Preeclampsia‐like syndrome induced by severe COVID‐19: a prospective observational study

Mendoza, Manel; Garcia‐Ruiz, Itziar; Maiz, Nerea; Rodo, Carlota; Garcia‐Manau, Pablo; Serrano, Berta; Lopez‐Martinez, Rosa Maria; Balcells, Joan; Fernandez‐Hidalgo, Nuria; Carreras, Elena; Suy, Anna

OBJECTIVES: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to preeclampsia (PE) in pregnancies with COVID‐19, and to assess their accuracy to differentiate between PE and the PE‐like features associated with COVID‐19. DESIGN: A prospective, observational study. SETTING: Tertiary referral hospital. PARTICIPANTS: Singleton pregnancies with COVID‐19 at >20+0 weeks. METHODS: 42 consecutive pregnancies were recruited and classified into two groups: severe and nonsevere COVID‐19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms‐like tyrosine kinase‐1/placental growth factor [sFlt‐1/PlGF]) were assessed in women with suspected PE. MAIN OUTCOME MEASURES: Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt‐1/PlGF. RESULTS: 34 cases were classified as nonsevere and 8 as severe COVID‐19. Six (14.3%) women presented signs and symptoms of PE, all six being among the severe COVID‐19 cases (75.0%). However, abnormal sFlt‐1/PlGF and UtAPI could only be demonstrated in one case. Two cases remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE‐like syndrome. CONCLUSIONS: Pregnant women with severe COVID‐19 can develop a PE‐like syndrome that might be distinguished from actual PE by sFlt‐1/PlGF, LDH and UtAPI assessment. Health care providers should be aware of its existence and monitor pregnancies with suspected preeclampsia with caution.