A Comprehensive Review of the Management of Pregnant Women with COVID-19: Useful Information for Obstetricians

Abstract

Due to the physiological changes of the cardiovascular system and respiratory system in pregnancy, pregnant women are vulnerable to pathogen infection and severe pneumonia. With the increasing incidence of COVID-19 pneumonia, its influence on pregnant women and neonates has attracted more attention. In this review, we collected all relevant articles published in English from September 1, 2019 to June 10, 2021, regarding the epidemiology, clinical presentations, chemical examinations, imaging findings, the timing of delivery and delivery mode, maternal and neonatal complications, medication, and vertical transmission of COVID-19 in pregnancy. It has been reported that compared with nonpregnant females, pregnant women with COVID-19 are more likely to develop into severe type. In particular, the risk of entering the intensive care unit and endotracheal intubation was higher. Chest computed tomography and blood routine examination are useful for the diagnosis of COVID-19 in a short period of time. COVID-19 pneumonia is not an independent indication for terminating the pregnancy, and it is not contraindicated for vaginal delivery. Compared to normal pregnant females, patients with COVID-19 showed an elevated susceptibility of preterm delivery. Multidisciplinary consultation was suggested in the treatment policy of COVID-19 in pregnancy. Currently, there is no evaluation on the safety, efficacy, and immunity of the approved vaccines for mothers and infants. In human placental tissues, the COVID-19 virus has been found by different detection methods. The mechanism by which the virus enters the placental tissue is unclear, which may be related to placental inflammation. The long-term prognosis of pregnant women with COVID-19 remains unclear and requires further detailed investigation.

What to Expect from COVID-19 and from COVID-19 Vaccine for Expecting or Lactating Women

“…Currently available data suggest that pregnant women with symptomatic infection develop a more severe disease compared to nonpregnant women [9][10][11]. This leads to an increase in terms of Intensive Care Unit (ICU) admission, need for mechanical ventilation, and for cardiocirculatory and pulmonary support through Extra-Corporeal Membrane Oxygenation (ECMO) [11][12][13][14][15][16]. A multicentric observational study performed on 2130 pregnant women (796 with SARS-CoV-2 infection and 1424 not infected), shows that the risk of maternal mortality is 22 times higher in the COVID-19 group compared to the control group of non-infected women [12].…”

COVID‐19 pharmacotherapy utilization patterns during pregnancy: International Registry of Coronavirus Exposure in Pregnancy

“… 1 , 2 , 3 , 4 Therefore, pregnant patients with symptomatic SARS‐CoV‐2 infection have been, and will be, treated to prevent or cure severe COVID‐19. 5 …”

“…Women infected with SARS‐CoV‐2 during pregnancy are at risk of developing severe illness and experience a higher rate of preterm births than pregnant women who are not infected 1–4 . Therefore, pregnant patients with symptomatic SARS‐CoV‐2 infection have been, and will be, treated to prevent or cure severe COVID‐19 5 …”

Factors Affecting the Preparedness of Pregnant Women Facing COVID-19 Vaccination

“…COVID-19 infection can be highly contagious through the air from the respiratory tract and close contact, and can be passed from one person to another. The clinical manifestations of this disease vary from mild to severe (Guo & Yang, 2021). Pregnant women and neonates are two high-risk populations that suffer from disproportionate rates of morbidity and mortality.…”