A recent review published in the American Journal of Reproductive Immunology, supported by the São Paulo Research Foundation (FAPESP), has highlighted significant pathophysiological similarities between preeclampsia and COVID-19 in pregnant women. The research, conducted by teams from the State University of Campinas (UNICAMP) in Brazil and Baylor College of Medicine in Texas, emphasizes the need for careful diagnosis and management of these conditions, especially during the COVID-19 pandemic.
Preeclampsia, characterized by high blood pressure and elevated protein levels in urine, poses serious risks to both mother and baby. During the pandemic, particularly before the availability of vaccines, there were concerns about a potential increase in preeclampsia cases among pregnant women infected with SARS-CoV-2. Studies indicated that these women faced a heightened risk of complications, including severe organ dysfunction and even death.
Differentiating between gestational preeclampsia and severe COVID-19 presented a significant clinical challenge. While preeclampsia typically arises in the third trimester and can lead to kidney and liver failure, the severe inflammation caused by COVID-19 can produce similar complications. Treatment protocols differ markedly; preeclampsia often necessitates immediate delivery via cesarean section, whereas COVID-19 management may allow for the continuation of the pregnancy with appropriate clinical support.
The review identifies shared biological pathways linking the two conditions, particularly involving the renin-angiotensin system and angiotensin-converting enzyme 2 (ACE2), the receptor that SARS-CoV-2 uses to enter human cells. These shared mechanisms suggest that COVID-19 may increase the risk of developing preeclampsia.
Maria Laura Costa do Nascimento, the lead author of the review and a professor of obstetrics at UNICAMP, noted, “Both severe COVID-19 and preeclampsia can involve multiple organ dysfunction and high blood pressure. It is possible that COVID-19 heightens the risk of preeclampsia, as several studies indicate a higher frequency of this condition in COVID-19 patients.”
In Brazil, preeclampsia accounts for over 300 maternal deaths annually. Nascimento pointed out that high-income countries have significantly reduced these fatalities through timely diagnosis and effective treatment strategies. However, the COVID-19 pandemic exacerbated existing trends, with maternal deaths rising sharply from 1,965 in 2020 to 3,030 in 2021, according to the Ministry of Health. The national average for maternal mortality reached 120 deaths per 100,000 live births during the pandemic, underscoring the urgent need for improved healthcare responses.
Nascimento emphasized that the rise in maternal mortality cannot solely be attributed to an increase in preeclampsia cases. Instead, it reflects deficiencies in epidemiological surveillance and accurate diagnosis. A multicenter study involving 16 maternity hospitals across Brazil revealed that the presence of both conditions significantly increased the risk of severe outcomes.
Additionally, Nascimento’s research group has identified specific biomarkers—proteins sFlt-1 and PlGF—that can help differentiate between preeclampsia and COVID-19. These markers, which regulate blood vessel function, display an imbalance in preeclampsia cases, with a decrease in proangiogenic proteins and an increase in antiangiogenic proteins. This finding could aid in achieving more accurate diagnoses.
Well-established risk factors for preeclampsia include chronic hypertension, previous preeclampsia, multiple pregnancies, diabetes, and autoimmune diseases. Nascimento suggests that COVID-19 may need to be included in the list of risk factors warranting close monitoring throughout pregnancy.
As researchers continue to explore the connections between these two conditions, the findings underscore the importance of vigilance in maternal health, particularly in the context of ongoing global health challenges.
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