Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Iran J Immunol. 2022 Sep;19(3):330-336. doi: 10.22034/iji.2022.93951.2267.
Pregnant women with coronavirus disease 2019 (COVID-19) have a higher risk of morbidity and mortality compared with the general population. Possible pathways are: I) in patients with COVID-19, cytokine storm defined as the excess release of pro-inflammatory cytokines such as interleukin 1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) has been associated with morbidities and an even higher rate of mortality. II) Labor, despite being a term/preterm, has an inflammatory nature, although, inflammation is more prominent in preterm delivery. During labor, different pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α are involved which as mentioned, all are crucial role players in the cytokine storm. III) Tissue injury, and during labor, (especially cesarean section) is shown to cause inflammation via pro-inflammatory cytokines release including those involved in the cytokine storm through the activation of nuclear factor κB (NFκB). IV) post-partum hemorrhage with a notable amount of blood loss which can cause significant hypoxemia. In this condition, hypoxia-inducible factor 1α which has a cross-talk with NFκB, leads to the expression of IL-1β, IL-6, and TNF-α as both angiogenic and pro-inflammatory factors. Considering all the mentioned issues and pathways, we suggest that clinicians be careful about the escalation of the inflammatory status in their pregnant COVID-19 patients during/following labor.
与普通人群相比，患有 2019 年冠状病毒病（COVID-19）的孕妇有更高的发病率和死亡率。可能的途径有：I）在 COVID-19 患者中，细胞因子风暴被定义为过度释放促炎细胞因子，如白细胞介素 1β（IL-1β）、IL-6 和肿瘤坏死因子-α（TNF-α），与发病率甚至更高的死亡率相关。II）分娩，尽管是足月/早产，具有炎症性质，但早产时炎症更为明显。在分娩过程中，涉及不同的促炎细胞因子，如 IL-1β、IL-6 和 TNF-α，如前所述，所有这些都是细胞因子风暴中的关键角色。III）组织损伤，在分娩过程中（特别是剖宫产）通过促炎细胞因子的释放引起炎症，包括通过核因子 κB（NFκB）的激活参与细胞因子风暴的细胞因子。IV）产后出血伴有大量失血，可导致明显的低氧血症。在这种情况下，缺氧诱导因子 1α与 NFκB 发生交叉对话，导致 IL-1β、IL-6 和 TNF-α的表达，作为血管生成和促炎因子。考虑到所有提到的问题和途径，我们建议临床医生在 COVID-19 孕妇分娩期间/之后要注意其炎症状态的升级。
