COVID-19 and the cardiovascular system in pregnancy

  • AS Herrey Barts Heart Centre Barts NHS Trust and University College London
  • A Osman Department of Obstetrics and Gynaecology Groote Schuur Hospital and University of Cape Town
  • P Soma-Pillay Department of Obstetrics and Gynaecology Maternal and Fetal Medicine Steve Biko Academic Hospital and University of Pretoria
  • K Sliwa Hatter Institute for Cardiovascular Research in Africa Division of Cardiology Department of Medicine Faculty of Health Sciences Groote Schuur Hospital and University of Cape Town
  • NAB Ntusi Hatter Institute for Cardiovascular Research in Africa Cape Universities Body Imaging Centre Division of Cardiology Department of Medicine Faculty of Health Sciences Groote Schuur Hospital and University of Cape Town

Abstract

Pregnancy and coronavirus disease-2019 (COVID-19) share several common features which makes differentiation between the 2 difficult. Both are multisystem disorders, may present with breathlessness, are associated with hypercoagulability and frequently cause significant anxiety in both the patient and those around them. Pregnancy represents a state of partial immune suppression, with pregnant women more vulnerable to viral infections. However, these concerns have not been borne out in clinical practice and have not stood up to epidemiological scrutiny. From limited data available on COVID-19 in pregnancy, the outcomes are mostly favourable. While cardiac disease and hypertension are independent predictors of hospital admission with COVID-19 in pregnancy, the prevalence of cardiac disease in the pregnant COVID-19 population is low. Pregnant women are younger, and asymptomatic SARSCoV-2 infection and favourable outcomes are reported in those below 55 years of age. Indeed, large numbers of asymptomatic cases have been reported in pregnancy, suggesting that pregnant patients with more severe disease courses may be over-represented in the current literature, particularly the early case reports and case series. Cardiovascular involvement in pregnancy includes new-onset hypertension, myocarditis, cardiomyopathy, pulmonary embolism and a pre-eclampsia-like syndrome.
Published
2020-11-04
Section
Articles