The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has been associated with worse outcomes in several patient populations, including the elderly and those with chronic comorbidities. Data from previous pandemics and seasonal influenza suggest that pregnant women may be at increased risk for infectionassociated morbidity and mortality. Physiologic changes in normal pregnancy and metabolic and vascular changes in high-risk pregnancies may affect the pathogenesis or exacerbate the clinical presentation of COVID-19. Specifically, SARS-CoV-2 enters the cell via the angiotensin-converting enzyme 2 (ACE2) receptor, which is upregulated in normal pregnancy. Upregulation of ACE2 mediates conversion of angiotensin II (vasoconstrictor) to angiotensin-(1-7) (vasodilator) and contributes to relatively low blood pressures, despite upregulation of other components of the reninangiotensin-aldosterone system. As a result of higher ACE2 expression, pregnant women may be at elevated risk for complications from SARS-CoV-2 infection. Upon binding to ACE2, SARS-CoV-2 causes its downregulation, thus lowering angiotensin-(1-7) levels, which can mimic/worsen the vasoconstriction, inflammation, and pro-coagulopathic effects that occur in preeclampsia. Indeed, early reports suggest that, among other adverse outcomes, preeclampsia may be more common in pregnant women with COVID-19. Medical therapy, during pregnancy and breastfeeding, relies on medications with proven safety, but safety data are often missing for medications in the early stages of clinical trials. We summarize guidelines for medical/obstetric care and outline future directions for optimization of treatment and preventive strategies for pregnant patients with COVID-19 with the understanding that relevant data are limited and rapidly changing.

Women with PEC have higher RVSP, higher rates of abnormal diastolic function, decreased global RVLSS, increased left-sided chamber remodeling, and higher rates of peripartum pulmonary edema, when compared with healthy pregnant women.

The purposes of this study were to 1) characterize changes in fibrinolytic activity in response to maximal exercise and 5-min venous occlusion and 2) compare responses in men of various habitual physical activity levels. Tissue plasminogen activator (TPA) activity and plasminogen activator inhibitor 1 (PAI-1) activity were measured in 15 inactive, 15 regularly active, and 15 highly active men. Data were analyzed using a three-way analysis of variance with repeated measures. Pretest TPA activity was similar among groups. TPA activity increased postexercise with higher values seen in the active groups (P < 0.001). The highly active group also significantly increased TPA activity postvenous occlusion (P < 0.01). Pretest PAI-1 activity was different among groups, with the inactive group showing the highest activity and the highly active group the lowest (P < 0.05). PAI-1 activity decreased with exercise (P < 0.01) but did not change with venous occlusion. In conclusion, active men exhibited greater changes in fibrinolytic activity with maximal exercise and venous occlusion than inactive men. This enhanced fibrinolytic activity may be an important mechanism mediating the cardioprotective effect provided by regular physical activity.

Objective To evaluate fetal responses to strenuous exercise in physically active and inactive women. Study Design 45 healthy women (15 Non-Exercisers, 15 Regularly Active, 15 Highly Active) underwent a peak treadmill test at 28-0/7 to 32-6/7 weeks. Fetal well-being [umbilical artery Dopplers, fetal heart tracing/rate, biophysical profile (BPP)] was evaluated pre and post-exercise. Uterine artery Dopplers were also obtained. Results Umbilical and uterine artery Doppler indices were similar among activity groups and did not change with exercise (P>.05). BPP and fetal heart tracings were reassuring in all groups. However, subgroup analyses showed transient post-exercise fetal heart rate decelerations and elevated umbilical and uterine artery Doppler indices in 5 Highly Active women. Following this, BPP and fetal heart tracings were reassuring. Conclusions Overall fetal well-being is reassuring after short-duration, strenuous exercise in both active and inactive pregnant women. A subset of Highly Active women experienced transient fetal heart rate decelerations and Doppler changes immediately after exercise. Athletes may push beyond a threshold intensity at which fetal well-being may be compromised. However, potential impact on neonatal outcomes is unknown.