A review of COVID-19: a threat to pregnant women?

Amanjot Kaur, Jasninder Singh, Shweta Shingla, Mandeep Kaur


The outbreak of Coronavirus disease-2019 (COVID-19) has widely spread worldwide. While, mild symptoms have been observed in a majority but on the other hand, the virus may cause severe pulmonary disease. The major concern has been the pregnant women. In this review, we have tried to cover COVID-19 infections transmission, diagnosis, management, prognosis during pregnancy. The evidence on vertical transmission has been lacking. However, physiological changes during pregnancy, make women more vulnerable to this COVID-19. The problem of anxiety also flares up the disease in pregnancy.


Coronavirus-2019, Vertical transmission, Immunosuppression, Hypoxia

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Guarner J. Three emerging coronaviruses in two decades. Am J Clin Pathol. 2020;9;153(4):420-1.

Drosten C, G√ľnther S, Preiser W, Van Der Werf S, Brodt H-R, Becker S et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med. 2003;15;348(20):1967-76.

Wong SF, Chow KM, Leung TN, Ng TK, Shek CC et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-7.

Al-Tawfiq JA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and COVID-19 infection during pregnancy. Travel Med Infect Dis. 2020.

Weiss SR, Navas-Martin S. Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. Microbiol Molec Biol Rev. 2005;69(4):635-64.

Aghaeepour N, Ganio EA, McIlwain D, Tsai AS, Tingle M. An immune clock of human pregnancy. Sci Immunol. 2017;2(15):2946.

Enninga EA, Nevala WK, Creedon DJ, Markovic SN, Holtan SG. Fetal sex-based differences in maternal hormones, angiogenic factors, and immune mediators during pregnancy and the postpartum period. Am J Reprod Immunol. 2015;73(3):251-62.

Rasmussen SA, Jamieson DJ, Macfarlane K, Cragan JD, Williams J, Henderson Z. Pandemic Influenza and Pregnancy Working Group. Pandemic influenza and pregnant women: summary of a meeting of experts. Am J Public Health. 2009;99(2):S248-54.

Mor G, Aldo P, Alvero AB. The unique immunological and microbial aspects of pregnancy. Nat Rev Immunol. 2017;17(8):469-82.

He F, Deng Y, Li W. Coronavirus disease 2019: What we know? J. Med. Virol. 2020;92:719-25.

Campbell KH, Tornatore JM, Lawrence, K. E, Illuzzi JL, Sussman LS, Lipkind HS et al. Prevalence of SARS-CoV-2 Among Patients Admitted for Childbirth in Southern Connecticut. JAMA. 2020;323(24);2520-2.

Rosnihan KB, Neves LA, Anton L, Joyner J, Valdes G, Merrill DC. Enhanced expression of Ang-(1-7) during pregnancy.Braz J Med Biol Res. 2004;37(8):1255-62.

Woodward A. A pregnant mother infected with the coronavirus gave birth, and her baby tested positive 30 hours later. https://www.businessinsider. com/wuhan-coronavirus-in-infant-born-from-infected-mother-2020-2. Accessed on 15th March, 2020.

Murphy S. Newborn baby tests positive for coronavirus in London. Accessed on 15th March, 2020.

Li Y, Zhao R, Zheng S, Chen X, Wang J. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis. 2020;26(6):1335-6.

Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020;S0163-4453(20)30109-2.

Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020;20(5):559-64.

Dong L, Tian J, He S, Zhu C, Wang J, Liu C et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020;323(18):1846-8.

Deprest J, Van Ranst M, Lannoo L, Bredaki E, Ryan G, David A et al. SARS-CoV2 (COVID-19) infection: is fetal surgery in times of national disasters reasonable. 2020.

Singhal, T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J. Pediatr. 2020;87:281-6.

Rothan H.A, Byrareddy S.N. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J. Autoimmun. 2020;109:102433.

Wu Y, Liu C, Dong L, Zhang C, Chen Y, Liu J et al. Coronavirus disease 2019 among pregnant Chinese women: Case series data on the safety of vaginal birth and breastfeeding. BJOG. 2020;127(9):1109-15.

Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, Li J et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. Lancet. 2020;395:809-15.

Lu C.W, Liu X.F, Jia Z.F. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395:e39.

Fung TS, Liu DX. Human Coronavirus: Host-Pathogen Interaction. Annu Rev Microbiol. 2019;73:529-57.

Hassan SA, Sheikh FN, Jamal S, Ezeh JK, Akhtar A. Coronavirus (COVID-19): A Review of Clinical Features, Diagnosis, and Treatment. Cureus 2020;12(3):e7355.

Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020;92:441-7.

Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand. 2020;99(5):565-8.

Liu H, Liu F, Li J, Zhang T, Wang D. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J Infect 2020;80(5):ES7-13.

Yang H, Sun G, Tang F. Clinical features and outcomes of pregnant women suspected of coronavirus disease 2019. J Infect. 2020;S0163-4453(20)30212-7.

Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiol. 2020;200642.

Pan F, Ye T, Sun P, Gui S, Liang B, Li L et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;296:E32-40.

Breslin N, Baptiste C, Gyamfi-Bannerman C, Miller R, Martinez R, Bernstein K et al. 2020. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol. 2020.

Hutter D, Kingdom J and Jaeggi E. Causes and mechanisms of intrauterine hypoxia and its impact on the fetal cardiovascular system: A review. Int J Pediatr. 2010;2010:401323.

Lim WS, Macfarlane JT, Colthorpe CL. Pneumonia and pregnancy. Thorax. 2001;56(5):398-405.

Baergen RN, Heller DS. Placental pathology in Covid-19 positive mothers: preliminary findings. Pediatr. Dev. Pathol. 2020;23(3):177-80.

Sinkey RG, Guzeloglu- Kayisli O, Arlier S, Guo X, Semerci N, Moore R et al. Thrombin-induced decidual colony-stimulating Factor-2 promotes abruption-related preterm birth by weakening fetal membranes. Am. J. Pathol. 2020;190:388-99.

Shanes ED, Mithal LB, Otero S, Azad HA, Miller ES, Goldstein JA. Placental pathology in COVID-19. Am J Clin Pathol. 2020;154(1):23-32.

Poon LC, Yang H, Lee JCS, Copel JA, Leung TY, Zhang Y et al. ISUOG interim guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals. Ultrasound Obstet Gynecol. 2020;55(5):700-8.

Centers for Disease Control and Prevention. Information for healthcare providers: COVID-19 and pregnant women. 2020.

Yam C, Jokubaitis V, Hellwig K, Dobson R. MS, pregnancy and COVID-19. Multiple Sclerosis Journal 2020;26(10):1137

Favre G, Pomar L, Qi X, Saines KN, Musso D, Baud D. Guidelines for pregnant women with suspected SARS-CoV-2 infection. Lancet Infect Dis. 2020;20(6):652-3.

Citrin OD, Blyakhman S, Shechtman S, Ornoy A. Pregnancy outcome following in utero exposure to hydroxychloroquine: a prospective comparative observational study. Reprod Toxicol. 2013;39:58-62.

Cooper WO, Cheetham TC, Li DK, Stein CM, Callahan ST, Morgan TM et al. Brief report: Risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune-mediated diseases in pregnancy. Arthritis Rheum. 2014;66:444-50.

Griffin MO, Fricovsky E, Ceballos G, Villarreal F. Tetracyclines: a pleiotropic family of compounds with promising therapeutic properties. Review of the literature. Am J Physiol Cell Physiol. 2010;299:C539-48.

Conforti C, Giuffrida R, Zalaudek I, Mio ND. Doxycycline, a widely used antibiotic in dermatology with a possible anti-inflammatory action against IL-6 in COVID-19 outbreak. Dermatol Ther. 2020;e13437.

Emingil G, Atilla G, Sorsa T. The effect of adjunctive subantimicrobial dose doxycycline therapy on GCF EMMPRIN levels in chronic periodontitis. J Periodontol. 2008;79:469-76.

Wu C, Liu Y, Yang Y, Zhang P, Zhong Wu, Wang Y et al. Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods. Acta Pharm Sin B. 2020;10:766-88.

Mulangu S, Dodd LE, Davey RT Jr, Tshiani Mbaya O, Proschan M, Mukadi D, et al. PALM Writing Group; PALM Consortium Study Team. A randomized, controlled trial of Ebola virus disease therapeutics. N Engl J Med. 2019;381:2293-303.

Liu F, Xu A, Zhang Y, Zhang P, Zhong WU, Wang Y et al. Patients of COVID-19 may benefit from sustained lopinavir combined regimen and the increase of eosinophil may predict the outcome of COVID-19 progression. Int J Infect Dis. 2020;95:183-91.

Tookey PA, Thorne C, Wyk JV, Norton M. Maternal and foetal outcomes among 4118 women with HIV infection treated with lopinavir/ritonavir during pregnancy: analysis of population-based surveillance data from the national study of HIV in pregnancy and childhood in the United Kingdom and Ireland. BMC Infect Dis. 2016;16:65-75.

Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y et al. Remdesivir in adults with severe COVID-19: a randomised, double blind, placebo-controlled, multicentre trial. Lancet. 2020;395:1569-78.

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-9.

Winthrop KL. The emerging safety profile of JAK inhibitors in rheumatic disease. Nat Rev Rheumatol. 2017;13:234-43.

Totura AL, Bavari S. Broad-spectrum coronavirus antiviral drug discovery. Expert Opin. Drug Discov. 2019;14(4):397-412.

Wang Z, Chen X, Lu Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci. Trends. 2020;16;14(1):64-8.

Horby P, Lim WS, Emberson J, Mafham M, Bell J, Linsell L, Staplin NA et al. Effect of dexamethasone in hospitalized patients with COVID-19: preliminary report).NEJM. 2020;4:201-4.

Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow? Acta Obstet Gynecol Scand. 2020;99:439-42.

Einav S, Ippolito M, Cortegiani A. Inclusion of pregnant in clinical trials of COVID-19 therapies: what have we learned? British journal of Anaesthesia.

Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020.

Elshafeey F, Magdi R, Hindi N, lshebiny M, Farrag N, Mahdy S et al. A systematic scoping review of COVID-19 during pregnancy and childbirth. Int J Gynaecol Obstet 2020;150(1):47-52.

Yang Z, Wang M, Zhu Z, Liu Y. Coronavirus disease 2019 (COVID-19) and pregnancy: A systematic review. J Matern Fetal Neonatal Med. 2019;2:94-8.

Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-7.