ABSTRACT
Background: Endothelial dysfunction is crucial in moderate to severe SARS-CoV-2 infection. Preeclampsia is an endothelial pregnancyrelated syndrome that shares some clinical and analytical features with COVID19. COVID19 signs in pregnant women might be misdiagnosed as preeclampsia leading to an iatrogenic preterm delivery. Aims: To address whether endothelial damage, microvascular thrombosis and dysregulated immune response exhibit different patterns in preeclampsia and COVID19 in pregnancy. Methods: Plasma samples were obtained from pregnant women with COVID19 pneumonia classified into moderate ( n = 10) or severe disease ( n = 9). Endothelial damage and immune response markers were assessed, including VCAM-1, TNF-receptor I (TNFRI), angiotensin II (ANGII), heparan sulfate (HS), PAI-1, dsDNA for neutrophil extracellular traps (NETs), C5b9, thrombomodulin (TM) and ADAMTS-13 activity. Results were compared to those in SARS-CoV-2 negative including healthy pregnant women as controls (C, n = 10), and patients with preeclampsia (PE, n = 13). Results: All endotheliopathy markers were significantly increased in severe COVID19 and PE patients compared to healthy pregnants ( p <0,05, Table 1), except TM and ADAMTS-13 activity. Patients with moderate COVID19 presented a biomarker profile similar to the observed in control patients. Severe COVID19 and PE profiles were distinctive among them regarding four markers: VCAM-1, TNFRI and ANGII, clearly higher in PE, and HS, significantly lower in PE. The principal component analysis (PCA) in Figure 1, demonstrated the separation between severe COVID19 and PE from moderate COVID19 or uncomplicated pregnancies. The first and second components explained 29.1% and 18.4% of the variance between groups. (Figure Presented) Conclusions: Severe COVID19 exhibits signs of endothelial damage and immune dysregulation and some of them are shared with preeclampsia. However, there are specific markers with the potential to discriminate between both conditions. Investigation in this direction could help to develop new strategies for the prevention and treatment of both entities. Grants: Fundació Clínic (HCB/2020/0401), JazzPharmaceuticals (IST-16-10355), Fundació La Marató de TV3 (202026-10).
Subject(s)
COVID-19 , Pre-Eclampsia , Female , Humans , Pregnancy , Prospective Studies , SARS-CoV-2ABSTRACT
OBJECTIVES: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre-eclampsia (PE) in pregnancies with COVID-19, and to assess their accuracy to differentiate between PE and the PE-like features associated with COVID-19. DESIGN: A prospective, observational study. SETTING: Tertiary referral hospital. PARTICIPANTS: Singleton pregnancies with COVID-19 at >20+0 weeks. METHODS: Forty-two consecutive pregnancies were recruited and classified into two groups: severe and non-severe COVID-19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor [sFlt-1/PlGF]) were assessed in women with suspected PE. MAIN OUTCOME MEASURES: Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt-1/PlGF. RESULTS: Thirty-four cases were classified as non-severe and 8 as severe COVID-19. Five (11.9%) women presented signs and symptoms of PE, all five being among the severe COVID-19 cases (62.5%). However, abnormal sFlt-1/PlGF and UtAPI could only be demonstrated in one case. One case remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE-like syndrome. CONCLUSIONS: Pregnant women with severe COVID-19 can develop a PE-like syndrome that might be distinguished from actual PE by sFlt-1/PlGF, LDH and UtAPI assessment. Healthcare providers should be aware of its existence and monitor pregnancies with suspected pre-eclampsia with caution. TWEETABLE ABSTRACT: This study shows that a pre-eclampsia-like syndrome could be present in some pregnancies with severe COVID-19.