Severity of COVID-19 in pregnancy: A review of current evidence

Abstract

Coronavirus disease 19 (COVID-19) has recently emerged as a major threat to human health. Infections range from asymptomatic to severe (increased respiratory rate, hypoxia, significant lung involvement on imaging) or critical (multi-organ failure or dysfunction or respiratory failure requiring mechanical ventilation or high-flow nasal cannula). Current evidence suggests that pregnancy women are at increased risk of severe disease, specifically the need for hospitalization, ICU admission, and mechanical ventilation, and the already complex management of infection with an emerging pathogen may be further complicated by pregnancy. The goal of this review is to provide an overview of what is known about the clinical course of COVID-19 in pregnancy, drawing on (a) experience with other coronaviruses such as SARS and MERS, (b) knowledge of immunologic and physiologic changes in pregnancy and how these might impact infection with SARS-CoV-2, and (c) the current literature reporting outcomes in pregnant women with SARS-CoV-2. We also briefly summarize considerations in management of severe COVID-19 in pregnancy.