Coronavirus Disease-2019 in Pregnancy

Abstract

Coronavirus disease-2019 (COVID-19) infection during pregnancy is associated with severe complications and adverse effects for the mother, the fetus, and the neonate. The frequency of these outcomes varies according to the region, the gestational age, and the presence of comorbidities. Many COVID-19 interventions, including oxygen therapy, high-flow nasal cannula, and invasive mechanical ventilation, are challenging and require understanding physiologic adaptations of pregnancy. Vaccination is safe during pregnancy and lactation and constitutes the most important intervention to reduce severe disease and complications.

Keywords: Acute respiratory distress syndrome; COVID-19; Perinatal outcomes; Pregnancy; SARS-CoV-2.

Fig. 1

Inflammatory responses in the placenta upon SARS-CoV-2 infection. Infected placentas show extensive infiltration of maternal immune cells. Angiotensin-converting enzyme 2 (ACE2) is the receptor of SARS-CoV-2 and plays a key role in pregnancy infection and complications. The placental mRNA expression of ACE2 is gestational age-dependent, increasing from the first- (7 to 9 weeks) through the third trimester (38 to 41 weeks). ACE2 is highly expressed in maternal-fetal interface cells, including stromal cells and perivascular cells of decidua, the cytotrophoblast, and syncytiotrophoblast in the placenta. In response to maternal-fetal infection, the syncytiotrophoblast shows increased chemokines and inflammatory markers expression.^, ACE2, angiotensin-converting enzyme 2; SDHA, succinate-ubiquinone oxidoreductase; TOP1, topoisomerase 1.

Fig. 2

Flowchart of management of severely critically ill pregnant women with COVID-19.