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European Journal of Applied Sciences – Vol. 10, No. 2
Publication Date: April 25, 2022
DOI:10.14738/aivp.102.12274. Pérez-Elizondo, S. B., Solis-Aguilar, J. G., Solis-Pacheco, J. R., Amézcua-López, J. A., Martínez-Gómez, C. M., & Aguilar-Uscanga, B. R.
(2022). SARS-CoV-2: Pregnancy, Delivery and Postpartum. A Short Review. European Journal of Applied Sciences, 10(2). 634-641.
Services for Science and Education – United Kingdom
SARS-CoV-2: Pregnancy, Delivery and Postpartum. A Short
Review
Sheila B. Pérez-Elizondo
CUCS, Universidad de Guadalajara. Guadalajara, Jalisco, México
Jessica G. Solis-Aguilar
CUCS, Universidad de Guadalajara. Guadalajara, Jalisco, México
Josue R. Solis-Pacheco
Department of pharmacobiology. CUCEI
Universidad de Guadalajara. Guadalajara, Jalisco, México
Jesús A. Amézcua-López
Department of pharmacobiology. CUCEI
Universidad de Guadalajara. Guadalajara, Jalisco, México
Celia M. Martínez-Gómez
CUCS, Universidad de Guadalajara. Guadalajara, Jalisco, México
Blanca R. Aguilar-Uscanga
Department of pharmacobiology. CUCEI
Universidad de Guadalajara. Guadalajara, Jalisco, México
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the ninth
documented coronavirus to infect humans and it is highly transmissible; has caused
a global pandemic and dramatic loss of human life worldwide. Isolated in Wuhan,
China in late 2019, it struck nations with significant economic and public health
consequences. The International Committee on Taxonomy of Viruses (ICTV) named
the virus as SARS-CoV-2 and the disease as COVID-19. However, few studies have
been published on the effects that this virus can have during pregnancy, childbirth
and postpartum, so the objective of this review is to alert about the possible
problems that women can present during their pregnancy, and provide adequate
and specialized. It has been described that SARSCoV-2 virus has a predilection for
the angiotensin converting enzyme (ACE) II receptor present in pneumocytes,
enterocytes and at the placental level. Placental involvement could lead to
hypoperfusion and thrombosis, resulting in fetal intrauterine growth restriction
and preterm delivery. Careful monitoring of pregnant patients who test positive for
SARS-CoV-2 is recommended because of the potential complications that could
occur in the mother and fetus. The recommendations include offering vaccines
against SARS-CoV-2 to pregnant and breastfeeding women, the provision of
comprehensive health care to the mother-child pair; for example, maternal support
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Pérez-Elizondo, S. B., Solis-Aguilar, J. G., Solis-Pacheco, J. R., Amézcua-López, J. A., Martínez-Gómez, C. M., & Aguilar-Uscanga, B. R. (2022). SARS- CoV-2: Pregnancy, Delivery and Postpartum. A Short Review. European Journal of Applied Sciences, 10(2). 634-641.
URL: http://dx.doi.org/10.14738/aivp.102.12274
networks and establishment of successful breastfeeding, which involves the
development of the maternal-neonatal bond.
Keywords: Pregnancy, postpartum, lactation, SARS-CoV-2, vaccine.
INTRODUCTION
In late 2019, Wuhan, the capital of Hubei province in China, experienced an outbreak of a new
coronavirus, which during the first 50 days of the epidemic killed more than 1,800 people and
infected more than 70,000. This virus was reported to be a member of coronavirus group b and
was named new coronavirus 2019 (2019-nCov). The International Committee on Taxonomy of
Viruses (ICTV) named the virus as SARS-CoV-2 and the resulting disease as COVID-19 (Shereen
et al., 2020).
Initially, it was thought that infected patients may have had in common the fact that they had
visited a seafood market where live animals were sold, or they may have used infected animals
or birds as a food source. However, subsequent investigations showed that some people were
infected even without visiting the seafood market. These observations indicated the spread of
the virus among humans, and it was subsequently reported in more than 100 countries around
the world. Person-to-person spread of the virus occurs due to close contact with an infected
person through coughing, sneezing, small respiratory droplets or aerosols and subsequent
inhalation of these through the nose or mouth.1
On January 30, 2020, the World Health Organization declared the outbreak an international
public health emergency. On February 11, 2020, the new coronavirus disease was officially
named by the World Health Organization (WHO) as COVID-19 (WHO, 2020).
The progression of the pandemic in a country also depends on other relevant population
factors, such as demographic characteristics. Therefore, in countries with disadvantaged social,
political and economic characteristics, medical care and policies such as vaccination, access to
diagnostic tests and screening of those likely to be infected play a key role (Angius et al., 2021).
Although the virus is prevalent in all age groups, immunocompromised individuals are
disproportionately affected with respect to the severity of symptoms; and it has been
previously described that pregnant women and their fetuses are particularly susceptible to
infections due to physiological changes such as cell-mediated immunity, immaturity of the
adaptive immune system, and cytokine dysregulation (Chen et al., 2020).
SARS-COV-2 IN PREGNANT WOMEN
Current knowledge about the effect of SARS-CoV-2 infection during pregnancy has largely been
obtained from case reports, case series, and population surveillance systems. These data have
focused particularly on maternal outcomes of women with symptomatic disease and maternal
death, stillbirth, and neonatal death; each has been reported to occur in about 1% of cases under
this setting (Kachikis et al. 2021).
At the onset of the SARS-CoV-2 pandemic, WHO designated pregnant women as a vulnerable
group based on preliminary reports of increased risk of fetal death, preterm delivery, and
intrauterine growth restriction, in addition to experience previously gained with already
known respiratory virus outbreaks; pregnant women were assumed to be at increased risk of
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European Journal of Applied Sciences (EJAS) Vol. 10, Issue 2, April-2022
Services for Science and Education – United Kingdom
morbidity and mortality from SARS-CoV-2 infection, particularly when symptomatic; The
clinical features of COVID-19 pneumonia in pregnant patients are similar to those reported in
non-pregnant patients who developed COVID-19 pneumonia, with clinical findings ranging
from asymptomatic presentation to severe disease and even death in some cases. The most
common symptoms in the pregnant woman with COVID-19 are fever, cough, and muscle pain
(Chen et al., 2020).
It has been previously described that SARSCoV-2 virus has a predilection for the ACE II receptor
present at the placental level. Placental involvement could cause hypoperfusion and
thrombosis, leading to intrauterine growth restriction and/or preterm delivery (Oltean et al.,
2021). The first studies regarding the placental histopathological changes in women with late
pregnancy and COVID-19, showed placental tissue analyzed showed fibrin deposits and
infarcts, which could condition placental hypoperfusion due to the presence of ACE II receptors
in the placenta Chen, et al. (2020).
The increased risk of pregnancy could be explained in part by impaired placental function. A
trial conducted by Radan et al. (2020), evaluated placental weight, birth weight/placental
weight ratio, and metabolic scale exponent β, an indicator of normal fetus-placental growth, as
well as, SARS-CoV-2 during pregnancy, which is associated with a higher incidence of low-birth- weight placenta, increased birth weight/placental weight ratio, and abnormal β-scale exponent
in the cohort of 153 patients. Emphasizing intensified fetal surveillance in these pregnancies
(Radan et al., 2020).
For this reason, it is important to advise pregnant women of the risks of SARS-CoV-2 infection;
for example, the aforementioned risks of preterm delivery, intrauterine growth restriction and
maternal admission to the intensive care unit (Anderson, 2020). With the ongoing concern
about SARS-CoV-2 around the world, the focus is on treatment in general; pregnant and
lactating women in this case (Bastug et al., 2020; Halasa et al., 2021).
After much effort, several vaccines were developed and approved for emergency use;
thereafter, a massive mass vaccination campaign was initiated. SARS-CoV-2 vaccines prove to
be quite effective in preventing COVID-19 and because SARS-CoV-2 is associated with adverse
events in pregnancy recommendations should offer SARS-CoV-2 vaccines to pregnant and
lactating women, despite their lack of inclusion in initial clinical trials (Angius et al., 2021;
Kachikis et al., 2021; Lipkind et al., 2021; Romero-Ramírez et al., 2022).
One point to consider is the doubts and concerns among pregnant women regarding the safety
of vaccines, which represent a persistent barrier to the acceptance of vaccines. Nevertheless, a
prospective cohort study reported that COVID-19 vaccines, were well tolerated among persons
who were pregnant, breastfeeding, or planning a pregnancy. Reactions on day 1 after the first
dose with BNT162b2 and mRNA-1273 vaccines were similar between groups and comparable
to findings among pregnant women. All groups reported an increase in reactions after the
second dose of these vaccines (Kachikis et al., 2021).
Nir et al. (2020) conducted a study in women who were immunized with the messenger RNA
vaccine BNT162b2 during the pregnancy period, demonstrated an efficient transfer of SARS- CoV-2 immunoglobulin G across the placenta to their newborns, with an adequate correlation