Wayne State Study: SARS-CoV-2 Increases Risk of Preeclampsia

Wayne State Study: SARS-CoV-2 Increases Risk of Preeclampsia

A newly published study found that women who contract COVID-19 during pregnancy are at significantly higher risk of developing pre-eclampsia, the leading cause of maternal and infant death worldwide.

In “SARS-COV-2 infection during pregnancy and risk of preeclampsia: a systematic review and meta-analysis” published in the American Journal of Obstetrics and Gynecology, researchers said their systematic review shows that women with SARS-CoV-2 infection during pregnancy had 62% higher odds of developing preeclampsia than those without the infection during pregnancy.

“This association was remarkably consistent across all predefined subgroups. Moreover, SARS-CoV-2 infection during pregnancy was associated with a significant increase in the odds of preeclampsia with severe features, eclampsia and HELLP syndrome,” said Roberto Romero, M.D., DMedSci, chief of the Perinatology Research Branch and professor of Molecular Obstetrics and Genetics at the Wayne State University School of Medicine.

Dr. Romero and Agustin Conde-Agudelo, M.D., M.P.H., Ph.D., adjunct professor of Obstetrics and Gynecology, published their findings after reviewing 28 previous studies that included 790,954 pregnant women, including 15,524 diagnosed with COVID-19 infection.

“Both asymptomatic and symptomatic infection significantly increased the risk of preeclampsia,” Dr. Romero said. “Nevertheless, the odds of developing preeclampsia were higher among patients with symptomatic illness than among those with asymptomatic illness.”

Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. Preeclampsia warning signs, in addition to elevated blood pressure, can include headaches, swelling in the face and hands, blurred vision, chest pain and shortness of breath. While the condition can manifest within a few hours, some women report few or no symptoms.

The condition is responsible for 76,000 maternal deaths and more than 500,000 infant deaths every year, according to estimates from the Preeclampsia Foundation. It can affect the liver, kidney and brain. Some mothers develop seizures (eclampsia) and suffer intracranial hemorrhage, the main cause of death in those who develop the disorder. Some women develop blindness. The babies of preeclamptic mothers are affected by the condition and may develop intrauterine growth restriction or die in utero.

The earlier the disease starts in pregnancy, the worse the outcome can be for the baby and mother. Women with preeclampsia often do not feel the effects until the condition is severe and becomes life-threatening. Effects on the mother include cardiac problems, possible brain hemorrhage, acute renal failure, blood clotting problems and possible blindness. If left undetected, the condition can progress to eclampsia and the mother may begin convulsing. For the fetus, preeclampsia has been connected to a reduction in placental blood flow, resulting in physical and mental disability, the slowing of fetal development, and in severe cases, infants may be stillborn.

HELLP syndrome is a form of severe preeclampsia that includes hemolysis (the rupturing of red blood cells), elevated liver enzymes and a low platelet count.

While further research is needed to determine the physical mechanisms between COVID-19 infection and preeclampsia, the authors said health care professionals should be aware of the association and closely monitor pregnant women who are infected for early detection of preeclampsia.

COVID “Long-Haulers” and Post-Viral Syndrome: “We Have to Believe Our Patients”

COVID “Long-Haulers” and Post-Viral Syndrome: “We Have to Believe Our Patients”

Scientific concern over “long-haulers”–former COVID patients who endure months of ongoing symptoms after recovery–is fueling a fresh wave of research into what is often called post-viral syndrome. Post-COVID care programs that focus on the after-effects of the virus are opening up around the US and abroad. In the US, hospitals such as New York City’s Mount Sinai, Hackensack Meridian Health, University of Texas Medical Branch Health, and Yale Medicine’s Winchester Chest Clinic have assembled special teams to treat former COVID patients who are finding that months after “recovery” they are still unable to return to work or resume their regular lives.

Post-COVID long-haulers are struggling with symptoms such as insurmountable fatigue, shortness of breath, “brain fog,” joint and chest pain, headaches, depression, and more. Their experiences tally with earlier studies of recovered SARS and H1NI influenza patients (a 2009 study of former SARS patients found that 40% suffered from chronic fatigue 4 years after recovery). Infectious diseases expert Anthony Fauci has said that lingering post-COVID symptoms are “highly suggestive” of  myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), which often originates with viral infection. And these after-effects are not confined to those who had severe cases of COVID-19. In a study released in July, the CDC found that “COVID-19 can result in prolonged illness even among persons with milder outpatient illness, including young adults.”

Researchers are still working to understand long-haulers’ symptoms and the causes of post-viral syndrome. Many believe that at least some of the issues occur when the body’s inflammatory response fails to deactivate after the virus has left the system. Susan Bleasdale, MD, associate professor of clinical medicine and an infectious disease specialist at the University of Illinois at Chicago, told Chicago Health Online that sometimes “Your immune system gets turned on to fight this, and it’s hard to get it turned off again.” Long-term studies (1-2 years) of post-COVID patients have been launched in the US and the UK, and a September 14 article in Nature suggests that “What [these studies] find will be crucial in treating those with lasting symptoms and trying to prevent new infections from lingering.”

What can be done for the long-haulers at present? First and foremost, listen to post-COVID patients’ accounts of their symptoms, and do not discount what they are saying. The substantial number of healthcare providers who have had the virus and are still suffering has made it harder to disregard the reality of long-haul effects. Zijian Chen, MD, who heads the Mount Sinai post-COVID recovery program, told MedPage Today, “I have colleagues affected by COVID-19 who have persistent symptoms. These are some of the hardest working and most honest people I know. I don’t see anything on their scans, but I believe them. We have to believe our patients to make sure we’re not neglecting them.”