Impact of COVID-19 on pregnant women's health: Consequences in obstetrics two years after the pandemic

Abstract

The pandemic linked to SARS-CoV-2 has profoundly disrupted the health systems and many studies have led to a better understanding of this virus, which is responsible for severe disease, particularly during pregnancy. Pregnancy is a risk factor for severe COVID-19. Term of pregnancy and vaccination status is the main risk factor in addition to classic comorbidities like general population. COVID-19 during pregnancy is responsible for more maternal death, stillbirth, pre-eclampsia spontaneous and induced prematurity. Vaccination is therefore strongly recommended for pregnant patients. In addition, the COVID-19 pandemic has highlighted a psychological and social dimension that should not be neglected in the management of a pregnant patient. Correlation between immunological changes and clinical impact are described in this review. Many conclusions can now be made and are summarized in this article in order to discuss possible future research.

Keywords: Chorioamnionitis; Inflammation; Preeclampsia like diseases; Pregnancy comorbidity; Pregnancy follow-up; Preterm birth; Telemedicine.

Graphical abstract

Fig. 1

Biology of SARS-CoV-2 infection and observed clinical effect. After infection of upper respiratory track, the virus disseminate in tissues expressing ACE2 and TRMPSS2 receptors. Together with viral replication patients with COVID-19 present with lymphopenia and high level of cytokine expression. Lymphopenia prone to infections with the microbe, which leads to disease progression and increased severity. In addition, cytokine storms can initiate inflammatory-induced multiple organ dysfunction, including lung injury that can lead to Acute respiratory distress syndroma (ARDS), respiratory failure, liver injury, kidney injury, and heart injury (Eijk et al., 2021; Yang et al., 2020). When patient are pregnant women these changes were able to increase maternal and fetal morbidity. Modification of cytokines and immune cells in maternal circulation and at the maternal-fetal interface may impact the pregnancy outcome (Zhao et al., 2022; Lu-Culligan et al., 2021; Garcia-Flores et al., 2022). Likethe hyperactivation of Hofbauer cells, effect on Galectin were observed that may impact the pregnancy outcome (Fangqi Zhao, AC Tallarek et al. ESRI 2022; Borwosky et al., 2022). In the peripheral blood, sEVs – small Extracellular vesicules composition are shown to be modified during COVID-19 infection and their role in the crosstalk between fetal tissues and mother immune system impaired (Tertel et al., 2022, Zabel Rachel et al., 2022). The modification of these markers drive many authors to evoque a preeclampsia like environment as the effect described in the following part of our review (Tertel et al., 2022; Schwartz et al., 2022; Conde-Agudelo and Romero, 2022). More surprisingly, placental damage appears to be 1) independent of the severity of maternal symptoms and 2) possible even without trophoblastic cells infection (Schwartz et al., 2021, Garcia-Flores et al., 2022). Finally, although described, maternal-fetal transmission of the virus is rare, and the direct consequences seem to be minor. Therefore the indirect placental vascular damage is the most harmful (Schwartz et al., 2021, Vivanti et al., 2020).

Fig. 2

Obstetrical complications potentially linked to SARS-CoV-2. SARS-CoV-2 placentitis is defined by increased perivillous fibrin deposition, histiocytic intervillositis and trophoblast necrosis. These changes can cause extensive placental damage leading to placental malperfusion and insufficiency that is incompatible with intrauterine survival. This locally confined changes of the placenta need our further vigilance and evaluation (Tallarek et al., 2021; ESRI, 2022).