Dyspnea and COVID-19: A Review of Confounding Diagnoses during the Postpartum Period / Dispneia e COVID-19: uma revisão de diagnósticos confundidores no período pós-parto

Abstract The puerperium is a complex period that begins with placental delivery and lasts for 6 weeks, during which readaptation of the female organism and redistribution of blood volume occur. This period is conducive to the occurrence of thromboembolic events. In the context of the SARS-CoV-2 pandemic, the virus responsible for COVID-19, the attention of the scientific community and health professionals has been focused on obtaining insights on different aspects of this disease, including etiology, transmission, diagnosis, and treatment. Regarding the pregnancy-postpartum cycle, it is opportune to review the clinical conditions that can occur during this period and to investigate dyspnea as a postpartum symptom in order to avoid its immediate association with COVID-19 without further investigation, which can lead to overlooking the diagnosis of other important and occasionally fatal conditions.

Resumo O puerpério é um período complexo que se inicia com a dequitação placentária e dura por 6 semanas, no qual a readaptação do organismo materno e a redistribuição do volume sanguíneo ocorrem, além de ser também um cenário propício para eventos pró-trombóticos. No contexto da pandemia de SARS-CoV-2, vírus responsável pela COVID-19, a atenção da comunidade científica e dos profissionais da saúde está voltada a elucidar os aspectos da doença, como a etiologia, a transmissão, o diagnóstico e o tratamento. Considerando o ciclo gravídico-puerperal, é oportuna a revisão de condições clínicas que ocorrem durante este período e que apresentam a dispneia como sintoma, a fimde evitar que ela seja automaticamente associada à COVID-19 sem investigações aprofundadas, o que pode levar à negligência do diagnóstico de outras condições importantes e que podem ser, por vezes, fatais.

Metabolomics applied to maternal and perinatal health: a review of new frontiers with a translation potential

The prediction or early diagnosis of maternal complications is challenging mostly because the main conditions, such as preeclampsia, preterm birth, fetal growth restriction, and gestational diabetes mellitus, are complex syndromes with multiple underlying mechanisms related to their occurrence. Limited advances in maternal and perinatal health in recent decades with respect to preventing these disorders have led to new approaches, and "omics" sciences have emerged as a potential field to be explored. Metabolomics is the study of a set of metabolites in a given sample and can represent the metabolic functioning of a cell, tissue or organism. Metabolomics has some advantages over genomics, transcriptomics, and proteomics, as metabolites are the final result of the interactions of genes, RNAs and proteins. Considering the recent "boom" in metabolomic studies and their importance in the research agenda, we here review the topic, explaining the rationale and theory of the metabolomic approach in different areas of maternal and perinatal health research for clinical practitioners. We also demonstrate the main exploratory studies of these maternal complications, commenting on their promising findings. The potential translational application of metabolomic studies, especially for the identification of predictive biomarkers, is supported by the current findings, although they require external validation in larger datasets and with alternative methodologies.