Liu Anna, Raja Xavier Janet, Singh Yogesh, Brucker Sara Y, Salker Madhuri S
Research Institute of Women's Health, Eberhard Karls University, Tübingen, Germany.
Institute of Medical Genetics and Applied Genomics, Eberhard Karls University, Tübingen, Germany.
Front Glob Womens Health. 2022 Feb 24;3:756362. doi: 10.3389/fgwh.2022.756362. eCollection 2022.
Whilst scientific knowledge about SARS-CoV-2 and COVID-19 is rapidly increasing, much of the effects on pregnant women is still unknown. To accommodate pregnancy, the human endometrium must undergo a physiological transformation called decidualization. These changes encompass the remodeling of endometrial immune cells leading to immunotolerance of the semi-allogenic conceptus as well as defense against pathogens. The angiotensin converting enzyme 2 (ACE2) plays an important regulatory role in the renin-angiotensin-system (RAS) and has been shown to be protective against comorbidities known to worsen COVID-19 outcomes. Furthermore, ACE2 is also crucial for decidualization and thus for early gestation. An astounding gender difference has been found in COVID-19 with male patients presenting with more severe cases and higher mortality rates. This could be attributed to differences in sex chromosomes, hormone levels and behavior patterns. Despite profound changes in the female body during pregnancy, expectant mothers do not face worse outcomes compared with non-pregnant women. Whereas mother-to-child transmission through respiratory droplets during labor or in the postnatal period is known, another question of transmission remains unanswered. Evidence of placental SARS-CoV-2 infection and expression of viral entry receptors at the maternal-fetal interface suggests the possibility of transmission. SARS-CoV-2 can cause further harm through placental damage, maternal systemic inflammation, and hindered access to health care during the pandemic. More research on the effects of COVID-19 during early pregnancy as well as vaccination and treatment options for gravid patients is urgently needed.
尽管关于严重急性呼吸综合征冠状病毒2（SARS-CoV-2）和冠状病毒病（COVID-19）的科学知识正在迅速增加，但对孕妇的许多影响仍不明确。为适应妊娠，人类子宫内膜必须经历一种称为蜕膜化的生理转变。这些变化包括子宫内膜免疫细胞的重塑，从而导致对半同种异体胚胎的免疫耐受以及对病原体的防御。血管紧张素转换酶2（ACE2）在肾素-血管紧张素系统（RAS）中起重要调节作用，并且已被证明对已知会使COVID-19病情恶化的合并症具有保护作用。此外，ACE2对蜕膜化以及早期妊娠也至关重要。在COVID-19中发现了惊人的性别差异，男性患者的病情更严重，死亡率更高。这可能归因于性染色体、激素水平和行为模式的差异。尽管怀孕期间女性身体会发生深刻变化，但与非孕妇相比，准妈妈的预后并不更差。虽然分娩期间或产后通过呼吸道飞沫的母婴传播是已知的，但另一个传播问题仍未得到解答。胎盘SARS-CoV-2感染以及母婴界面处病毒进入受体表达的证据表明存在传播的可能性。SARS-CoV-2可通过胎盘损伤、母体全身炎症以及在大流行期间阻碍获得医疗保健而造成进一步损害。迫切需要对COVID-19在妊娠早期的影响以及妊娠患者的疫苗接种和治疗方案进行更多研究。
