Abstract
Whilst scientific knowledge about SARS-CoV-2 and COVID-19 is rapidly increasing, much of the effects on pregnant women is still unknown. To accommodate pregnancy, the human endometrium must undergo a physiological transformation called decidualization. These changes encompass the remodeling of endometrial immune cells leading to immunotolerance of the semi-allogenic conceptus as well as defense against pathogens. The angiotensin converting enzyme 2 (ACE2) plays an important regulatory role in the renin-angiotensin-system (RAS) and has been shown to be protective against comorbidities known to worsen COVID-19 outcomes. Furthermore, ACE2 is also crucial for decidualization and thus for early gestation. An astounding gender difference has been found in COVID-19 with male patients presenting with more severe cases and higher mortality rates. This could be attributed to differences in sex chromosomes, hormone levels and behavior patterns. Despite profound changes in the female body during pregnancy, expectant mothers do not face worse outcomes compared with non-pregnant women. Whereas mother-to-child transmission through respiratory droplets during labor or in the postnatal period is known, another question of in utero transmission remains unanswered. Evidence of placental SARS-CoV-2 infection and expression of viral entry receptors at the maternal-fetal interface suggests the possibility of in utero transmission. SARS-CoV-2 can cause further harm through placental damage, maternal systemic inflammation, and hindered access to health care during the pandemic. More research on the effects of COVID-19 during early pregnancy as well as vaccination and treatment options for gravid patients is urgently needed.
Highlights
Since its emergence in December 2019 in Wuhan, China, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected over 250 million people and caused more than 4.9 million deaths worldwide [1, 2]
Since these drugs were thought to increase the expression of angiotensin-converting enzyme 2 (ACE2), it was hypothesized that their application would lead to higher infection rates and more severe COVID-19 cases [65, 66]
As higher levels of soluble ACE2 (sACE2) are correlated with cardiovascular disease and diabetes, known risk factors for more severe cases of COVID-19, this may contribute to the male disadvantage [192]
Summary
Since its emergence in December 2019 in Wuhan, China, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected over 250 million people and caused more than 4.9 million deaths worldwide (as of October 2021) [1, 2]. The disease caused by SARS-CoV-2 is termed Coronavirus Disease 2019 (COVID-19) and was declared a global pandemic in March 2020 [3]. The immune system is altered during pregnancy, resulting in immunotolerance. COVID-19 in Women and Pregnancy of the semi-allogenic conceptus as well as protection of both mother and fetus against pathogens [4]. Research indicates that during pregnancy, expectant mothers are more susceptible to some infectious diseases, such as influenza or Ebola [5, 6]. The aim of this review is to illustrate what is known about COVID-19 and how it affects pregnancy. What is known about implications of COVID-19 infection during pregnancy will be reviewed, with particular focus on the possibility of vertical transmission of SARS-CoV-2
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