SARS-CoV-2 in diabetic pregnancies: a systematic scoping review

Claudia Eberle,Tamarra James-Todd,Stefanie Stichling

doi:10.1186/s12884-021-03975-3

Claudia Eberle, Tamarra James-Todd + Show 1 more

Open Access

https://doi.org/10.1186/s12884-021-03975-3

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Abstract

BackgroundCurrently, we suffer from an increasing diabetes pandemic and on the other hand from the SARS-CoV-2 pandemic. Already at the beginning of the SARS-CoV-2 pandemic, it was quickly assumed that certain groups are at increased risk to suffer from a severe course of COVID-19. There are serious concerns regarding potential adverse effects on maternal, fetal, and neonatal outcomes. Diabetic pregnancies clearly need special care, but clinical implications as well as the complex interplay of diabetes and SARS-CoV-2 are currently unknown. We summarized the evidence on SARS-CoV-2 in diabetic pregnancies, including the identification of novel potential pathophysiological mechanisms and interactions as well as clinical outcomes and features, screening, and management approaches.MethodsWe carried out a systematic scoping review in MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection in September 2020.ResultsWe found that the prognosis of pregnant women with diabetes mellitus and COVID-19 may be associated with potential underlying mechanisms such as a simplified viral uptake by ACE2, a higher basal value of pro-inflammatory cytokines, being hypoxemic as well as platelet activation, embolism, and preeclampsia. In the context of “trans-generational programming” and COVID-19, life-long consequences may be “programmed” during gestation by pro-inflammation, hypoxia, over- or under-expression of transporters and enzymes, and epigenetic modifications based on changes in the intra-uterine milieu. COVID-19 may cause new onset diabetes mellitus, and that vertical transmission from mother to baby might be possible.ConclusionsGiven the challenges in clinical management, the complex interplay between COVID-19 and diabetic pregnancies, evidence-based recommendations are urgently needed. Digital medicine is a future-oriented and effective approach in the context of clinical diabetes management. We anticipate our review to be a starting point to understand and analyze mechanisms and epidemiology to most effectively treat women with SARS-COV-2 and diabetes in pregnancy.

Highlights

We suffer from an increasing diabetes pandemic and on the other hand from the SARSCoV-2 pandemic
Already at the beginning of the SARSCoV-2 pandemic, it was quickly assumed that certain groups such as elderly, pregnant women and those with multiple or chronic comorbidities, such as diabetes mellitus, are more likely to get infected and are at increased risk to suffer from a severe course of Coronavirus Disease 2019 (COVID-19)[2,3,4]
We identified n = 1,938 citations without duplicates for COVID-19 and Diabetes Mellitus, n = 985 for COVID-19 and pregnancy, n = 70 for COVID-19 and gestational diabetes mellitus (GDM)/diabetic pregnancies

Summary

Introduction

We suffer from an increasing diabetes pandemic and on the other hand from the SARSCoV-2 pandemic. Already at the beginning of the SARS-CoV-2 pandemic, it was quickly assumed that certain groups are at increased risk to suffer from a severe course of COVID-19. Diabetic pregnancies clearly need special care, but clinical implications as well as the complex interplay of diabetes and SARS-CoV-2 are currently unknown. Already at the beginning of the SARSCoV-2 pandemic, it was quickly assumed that certain groups such as elderly, pregnant women and those with multiple or chronic comorbidities, such as diabetes mellitus, are more likely to get infected and are at increased risk to suffer from a severe course of Coronavirus Disease 2019 (COVID-19)[2,3,4]. Diabetic pregnancies clearly need special care, but, clinical implications of COVID-19 are currently unknown [7]

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