The Misattributed and Silent Causes of Poor COVID-19 Outcomes Among Pregnant Women.

Yossy Machluf,Yoram Chaiter,Sherman Rosenfeld,Izhar Ben Shlomo,Yaron Dekel

doi:10.3389/fmed.2021.745797

Abstract

Abundant evidence strongly suggests that the condition of pregnancy makes women and their fetuses highly vulnerable to severe Corona-virus 2019 (COVID-19) complications. Here, two novel hypoxia-related conditions are proposed to play a pivotal role in better understanding the relationship between COVID-19, pregnancy and poor health outcomes. The first condition, “misattributed dyspnea (shortness of breath)” refers to respiratory symptoms common to both advanced pregnancy and COVID-19, which are mistakenly perceived as related to the former rather than to the latter; as a result, pregnant women with this condition receive no medical attention until the disease is in an advanced stage. The second condition, “silent hypoxia”, refers to abnormally low blood oxygen saturation levels in COVID-19 patients, which occur in the absence of typical respiratory distress symptoms, such as dyspnea, thereby also leading to delayed diagnosis and treatment. The delay in diagnosis and referral to treatment, due to either “misattributed dypsnea” or “silent hypoxia”, may lead to rapid deterioration and poor health outcome to both the mothers and their fetuses. This is particularly valid among women during advanced stages of pregnancy as the altered respiratory features make the consequences of the disease more challenging to cope with. Studies have demonstrated the importance of monitoring blood oxygen saturation by pulse oximetry as a reliable predictor of disease severity and outcome among COVID-19 patients. We propose the use of home pulse oximetry during pregnancy as a diagnostic measure that, together with proper medical guidance, may allow early diagnosis of hypoxia and better health outcomes.

Highlights

This perspective article deals with the current advances in our understanding of the underlying conditions contributing to poor outcomes of Corona-virus disease 2019 (COVID-19) among pregnant women, and the consequent future directions for policy
We put the spotlight on a condition we suggest to term “misattributed dyspnea”, namely a common COVID-19 symptom due to hypoxia that coincides with pregnancy-related features, which may be perceived as related to the pregnancy rather than to COVID-19 and receive no attention
We describe the phenomena of “silent hypoxia,” which refers to COVID-19 hypoxic patients who do not experience the common respiratory distress symptom of dyspnea

Summary

INTRODUCTION

This perspective article deals with the current advances in our understanding of the underlying conditions contributing to poor outcomes of Corona-virus disease 2019 (COVID-19) among pregnant women, and the consequent future directions for policy. Considering the physiological and metabolic changes during advanced stages of the pregnancy, and their impact on the immune system, respiratory system and cardiovascular function, COVID-19 infected pregnant women are more physically compromised and less able to cope with the disease in general and with the consequences of delayed diagnosis and overdue referral to treatment, compared to non-pregnant women. We propose that these may occur due to two main conditions: misattributed dyspnea and silent hypoxia. Accumulating evidence suggest that such implementation, combined with public education and guidance as described before, may serve as useful preventive means for pregnant woman with COVID-19

CONCLUDING REMARKS

Findings

DATA AVAILABILITY STATEMENT