COVID-19 infection during pregnancy increases risk of developing preeclampsia, study finds

A recently published study found that women who contract COVID-19 during pregnancy are at a significantly higher risk of developing preeclampsia, the leading cause of maternal and infant death worldwide.

In “SARS-COV-2 infection in pregnancy and risk of preeclampsia: a systematic review and meta-analysis” https://www.ajog.org/article/S0002-9378(21)00947-9/fulltext published in The American Journal of Obstetrics and Gynecology, the researchers said their systematic review shows that women infected with SARS-CoV-2 during pregnancy were 62% more likely to develop preeclampsia than those without infection during pregnancy.

This association was remarkably consistent across all predefined subgroups. Additionally, infection with SARS-CoV-2 during pregnancy has been associated with a significantly increased risk of preeclampsia with severe features, eclampsia and HELLP syndrome. “

Roberto Romero, MD, DMedSci, Chief Perinatal Research Branch and Professor of Molecular Obstetrics and Genetics, Wayne State University School of Medicine

Dr Romero and Agustin Conde-Agudelo, MD, MPH, Ph.D., assistant professor of obstetrics and gynecology, released their results after reviewing 28 previous studies that included 790,954 pregnant women, including 15,524 diagnosed with a COVID-19 infection.

“Asymptomatic and symptomatic infections greatly increase the risk of preeclampsia,” said Dr. Romero. “Nevertheless, the chances of developing preeclampsia were higher in patients with symptomatic disease than in those with asymptomatic disease.”

Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. The warning signs of preeclampsia, in addition to high blood pressure, can include headache, swelling of the face and hands, blurred vision, chest pain, and shortness of breath. Although the disease can manifest itself within hours, some women report little or no symptoms.

The disease is responsible for 76,000 maternal deaths and more than 500,000 infant deaths each year, according to estimates by the Preeclampsia Foundation. It can affect the liver, kidneys and brain. Some mothers develop seizures (eclampsia) and suffer from intracranial hemorrhage, the leading cause of death in those who develop the disease. Some women develop blindness. Babies of preeclampsia mothers are affected by the disease and may develop intrauterine growth restriction or die in utero.

The earlier the disease starts in pregnancy, the worse the outcome can be for the baby and the mother. Women with preeclampsia often do not feel the effects until the disease is severe and life threatening. Effects on the mother include heart problems, possible brain hemorrhage, acute kidney failure, blood clotting problems, and possible blindness. If not detected, the disease may progress to eclampsia and the mother may begin to have seizures. For the fetus, preeclampsia has been associated with reduced placental blood flow, resulting in physical and mental disability, slower fetal development, and in severe cases infants may be stillborn.

HELLP syndrome is a form of severe preeclampsia that includes hemolysis (the breakdown of red blood cells), high liver enzymes, and low platelet count.

While more research is needed to determine the physical mechanisms between COVID-19 infection and preeclampsia, the authors said healthcare professionals should be aware of the association and closely monitor infected pregnant women for early detection of preeclampsia.

Source:

Journal reference:

Lai, J., et al. (2021) SARS-CoV-2 and subsequent development of preeclampsia and preterm labor: evidence for a dose-response relationship supporting causation. American Journal of Obstetrics and Gynecology. doi.org/10.1016/j.ajog.2021.08.020.


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