Impact of COVID-19 on cardio-obstetric risk indicators: Future directions

ABSTRACT

Cardiovascular illness is one the foremost causes of death in females. The goal of preventive medicine is to identify and target high-risk females belonging to the younger age group in order to prevent future onset of cardiovascular pathologies. Certain obstetric complications like idiopathic preterm birth, preeclampsia (PE), gestational diabetes and abruptio placentae mark their presence in the checklist of risk indicators for cardiovascular diseases (CVD) among the female population. Previous severe acute respiratory syndrome-1 (SARS-1) infections recorded a significant impact on maternal and fetal outcomes. In this article, we aim to focus on the incidence of cardiovascular risk indicators with the incessant novel Coronavirus disease-19 (COVID-19) pandemic in pregnant women and to provide recommendations for venous thromboembolism (VTE) prophylaxis in infected females. As the disease is novel and gradually unfolding to clinicians globally, the data and the publications are also evolving. Studies on COVID-19 in pregnancy has shown an increase in the number of preterm births, and PE with some reports on vertical transmission, but no significant increase in miscarriage, still births and teratogenicity. Preterm births appear more likely to be iatrogenic rather than idiopathic, owing to severity of infection or maternal/fetal safety. Causal association of virus with PE needs further analysis by large population studies, as both have common overlapping clinical and laboratory parameters. Direct placental involvement by virus leading on to PE or infection itself simulating PE needs further explication. Assessment of placental function, histopathological examination, and measurement of antiangiogenic factors are some of the suggested measures to differentiate further. Peripartum cardiomyopathy in COVID-19 positive pregnant females has not yet been actively explored, particularly in cases of clinical deterioration. Practical utilization of handheld point-of-care echocardiography machines stand in need for diagnosing myocardial dysfunction in this pandemic. COVID-19 infection and pregnancy together may impart a greater thromboembolism risk due to their inherent hypercoagulable states. All pregnant females with COVID-19 infection are candidates for VTE prophylaxis, both antepartum and postpartum depending on the severity of illness.