COVID-19 during Pregnancy and Postpartum:

Abstract

Coronavirus Disease 2019 (COVID-19) triggered by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection has been declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Oxidative stress and its related metabolic syndromes are potential risk factors in the susceptibility to, and severity of COVID-19. In concert with the earliest reports of COVID-19, obstetricians started to diagnose and treat SARS-CoV-2 infections during pregnancy (“COVID-19-Pregnancy”). High metabolic demand to sustain normal fetal development increases the burden of oxidative stress in pregnancy. Intracellular redox changes intertwined with acute phase responses at the maternal-fetal interface could amplify during pregnancy. Interestingly, mother-to-fetus transmission of SARS-CoV-2 has not been detected in most of the COVID-19-Pregnancy cases. This relative absence of vertical transmission may be related to the presence of lactoferrin in the placenta, amniotic fluid, and lacteal secretions. However, the cytokine-storm induced during COVID-19-Pregnancy may cause severe inflammatory damage to the fetus, and if uncontrolled, may later result in autism spectrum-like disorders and brain development abnormalities in neonates. Considering this serious health threat to child growth and development, the prevention of COVID-19 during pregnancy should be considered a high priority. This review summarizes the intricate virulence factors of COVID-19 and elucidate its pathobiological spectrum during pregnancy and postpartum periods with a focus on the putative and complex roles of endogenous and exogenous lactoferrin in conferring immunological advantage to the host.

Keywords:

• lactoferrin
• coronavirus infections
• pregnancy
• infant
• female

Acknowledgements

We thank Prof. Joris Messens (VIB-VUB Center for Structural Biology & Brussels Center for Redox Biology, Belgium) for proving suggestions on redox biology section of this manuscript.

Declaration of interest

The authors declare no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Sreus A. G. Naidu

Dr. Sreus A.G. Naidu, MS, PharmD, has earned Doctorate in Pharmacy and MS in Regulatory Science from the University of Southern California. Sreus has over 15 years of experience working at N-terminus Research Laboratory based in California, which specializes in the isolation, purification, and activation of bioactive molecules. He is co-inventor on multiple patents with applications in human nutrition and animal healthcare.

Roger A. Clemens

Professor Roger A. Clemens, DrPH, FIFT, CFS, FASN, FACN, CNS, FIAFST, is Associate Director of the Regulatory Science program and Adjunct Professor of Pharmacology and Pharmaceutical Sciences within the USC School of Pharmacy. Dr. Clemens was the Director of Analytical Research at USC for 5 years, and the Scientific Advisor for Nestlé USA for more than 21 years. He has published more than 50 original manuscripts in nutrition and food science, participated in more than 200 invited domestic and international lectures, and served as an expert panel member for the food industry, scientific organizations, trade associations and regulatory agencies in the United States and Canada.

Peter Pressman

Dr. Peter Pressman, MD, MS, FACN, was trained at Northwestern University and the University of Chicago. He served as a Naval Medical Officer in austere settings in which food insecurity is endemic. Pressman has extensive experience addressing protein calorie malnutrition in conflict zones in central Asia, and the Middle East, and in the developing world in sub-Saharan Africa. Pressman pursued his interests in medical nutrition at the University of Southern California, as Associate Director of the Internal Medicine Residency Program and Director of Educational Programs of the Pacific Center for Health Policy and Ethics. Subsequently, in collaboration with Professor Roger Clemens, he has co-authored and published papers and book chapters in the realm of medical nutrition and public health, and co-taught the nutrition course in the Global Medicine Program at USC's Keck School of Medicine. He currently holds positions with The Daedalus Foundation and Polyscience Consulting.

Mehreen Zaigham

Dr. Mehreen Zaigham, BSc, MD, PhD, is a post-doctoral fellow and resident at the Department of Obstetrics and Gynecology, Lund University, Sweden. Mehreen has worked on several projects investigating the role of birth asphyxia to short- and long-term neurodevelopmental outcomes in infants including the importance of umbilical cord blood gases. In the current COVID-19 pandemic, her focus has been to understand the effect of SARS-CoV-2 infection in pregnant women and their fetuses.

Kamran Kadkhoda

Dr. Kamran Kadkhoda, PhD, SM(ASCP), D(ABMM), D(ABMLI), is the Medical Director of Immunopathology Laboratory, Robert J. Tomisch Pathology & Laboratory Medicine Institute, Cleveland Clinic, Ohio. His research interests are serological diagnosis of infectious diseases, sero-epidemiological investigations, and molecular laboratory diagnosis of blood-borne pathogens.

Kelvin J. A. Davies

Professor Kelvin J. A. Davies, PhD, DSc, MAE, FRSC, FRCP, FLS, FRI, is the James E. Birren Chair and Dean of Faculty at the University of Southern California's, Leonard Davis School of Gerontology. He is also Distinguished Professor of Molecular and Computational Biology and Biochemistry & Molecular Medicine. Davies was educated at London and Liverpool Universities, the University of Wisconsin, Harvard University, and the University of California at Berkeley. Previously, he was a faculty member at Harvard University, Harvard Medical School, and Albany Medical College. He pioneered the study of protein oxidation and proteolysis during adaptation to oxidative stress and discovered stress-genes including calcineurin regulator RCAN1 whose mis-regulation contributes to Alzheimer and Huntington diseases and Down syndrome. He demonstrated that impaired induction of Proteasome and Lon protease genes contributes to senescence and diminished stress-resistance and has pioneered the concept of impaired ‘Adaptive Homeostasis' as a major factor in aging. Davies has been awarded 15 honorary Doctoral degrees and has been elected as a fellow of 14 national and international academies including AAAS, Royal Society of Medicine, Royal Society of Chemistry, Royal College of Physicians, and Academy of Europe. He was knighted in 2012 as a chevalier of France's Ordre National du Mérite and elevated as a Knight Commander in 2018.

A. Satyanarayan Naidu

Professor A Satyanarayan Naidu, PhD, FACN, FLS, FISSVD, is the Director of N-terminus Research Laboratory in California, USA. After receiving PhD in Medical Microbiology (1985) from the Osmania University in India, Dr. Naidu served the Directorate of Public Health Services (DPHS), the Government of A.P., India and the World Health Organization (WHO) Surveillance program. He performed post-doctoral research at the Medical University of Pécs, Hungary and the Biomedical Center-Uppsala, Sweden. Dr. Naidu joined the faculty at the Lund University; Sweden (1988–1992), the University of North Carolina at Chapel Hill, USA (1993–1997). He was appointed as the Director at the Center for Antimicrobial Research, California State University-Pomona, USA (1998-2000). Dr. Naidu's discoveries on Staphylococcal toxic shock syndrome (TSS) and E. coli hemolytic uremic syndrome (HUS) have garnered international recognition. He was principal investigator for several NIH grants, published more than 100 peer-reviewed research publications, written over 30 book chapters, and authored 4 reference volumes in the field of medical sciences. He holds 24 core patents, and his technology transfers in biomedical technology reach worldwide. Dr. Naidu is an elected fellow of the Royal Society for Medicine, the Linnean Society of London, the American College of Nutrition, and the International Society for the Study of Vulvovaginal Disease.