COVID-19 and Pregnancy. When are complications expected?
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v31.i3.27741Keywords:
COVID-19, fetus, infant, infectious disease transmission, newborn, pregnancy, pregnancy outcome, SARS-CoV-2, verticalAbstract
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is a RNA virus that cause coronavirus disease 2019 (COVID-19). The clinical spectrum SARS-COV-2 infection ranges from asymptomatic infection to critical and fatal illness. The expression of host receptor for SARS-CoV-2 cell entry in placental tissue and the identification of SARS-COV-2 in the placental tissue supports that SARS-COV-2 infection may affect pregnancy outcomes. At the moment, there is some evidence of the impact of the infection in pregnancy and fetal outcomes especially in symptomatic cases.
Objectives: The aim of this study was to review the current state of the art of SARS-COV-2 infection during pregnancy and risk of adverse maternal, pregnancy and fetal outcomes, and to assess when these outcomes are most likely to occur.
Main text: Asymptomatic COVID-19 disease in pregnancy is common. When present, symptoms and signs are similar to those in nonpregnant individuals. Infected pregnant women have a higher risk of rapid clinical deterioration and symptomatic pregnant patients appear to be at increased risk of severe disease and death. There is no evidence of an increased risk of congenital abnormalities or pregnancy loss in women with COVID-19 during pregnancy. Vertical transmission does not seem to be common. There is an association between COVID-19 in pregnancy and preterm labour, cesarean delivery, preeclampsia and stillbirth.
Conclusions: Maternal complications are expected in pregnant women with older age, obesity, preexisting comorbidities or unvaccinated. Adverse pregnancy and fetal outcomes are expected in pregnant women with symptomatic disease and when maternal infection occurs after 20 weeks of gestation.
Downloads
References
Gorbalenya AE, Baker SC, Baric RS, et al. The species Severe acute respiratory syndrome related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536-544. doi: https://doi.org/10.1038/s41564-020-0695-z.
WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 (Accessed on February 16, 2021).
Weekly epidemiological update - 16 February 2021. https://www.who.int/publications/m/item/weekly-epidemiological-update---16-february-2021 (Accessed on February 16, 2021).
Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270. doi: https://doi.org/10.1038/s41586-020-2012-7.
Ellington S, Strid P, Tong V, et al. Characteristics of Women of Reproductive Age with Laboratory Confirmed SARS-CoV-2 Infection by Pregnancy Status— United States, January 22 – June 7, 2020. MMWR Morb Mortal Wkly Rep 2020; 69(25):769-75. doi: https://doi.org/10.15585/mmwr.mm6925a1.
Zambrano LD, Ellington S, Strid P, Galang RR, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1641-47. doi: https://doi.org/10.15585/mmwr.mm6944e3.
Jing Y, Run-Qian L, Hao-Ran W, et al. Potential influence of COVID-19/ACE2 on the female reproductive system. Mol Hum Reprod. 2020;26(6):367-373. doi: https://doi.org/10.1093/molehr/gaaa030.
Algarroba GN, Rekawek P, Vahanian SA, et al. Visualization of severe acute respiratory syndrome coronavirus 2 invading the human placenta using electron microscopy. Am J Obstet Gynecol. 2020;223(2):275-278. doi: https://doi.org/10.1016/j.ajog.2020.05.023.
Muyayalo KP, Huang DH, Zhao SJ, Xie T, Mor G, Liao AH. COVID-19 and Treg/Th17 imbalance: Potential relationship to pregnancy outcomes. Am J Reprod Immunol. 2020;84(5):e13304. doi: https://doi.org/10.1111/aji.13304.
Baergen RN, Heller DS. Placental pathology in Covid-19 positive mothers: preliminary findings. Pediatr Dev Pathol. 2020;23(3):177-180. doi: https://doi.org/10.1177/1093526620925569.
Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020;370:m3320. doi: https://doi.org/10.1136/bmj.m3320.
Khan DSA, Hamid LR, Ali A, et al. Differences in pregnancy and perinatal outcomes among symptomatic versus asymptomatic COVID-19-infected pregnant women: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2021;21(1):801. doi: https://doi.org/10.1186/s12884-021-04250-1.
Patberg ET, Adams T, Rekawek P, et al. Coronavirus disease 2019 infection and placental histopathology in women delivering at term. Am J Obstet Gynecol 2021;224(4):382.e1-18. https://doi.org/doi:10.1016/j.ajog.2020.10.020.
Suhren JT, Meinardus A, Hussein K, Schauman N. Meta-analysis on COVID-19-pregnancy-related placental pathologies shows no specific pattern. Placenta 2022;117:72-77. doi: https://doi.org/10.1016/j.placenta.2021.10.010.
Kasehagen L, Byers P, Taylor K, et al. COVID-19-Associated Deaths After SARS-CoV-2 Infection During Pregnancy - Mississippi, March 1, 2020-October 6, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(47):1646-1648. doi: https://doi.org/10.15585/mmwr.mm7047e2.
Galang RR, Newton SM, Woodworth KR, et al. Risk Factors for Illness Severity Among Pregnant Women With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 Infection-Surveillance for Emerging Threats to Mothers and Babies Network, 22 State, Local, and Territorial Health Departments, 29 March 2020-5 March 2021. Clin Infect Dis. 2021;73(Suppl 1):S17-S23. doi: https://doi.org/10.1093/cid/ciab432.
Cosma S, Carosso AR, Cusato J, et al. Coronavirus disease 2019 and first-trimester spontaneous abortion: a case-control study of 225 pregnant patients. 2021;224(4):391.e1-391.e7. doi: https://doi.org/10.1016/j.ajog.2020.10.005.
la Cour Freiesleben N, Egerup P, Hviid KVR, et al. SARS-CoV-2 in first trimester pregnancy: a cohort study. 2021;36(1):40-47. doi: https://doi.org/10.1093/humrep/deaa311.
Rotshenker-Olshinka K, Volodarsky-Perel A, Steiner N, et al. COVID-19 pandemic effect on early pregnancy: are miscarriage rates altered, in asymptomatic women? Arch Gynecol Obstet 2021; 021;303(3):839-845. doi: https://doi.org/10.1007/s00404-020-05848-0.
Metz TD, Clifton RG, Hughes BL, et al. Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19). Obstet Gynecol 2021;137(4):571-580. doi: https://doi.org/10.1097/AOG.0000000000004339.
Woodworth KR, Olsen EO, Neelam V, et al. Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy - SET-NET, 16 Jurisdictions, March 29-October 14, 2020. MMWR Morb Mortal Wkly Rep, 2020;69(44):1635-1640. doi: https://doi.org/10.15585/mmwr.mm6944e2.
Hamilton BE, Martin JA, Osterman MJK. Births: Provisional data for 2020. Vital Statistics Rapid Release; no 12. Hyattsville, MD: National Center for Health Statistics. May 2021. https://www.cdc.gov/nchs/data/vsrr/vsrr012-508.pdf.
Conde-Agudelo A, Romero R. SARS-CoV-2 infection during pregnancy and risk of preeclampsia: a systematic review and meta-analysis. Am J Obstet Gynecol 2022;226(1):68-89.e3. doi: https://doi.org/10.1016/j.ajog.2021.07.009.
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395(10234):1417-18. doi: https://doi.org/10.1016/S0140-6736(20)30937-5.
Villar J, Ariff S, Gunier RB, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: The INTERCOVID multinational cohort study. JAMA Pediatr. 2021;175(8):817-826. doi: https://doi.org/10.1001/jamapediatrics.2021.1050.
Badr DA, Picone O, Bevilacqua E, et al. Severe acute respiratory syndrome coronavirus 2 and pregnancy outcomes according to gestational age at time of infection. Emerg Infect Dis. 2021;27(10):2535-2543. doi: https://doi.org/10.3201/eid2710.211394.
Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843-1844. doi: https://doi.org/10.1001/jama.2020.3786.
Edlow AG, Li JZ, Collier AY, et al. Assessment of maternal and neonatal SARS-CoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19 pandemic. JAMA Netw Open. 2020;3(12):e2030455. doi: https://doi.org/10.1001/jamanetworkopen.2020.30455.
Vivanti AJ, Vauloup-Fellous C, Prevot S, et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020;11(1):3572. doi: https://doi.org/10.1038/s41467-020-17436-6.
Allotey J, Chatterjee S, Kew T, et al. SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis. BMJ. 2022;376:e067696. doi: https://doi.org/10.1136/bmj-2021-067696.
DeSisto CL, Wallace B, Simeone RM, et al. Risk for stillbirth among women with and without COVID-19 at delivery hospitalization - United States, March 2020-September 2021. MMWR Morb Mortal Wkly Rep. 2021;70(47):1640-1645. doi: https://doi.org/10.15585/mmwr.mm7047e1.
Magnus MC, Örtqvist AK, Dahlqwist E, et al. Association of SARS-CoV-2 vaccination during pregnancy with pregnancy outcomes. JAMA. 2022;327(15):1469-1477. doi: https://doi.org/10.1001/jama.2022.3271.
Brinkley E, Mack CD, Albert L, et al. COVID-19 vaccinations in pregnancy: comparative evaluation of acute side effects and self-reported impact on quality of life between pregnant and non-pregnant women in the United States. Am J Perinatol. 2022;10.1055/s-0042-1748158. doi: https://doi.org/10.1055/s-0042-1748158.
Stock SJ, Carruthers J, Calvert C, et al. SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland. Nat Med. 2022;28(3):504-512. doi: https://doi.org/10.1038/s41591-021-01666-2.
Halasa NB, Olson SM, Staat MA, et al. Effectiveness of maternal vaccination with mRNA COVID-19 vaccine during pregnancy against COVID-19-associated hospitalization in infants aged <6 months - 17 States, July 2021-January 2022. MMWR Morb Mortal Wkly Rep. 2022;71(7):264-270. doi: https://doi.org/10.15585/mmwr.mm7107e3.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Daniela Reis Gonçalves, Ana Andrade, Joana Dias, Marta Moreira, António Braga, Luísa Ferreira, Jorge Braga
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.
