The impact of COVID-19 in pregnancy: Part I. Clinical presentations and untoward outcomes of pregnant women with COVID-19

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019, COVID-19) is a pandemic disease with rapidly and widely disseminating to the world. Based on experiences about the H1N1, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) coronavirus pandemics, pregnant women who are infected are disproportionately more likely to develop severe illness and need more hospitalizations, intensive care, and finally die of diseases compared with those nonpregnant counterparts or those pregnant women without infection. Although more than one half of pregnant women with COVID-19 are asymptomatic, and as well as their symptoms are frequently mild, this observation presents a further challenge regarding service provision, prevention, and management, in which this may result in overlooking the risk of COVID-19 during pregnancy. As predictable, despite much advance in critical care in recent decades, during the 2020 COVID-19 pandemic, pregnant women with COVID-19 are really at higher risk to progress to severe illness; require hospitalization; need intensive care, such as the use of mechanical ventilation as well as extracorporeal membrane oxygenation (ECMO), and of most important, die than their nonpregnant counterparts and pregnant women without COVID-19. The magnitude of the risk to pregnant women further extend to their newborn from COVID-19 with resultant significantly increasing perinatal and neonatal morbidity and mortality rates. The heightened risk of untoward outcomes in pregnant women emphasizes an urgent need of national or international recommendations and guidelines to optimize prevention and management strategies for COVID-19 in pregnancy. Active and passive prevention of COVID-19 is approved as effective strategies for women who attempt to be pregnant or during pregnancy. Understanding that pregnant women who are a vulnerable population is essential to improve the care in the novel and urgent COVID-19 pandemic. The current review is a part I to summarize the up-to-date information about the impact of laboratory-confirmed SARS-CoV-2 infection on pregnant women and focus on clinical presentations and untoward pregnancy outcomes of these pregnant women infected with SARS-CoV-2.

The association between pregnancy and COVID-19: A systematic review and meta-analysis

“…It is well known that pregnancy alters the immune system and its response to viral infection, and infection with coronavirus, in theory, could lead to more severe symptoms, especially in the third trimester [ 8 ]. One study found that the incidence of SARS-CoV-2 infection in pregnant women was 3.02 times greater than that in the general population [ 9 ], and Peng-hui Wang et al [ 10 ] pointed out that pregnant women with COVID-19 are more prone to develop severe conditions with a high mortality rate. Previous studies have shown that pregnant women infected with Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) or Middle East Respiratory Syndrome Coronavirus had a higher risk of developing adverse complications.…”

Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants?

“…6 However, these newborns may be complicated by premature preterm labor, which has been dramatically increased in recent years. 7 The challenge is not only exacerbated by shortage of obstetricians and pediatricians, but also associated with a dramatically increasing heavy economic and social burden. 6 To achieve this goal, we are looking forward to seeing the authors' kind response.…”

Clinical and Evolutionary Characteristics of Pregnant and Postpartum Women with COVID-19 Admitted to a Hospital in the Central Region of Brazil

“…Critical meta-analysis studies have identified that pregnant women with CO-VID-19 are more asymptomatic than nonpregnant women of the same age group with COVID-19. However, these pregnant women with COVID-19 indicated a higher likelihood of fatal complications associated with the disease, resulting in a high mortality rate [4] [5].…”