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Am J Reprod Immunol
. 2020 Aug 5;e13317.
doi: 10.1111/aji.13317. Online ahead of print.
Is Pregnancy an Immunological Contributor to Severe or Controlled COVID-19 Disease?
Nazeeh Hanna 1 , Monica Hanna 2 , Surendra Sharma 3
Affiliations
- PMID: 32757366
- DOI: 10.1111/aji.13317
Abstract
Since its emergence in Wuhan as a novel coronavirus disease, it has taken only a few months since January 2020 for it to be recognized as a wide spread COVID-19 pandemic which has contributed to global health devastation. As pointed out by health experts, it is a once in a century pandemic of our times. Clinical observations so far indicate that the older population and immune compromised individuals, particularly in African American and Hispanic/Latino communities, are at much higher risk for infection with this novel coronavirus. In this regard, pregnancy offers an altered immunity scenario which may allow severe COVID-19 disease. The literature is so far highly conflicting on this issue. This review will offer a conceptual basis for severe or controlled disease and address trepidations for pregnant women associated with COVID-19 pandemic, particularly in the comparative context of clinical consequences of other coronaviruses such as SARS and MERS. We will highlight the possible consequences of COVID -19 on the general health of pregnant women as well as its possible effects at the maternal-fetal interface. For the placenta-related pathology, we will focus our discussion on the temporal expression of ACE2 throughout gestation for possible propagation of SARS-CoV-2 in the placenta in infected women and ensuing consequences.
Keywords: Coronavirus disease (COVID-19); Middle East respiratory syndrome (MERS); angiotensin-converting enzyme-related carboxypeptidase 2 (ACE2); extravillous trophoblasts (EVTs); severe acute respiratory syndrome (SARS); severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); syncytiotrophoblasts (STBs).