Maternal immune responses and obstetrical outcomes of pregnant women with COVID-19 and possible health risks of offspring

Abstract

Coronavirus disease 2019 (COVID-19) pandemic has spread rapidly across the world. The vast majority of patients with COVID-19 manifest mild to moderate symptoms but may progress to severe cases or even mortalities. Young adults of reproductive age are the most affected population by SARS-CoV-2 infection. However, there is no consensus yet if pregnancy contributes to the severity of COVID-19. Initial studies of pregnant women have found that COVID-19 significantly increases the risk of preterm birth, intrauterine growth restriction, and low birth weight, which have been associated with non-communicable diseases in offspring. Besides, maternal viral infections with or without vertical transmission have been allied with neurological and behavioral disorders of the offspring. In this review, obstetrical outcomes of women with COVID-19 and possible risks for their offspring are discussed by reviewing maternal immune responses to COVID-19 based on the current evidence. Structural and systemic follow-up of offspring who are exposed to SARS-CoV-2 in-utero is suggested.

Keywords: Behavioral disorders; COVID-19; Obstetrical outcomes; Offspring; SARS-CoV-2.

Fig. 1

Possible lofng-term impact on offspring health exposed to SARS-CoV-2 infection during pregnancy. Maternal SARS-CoV-2 infection may directly and indirectly via placental pathology, induce preterm birth, intrauterine growth restriction, low birth weight, and possible early pregnancy loss. Placenta, with and without the presence of SARS-CoV-2, may develop vascular placental mal-perfusion and functional impairment, consequently developing obstetrical complications. Fetal SARS-CoV-2 infection has been reported. However, the evidence of fetal immune activation or pro-inflammatory cytokine production by fetal immune effectors has not been reported. If any, fetal functional immune responses to SARS-CoV-2 may induce pregnancy complications as well (dotted lines). Considering maternal immune responses to SARS-CoV-2, and obstetrical complications associated with COVID-19, possible long-term impacts on offspring health are presented.