SARS-CoV-2 infection during pregnancy and pregnancy-related conditions: concerns, challenges, management and mitigation strategies – a narrative review

Kumar, Rakesh; Yeni, Cut Meurah; Utami, Niken Asri; Masand, Rupali; Asrani, Rajesh Kumar; Patel, Shailesh Kumar; Kumar, Akshay; Yatoo, Mohd. Iqbal; Tiwari, Ruchi; Natesan, Senthilkumar; Vora, Kranti Suresh; Nainu, Firzan; Bilal, Muhammad; Dhawan, Manish; Emran, Talha Bin; Ahmad, Tauseef; Harapan, Harapan; Dhama, Kuldeep

The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health problem. The SARS-CoV-2 triggers hyper-activation of inflammatory and immune responses resulting in cytokine storm and increased inflammatory responses on several organs like lungs, kidneys, intestine, and placenta. Although SARS-CoV-2 affects individuals of all age groups and physiological statuses, immune-compromised individuals such as pregnant women are considered as a highly vulnerable group. This review aims to raise the concerns of high risk of infection, morbidity and mortality of COVID-19 in pregnant women and provides critical reviews of pathophysiology and pathobiology of how SARS-CoV-2 infection potentially increases the severity and fatality during pregnancy. This article also provides a discussion of current evidence on vertical transmission of SARS-CoV-2 during pregnancy and breastfeeding. Lastly, guidelines on management, treatment, preventive, and mitigation strategies of SARS-CoV-2 infection during pregnancy and pregnancy-related conditions such as delivery and breastfeeding are discussed.