Wenling Yao, Junchao Qiu, Xiao Zhirong, Ouyang Shi
Department of Infectious Diseases, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
Rev Inst Med Trop Sao Paulo. 2020;62:e62. doi: 10.1590/s1678-9946202062062. Epub 2020 Aug 31.
The consequences of COVID-19 infecting pregnant women and the potential risks of vertical transmission have become a major issue. Since little is currently known about COVID-19 in pregnancy, the understanding of COVID-19 in this particular group will be updated in time, and a comprehensive review will be useful to evaluate the impact of COVID-19 in pregnancy. Based on recently published literature and official documents, this review provides an introduction to the pathogenesis, pathology, and clinical features of COVID-19 and has focused on the current researches on clinical features, pregnancy outcomes and placental histopathological analysis from pregnant women infected with SARS-CoV-2 in comparison with SARS-CoV and MERS-CoV. These viruses trigger a cytokine storm in the body, produce a series of immune responses, and cause changes in peripheral leukocytes and immune system cells leading to pregnancy complications that may be associated with viral infections. The expression of ACE2 receptors in the vascular endothelium may explain the histological changes of placentas from pregnant women infected by SARS-CoV-2. Pregnant women with COVID-19 pneumonia show similar clinical characteristics compared with non-pregnant counterparts. Although there is no unequivocal evidence to support the fetal infection by intrauterine vertical transmission of SARS, MERS and SARS-CoV-2 so far, more and more articles began to report maternal deaths due to COVID-19. In particular, from February 26, 2020 (date of the first COVID-19 case reported in Brazil) until June 18, 2020, Brazil reported 124 maternal deaths. Therefore, pregnant women and neonates require special attention regarding the prevention, diagnosis and management of COVID-19.
新型冠状病毒肺炎（COVID-19）感染孕妇的后果及垂直传播的潜在风险已成为一个重大问题。由于目前对妊娠期COVID-19了解甚少，对这一特定群体中COVID-19的认识将及时更新，全面综述有助于评估COVID-19对妊娠的影响。基于最近发表的文献和官方文件，本综述介绍了COVID-19的发病机制、病理学和临床特征，并重点关注了与严重急性呼吸综合征冠状病毒（SARS-CoV）和中东呼吸综合征冠状病毒（MERS-CoV）相比，感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的孕妇的临床特征、妊娠结局及胎盘组织病理学分析的当前研究。这些病毒在体内引发细胞因子风暴，产生一系列免疫反应，并导致外周白细胞和免疫系统细胞发生变化，从而引发可能与病毒感染相关的妊娠并发症。血管内皮中血管紧张素转换酶2（ACE2）受体的表达可能解释了感染SARS-CoV-2的孕妇胎盘的组织学变化。与非孕妇相比，患有COVID-19肺炎的孕妇表现出相似的临床特征。尽管目前尚无明确证据支持SARS、MERS和SARS-CoV-2通过宫内垂直传播导致胎儿感染，但越来越多的文章开始报道COVID-19导致的孕产妇死亡。特别是，从2020年2月26日（巴西报告首例COVID-19病例的日期）至2020年6月18日，巴西报告了124例孕产妇死亡。因此，在COVID-19的预防、诊断和管理方面，孕妇和新生儿需要特别关注。
