Does <scp>COVID</scp>‐19 cause pre‐eclampsia?

Khalil, Asma; Samara, Athina; Chowdhury, Tasnim; O’Brien, Pat

doi:10.1002/uog.24809

Cited by 20 publications

(10 citation statements)

References 64 publications

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“…Initial investigations of pregnant women infected with SARS-CoV-2 had revealed the development of a preeclampsia-like syndrome 145 , 146 . Later evidence supported COVID-19 as a risk factor for preeclampsia 7 , 147 and indicated a dose-response relationship with disease severity 6 ; however, the mechanisms and causality of such an association are still poorly understood 65 , 147 , 148 . Our current findings revealed that some proteins implicated in inflammatory and angiogenic processes were perturbed in patients with COVID-19, regardless of pregnancy status; yet, specific proteins were only modified by SARS-CoV-2 infection in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy-specific responses to COVID-19 revealed by high-throughput proteomics of human plasma

et al. 2023

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Background Pregnant women are at greater risk of adverse outcomes, including mortality, as well as obstetrical complications resulting from COVID-19. However, pregnancy-specific changes that underlie such worsened outcomes remain unclear. Methods Plasma samples were collected from pregnant women and non-pregnant individuals (male and female) with (n = 72 pregnant, 52 non-pregnant) and without (n = 29 pregnant, 41 non-pregnant) COVID-19. COVID-19 patients were grouped as asymptomatic, mild, moderate, severe, or critically ill according to NIH classifications. Proteomic profiling of 7,288 analytes corresponding to 6,596 unique protein targets was performed using the SOMAmer platform. Results Herein, we profile the plasma proteome of pregnant and non-pregnant COVID-19 patients and controls and show alterations that display a dose-response relationship with disease severity; yet, such proteomic perturbations are dampened during pregnancy. In both pregnant and non-pregnant state, the proteome response induced by COVID-19 shows enrichment of mediators implicated in cytokine storm, endothelial dysfunction, and angiogenesis. Shared and pregnancy-specific proteomic changes are identified: pregnant women display a tailored response that may protect the conceptus from heightened inflammation, while non-pregnant individuals display a stronger response to repel infection. Furthermore, the plasma proteome can accurately identify COVID-19 patients, even when asymptomatic or with mild symptoms. Conclusion This study represents the most comprehensive characterization of the plasma proteome of pregnant and non-pregnant COVID-19 patients. Our findings emphasize the distinct immune modulation between the non-pregnant and pregnant states, providing insight into the pathogenesis of COVID-19 as well as a potential explanation for the more severe outcomes observed in pregnant women.

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Section: Discussionmentioning

confidence: 99%

Pregnancy-specific responses to COVID-19 revealed by high-throughput proteomics of human plasma

et al. 2023

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“…Pregnant women can be selected for antibiotic prophylaxis: by the presence of perinatal risk factors (premature birth, PPROM, fever, presence of GBS in the urine during pregnancy, or neonatal infection with GBS during a prior pregnancy), in the event of previously established GBS colonization in the third trimester of pregnancy, typically between the 35th and 37th week, or in the case of established perinatal GBS colonization of the mother. Nevertheless, in 2019 the Health Council of Slovenia adopted a proposal to introduce universal screening for GBS in the 35th to 37th week of pregnancy ( 49 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis: where do we stand now?

et al. 2023

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Intraamniotic infection is an infection resulting in the inflammation of any combination of the amniotic fluid, the placenta, the fetus itself, the fetal membranes, umbilical cord, or the decidua. In the past, an infection of the amnion and chorion or both was dubbed chorioamnionitis. In 2015, a proposal was made by an expert panel that, instead of clinical chorioamnionitis, the name intrauterine inflammation or infection or both be used, abbreviated as Triple I or simply IAI. However, the abbreviation IAI did not gain popularity, and this article uses the term chorioamnionitis. Chorioamnionitis may arise prior to, during, or following labor. It can present as a chronic, subacute, or acute infection. Its clinical presentation is generally referred to as acute chorioamnionitis. The treatment of chorioamnionitis varies widely across the world due to different bacterial causes and the absence of sufficient evidence to support a specific treatment regimen. There are limited randomized controlled trials that have evaluated the superiority of antibiotic regimens for treating amniotic infections during labor. This lack of evidence-based treatment suggests that the current choice of antibiotics is based on limitations in existing research, rather than absolute science. Chorioamnionitis cannot be cured by antibiotic therapy alone without delivery, and therefore it is necessary to make a decision according to the guidelines for induction of labor or acceleration of delivery. When a diagnosis is suspected or established, it is therefore necessary to apply broad-spectrum antibiotics according to the protocol used by each country, and to continue with them until delivery. A commonly recommended first-line treatment for chorioamnionitis is a simple regimen consisting of amoxicillin or ampicillin and once-daily gentamicin. Available information is not sufficient to indicate the best antimicrobial regimen to treat this obstetric condition. However, the evidence that is currently available suggests that patients with clinical chorioamnionitis, primarily women with a gestational age of 34 weeks or more and those in labor, should receive treatment with this regime. However, antibiotic preferences may vary based on local policy, clinician experience and knowledge, bacterial reasons for the infection, antimicrobial resistance patterns, maternal allergies, and drug availability.

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“…The most recent meta-analysis [6] has become a milestone in knowledge regarding the relationship between COVID-19 and preeclampsia; however, the wide majority (over 94%) of patients considered were diagnosed by PCR testing at time of admission for delivery [26]. Given the contradiction with cohorts that have failed to find an association when including infection throughout pregnancy or employing This article is protected by copyright.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Severe Acute Respiratory Syndrome-Coronavirus-2 Antibody Status at the Time of Delivery and the Risk of Preeclampsia

et al. 2023

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Objective: Evaluate the association between SARS-CoV-2 serologic status in immunologically naïve patients and risk of preeclampsia at time of delivery. Study design: We conducted a retrospective cohort study of pregnant patients admitted to our institution from August 1st to September 30th, 2020. We recorded maternal medical and obstetric characteristics, and SARS-CoV-2 serologic status. Our primary outcome was the incidence of preeclampsia. Antibody testing was performed and patients were classified into seropositive groups: IgG+, IgM+, or both IgG+ and IgM+. Bivariate and multivariable analyses were performed. Results: We included 275 patients that were negative for SARS-CoV-2 antibodies, and 165 that were positive. Seropositivity was not associated with higher rates of preeclampsia (p=0.183), or with preeclampsia with severe features (p=0.916) even after adjusting for maternal age> 35, BMI≥ 30, nulliparity, and previous history of preeclampsia, and type of serologic status. Previous preeclampsia had the greatest association with development of preeclampsia (OR=13.40 95% CI [4.98-36.09]; p< 0.05), and with preeclampsia with severe features (OR=5.46 95% CI [1.65-18.02]; p< 0.05). Conclusions: We found that in an obstetric population there was no association between SARS-CoV-2 antibody status and the risk of preeclampsia.

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Does COVID‐19 cause pre‐eclampsia?

Cited by 20 publications

References 64 publications

Pregnancy-specific responses to COVID-19 revealed by high-throughput proteomics of human plasma

Pregnancy-specific responses to COVID-19 revealed by high-throughput proteomics of human plasma

Clinical chorioamnionitis: where do we stand now?

Severe Acute Respiratory Syndrome-Coronavirus-2 Antibody Status at the Time of Delivery and the Risk of Preeclampsia

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