Pathogenetic traits of preeclampsia in COVID-19. A relevant literature review

Abstract

The aim of this study was to present the latest data on the association of preeclampsia and coronavirus infection and on the preeclampsia-like syndrome, and to analyze the current literature on the pathogenetic relationships between COVID-19 and preeclampsia and on morphological changes in placental tissue in patients with these gestational complications. A significant portion of studies indicate an increased risk of developing preeclampsia in patients with coronavirus infection during pregnancy, regardless of gestational age, especially in severe COVID-19, but other researchers report no association between coronavirus infection and the onset of preeclampsia. The supposed pathogenetic connection between these pathologies consists in the development of systemic endothelial dysfunction and dysregulation of the renin-angiotensin-aldosterone system, while the direct effect of SARS-CoV-2 on the placentation is poorly understood and is a subject of debate. A new concept of the so-called “preeclampsia-like syndrome” has been introduced, which presumably occurs in patients with a severe form of the novel coronavirus infection as its extrapulmonary manifestation. The measurement of the ratio of soluble fms-like tyrosine kinase-1 activity to the level of placental growth factor ratio has been proposed as a differential diagnostic test between preeclampsia and the preeclampsia-like syndrome, but its prognostic value remains ambiguous. The morphological examination of placentas in patients with coronavirus infection and preeclampsia indicates the signs of maternal and fetal vascular malperfusion. The literature on the association between coronavirus infection and preeclampsia remains controversial, however, the better half of the researchers is indicative of a significant increase in the risk of developing this serious complication in pregnant women with COVID-19, especially for its severe form. New information about the preeclampsia-like syndrome, as well as the virtual absence of studies of placental morphology in patients with preeclampsia and coronavirus infection during pregnancy, dictate the need for further study to better understand the association between these two pathologies, determine the possibilities of patient surveillance and prevent complications.