COVID-19 in pregnancy: possible mechanisms not to be discounted

Abstract

SARS-CoV-2 has infected more than 16 million people worldwide. Related complications and death from COVID-19 disease and their underlying pathophysiology are intensely investigated. Pregnant women are among the affected. Although the severity of disease in pregnancy does not appear to be increased, the effects of infection on pregnancy should not escape careful examination. The currently known receptor for the virus, ACE2, regulates the renin-angiotensin system and is increased during pregnancy. Virus–receptor interactions may have significant effects on placental function, fetal development, and maternal immunity. The manifestation of cardiovascular complications of infection produces the hypothesis that a significant effect of the virus may be its influence on the maternal vascular system. Interference with the vascular adaptations to pregnancy and the post-partum may have implications for concurrent and future pregnancies as well as for long-term cardiovascular health. We should not miss the opportunity to learn from this virus about the physiology of pregnancy.

Keywords:

• Covid-19 during pregnancy
• placental function
• fetal development
• maternal immunity
• long-term maternal vascular health

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Dr Bonney acknowledges that she receives salary support for her research in vascular biology in pregnancy and also has NIH grant funding [NIHR01HL141747].