant and lactating women is limited (Lai et al, 2020).…”

A review of severe acute respiratory syndrome coronavirus 2 infection in the reproductive system

“…Based on the limited data, the possibility of testicular damage and possibly subsequent impairment of daily activities in human beings still have an uncertain influence on the male and female fertility, including the performance and pregnancy status after SARS-CoV-2 infection. 26 , 27 We should pay attention to reproductive health, especially in male patients, under the potential risk of SARS-CoV-2 infection. The relevance between SARS-CoV-2 infection and fertility function needs further warranted.…”