What are the implications of coronavirus disease 2019 (COVID-19) during pregnancy?

Updated: Jan 12, 2021
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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The response to the unique maternal immune system to SARS-CoV-2 is not known. The maternal immune system must protect against microbial infections while simultaneously developing tolerance to fetal allogeneic antigens. In the respiratory tract, estrogen-mediated edema limits lung expansion and may predispose pregnant women to respiratory pathogens. [65]

Currently, there is no evidence of vertical transmission of SARS-CoV-2 as per two small studies from China. [66, 67] Detectable SARS-CoV-2 RNA has not been isolated from amniotic fluid, placenta, or breast milk. Owing to the limited number of reported cases of COVID-19 in the first trimester, it is still unclear if the viral infection impacts embryogenesis leading to a congenital anomaly. [68] However, in the third trimester of pregnancy, COVID-19 may result in a severe inflammatory response. This cytokine storm–mediated inflammatory response increases maternal serum levels of IL-17a, IL-2, and IL-7, among others, and can pose an indirect risk to fetal brain development, leading to neuronal dysfunction. [65]

The current situation warrants further research and large-scale studies into the risks, clinical manifestations, management, and complications of COVID-19 in pregnancy.

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