Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.
Am J Reprod Immunol. 2024 Aug;92(2):e13915. doi: 10.1111/aji.13915.
The emergence of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to the global COVID-19 pandemic, significantly impacting the health of pregnant women. Obstetric populations, already vulnerable, face increased morbidity and mortality related to COVID-19, aggravated by preexisting comorbidities. Recent studies have shed light on the potential correlation between COVID-19 and preeclampsia (PE), a leading cause of maternal and perinatal morbidity worldwide, emphasizing the significance of exploring the relationship between these two conditions. Here, we review the pathophysiological similarities that PE shares with COVID-19, with a particular focus on severe COVID-19 cases and in PE-like syndrome cases related with SARS-CoV-2 infection. We highlight cellular and molecular mechanistic inter-connectivity between these two conditions, for example, regulation of renin-angiotensin system, tight junction and barrier integrity, and the complement system. Finally, we discuss how COVID-19 pandemic dynamics, including the emergence of variants and vaccination efforts, has shaped the clinical scenario and influenced the severity and management of both COVID-19 and PE. Continued research on the mechanisms of SARS-CoV-2 infection during pregnancy and the potential risk of developing PE from previous infections is warranted to delineate the complexities of COVID-19 and PE interactions and to improve clinical management of both conditions.
严重急性呼吸综合征冠状病毒 2 型(SARS-CoV-2)的出现导致了全球 COVID-19 大流行,这对孕妇的健康产生了重大影响。已经处于弱势的产科人群因 COVID-19 相关的发病率和死亡率增加,加上先前存在的合并症而面临更大的风险。最近的研究揭示了 COVID-19 与子痫前期(PE)之间的潜在关联,PE 是全球孕产妇和围产期发病率的主要原因,这强调了探索这两种情况之间关系的重要性。在这里,我们回顾了 PE 与 COVID-19 之间共享的病理生理相似性,特别关注严重 COVID-19 病例和与 SARS-CoV-2 感染相关的 PE 样综合征病例。我们强调了这两种情况之间细胞和分子机制的相互联系,例如肾素-血管紧张素系统、紧密连接和屏障完整性以及补体系统的调节。最后,我们讨论了 COVID-19 大流行动态,包括变异的出现和疫苗接种工作,如何塑造了临床情况,并影响了 COVID-19 和 PE 的严重程度和管理。需要继续研究 SARS-CoV-2 感染在怀孕期间的机制,以及先前感染引发 PE 的潜在风险,以阐明 COVID-19 和 PE 相互作用的复杂性,并改善这两种情况的临床管理。