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Review
. 2024 Aug;92(2):e13915.
doi: 10.1111/aji.13915.

Preeclampsia in the Context of COVID-19: Mechanisms, Pathophysiology, and Clinical Outcomes

Guilherme M Nobrega  1   2 , Brittany R Jones  2 , Indira U Mysorekar  2   3   4 , Maria Laura Costa  1
Affiliations
Review

Preeclampsia in the Context of COVID-19: Mechanisms, Pathophysiology, and Clinical Outcomes

Guilherme M Nobrega et al. Am J Reprod Immunol. 2024 Aug.

Abstract

The emergence of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to the global COVID-19 pandemic, significantly impacting the health of pregnant women. Obstetric populations, already vulnerable, face increased morbidity and mortality related to COVID-19, aggravated by preexisting comorbidities. Recent studies have shed light on the potential correlation between COVID-19 and preeclampsia (PE), a leading cause of maternal and perinatal morbidity worldwide, emphasizing the significance of exploring the relationship between these two conditions. Here, we review the pathophysiological similarities that PE shares with COVID-19, with a particular focus on severe COVID-19 cases and in PE-like syndrome cases related with SARS-CoV-2 infection. We highlight cellular and molecular mechanistic inter-connectivity between these two conditions, for example, regulation of renin-angiotensin system, tight junction and barrier integrity, and the complement system. Finally, we discuss how COVID-19 pandemic dynamics, including the emergence of variants and vaccination efforts, has shaped the clinical scenario and influenced the severity and management of both COVID-19 and PE. Continued research on the mechanisms of SARS-CoV-2 infection during pregnancy and the potential risk of developing PE from previous infections is warranted to delineate the complexities of COVID-19 and PE interactions and to improve clinical management of both conditions.

Keywords: COVID‐19; SARS‐CoV‐2; complement system proteins; maternal morbidity; preeclampsia; renin‐angiotensin system; tight junctions.

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Conflict of interest statement

Conflict of Interest Statement

GMN, BRJ and MLC declare no conflict of interest. IUM serves on the scientific advisory board of Seed Health.

Figures

Figure 1.
Figure 1.
Gross features and cellular and molecular pathway intersections of SARS-CoV-2 infection and preeclampsia on the placenta.
Figure 2.
Figure 2.
Timeline of COVID-19 pandemic dynamics and repercussions on preeclampsia.
See this image and copyright information in PMC

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