COVID-19 Pregnancy and Fertility: A Narrative Review

Pregnant women are currently worrying about both the effects of COVID-19 infection as well as the vaccine on their fetus and newborn. This narrative review is a summary of the literature on COVID-19 psychological problems of pregnant women, and infection effects on the women, their fetuses and neonates. The psychological problems studies have consistently shown a prevalence of approximately 20-40% anxiety and depression in pregnant women during COVID-19. Although early pandemic research suggested that the severity of COVID infection and the clinical course for infected pregnant women was no worse than for non-pregnant infected women, later pandemic, larger sample studies and meta-analyses suggest that infected pregnant women have more obstetric complications and negative outcomes than pregnant women without infection. Greater prevalence of pre-eclampsia, fetal distress, premature rupture of the membranes and preterm delivery have been reported for pregnant women who are infected, especially during the third trimester. Older pregnant women and those with comorbidities including elevated BMI, diabetes and hypertension are also at greater risk for obstetric complications. Mixed data have been presented on vertical transmission of the virus to the fetus as well as questions about vertical transmission via reduced natural killer cells protecting the placenta and increased ACE-2 receptors. Although the neonatal infection rate has been relatively low, antibodies noted in some neonates (IgG and IgM) suggest intrauterine, delivery or postnatal transmission. The very limited data on vaccination during pregnancy suggest positive effects. Although the data are even more limited on vaccination and fertility, there are no known negative effects. Methodological limitations of this literature include the data having been cross-sectional and derived from samples of symptomatic, hospitalized pregnant women at different gestational ages and different times during the pandemic.