COVID‐19 in pregnant women and children: Insights on clinical manifestations, complexities, and pathogenesis

Abstract

Pregnancy changes the body's immune system to counteract the spectrum of infections, including COVID-19, which can pose complications. Pregnant women are less likely to contract COVID-19 infections than the general public. However, pregnant women are at slightly increased risk of becoming severely unwell if they do catch COVID-19, and congenital conditions in pregnant women may worsen the state of infection and lead to critical stages and even mortality. The possibility of vertical transmission has been reported in only a few cases of COVID-19; however, it was not noted in cases of SARS and MERS. Vaccination coverage in pregnant women remains a challenge. Children are the next suspected and vulnerable population to acquire infection after the first and second waves. Children are disproportionately infected compared with older populations, but the severity of infection is less compared to adults. This review highlights the complexities of COVID-19 in pregnant women and the underlying reasons why children tend to be comparatively less severely affected.Ethnicity, nutrition, lifestyle, and therapeutics influence the severity of infection in children. Low expression of angiotensin-converting enzyme 2 receptors, indigenous virus competence, and maternal immunity is the first-line defense for children against COVID-19. Habituating herbal medicines from childhood may help support a robust and defensive immune system to counteract novel antigens and encourage healthy generations.

Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate

“…Nevertheless, pregnant women with mild COVID-19 have similar obstetric outcomes as uninfected pregnant women [33] . Furthermore, the death rate in pregnant women with symptomatic COVID-19 is higher (OR: 1.84, 95 % CI: 1.26–2.69) than non-pregnant women [33] , [34] .…”

“…Several studies show a higher risk of severe disease, pneumonia, admission to the ICU, mechanical ventilation, and the need for extracorporeal membrane oxygenation in pregnant women in any trimester of pregnancy, compared to non-pregnant women of the same age [33] , [34] , [80] . Nevertheless, pregnant women with mild COVID-19 have similar obstetric outcomes as uninfected pregnant women [33] .…”

“…Pregnant women suffer a similar rate of clinical complications; however, women with mild infection experience the same outcomes as uninfected pregnant women [33] . Pregnant women with severe and critical diseases have a higher risk of perinatal infection, morbidity, and maternal death [33] , [34] .…”

Associations and Disease–Disease Interactions of COVID-19 with Congenital and Genetic Disorders: A Comprehensive Review

“…Since the ACE2, the host cell receptor interacting with the SARS-CoV-2 spike protein (S) and S protein proteases (furin and the transmembrane serine protease TMPRSS2, which are needed for viral S protein priming) are expressed in early gametes, zygotes, and four-cell stage embryos [ 188 ] and since developing human embryos also possess the machinery necessary for viral internalization and replication, it is possible that the in utero maternal to fetal transmission of SARS-CoV-2 might occur during early pregnancy [ 188 ]. In a recent study of an early miscarriage in a SARS-CoV-2 maternal infection, prominent damage of the placenta and fetal organs, such as lung and kidney, was reported, indicating that congenital SARS-CoV-2 infection during the first trimester of pregnancy is possible and that coronaviruses target fetal organs [ 189 ]. Although it was suggested that congenital SARS-CoV-2 infection during early pregnancy could potentially trigger neurodevelopmental complications [ 178 ], no supporting evidence has been reported, so far.…”

“…Although it was suggested that congenital SARS-CoV-2 infection during early pregnancy could potentially trigger neurodevelopmental complications [ 178 ], no supporting evidence has been reported, so far. Furthermore, it was established that pregnant women are less likely to contract SARS-CoV-2 than the general public [ 189 ], and that the likelihood of SARS-CoV-2 vertical transmission is low [ 190 , 191 , 192 , 193 , 194 , 195 ]. For example, only 5.7% of 176 neonatal SARS-CoV-2 infections cases were classified as confirmed congenital infections [ 196 ].…”