review · American Journal of Reproductive Immunology
Pregnant women face higher risks of severe illness and mortality from COVID-19 due to physiological susceptibility to respiratory pathogens and their distinct immunological state. Severe infections during pregnancy have been associated with adverse outcomes such as preterm labour, spontaneous abortion, fetal distress, and neonatal complications, though direct causal links remain unconfirmed. Examination of immune responses suggests that an imbalance between regulatory T cells and T helper 17 cells contributes to the severe, uncontrolled systemic inflammation seen in critical COVID-19 cases. Because disruptions in these CD4-positive T-cell ratios are known to harm pregnancy, such deregulation caused by SARS-CoV-2 infection may drive negative maternal and perinatal outcomes. Additionally, vertical transmission between mother and child represents another potential mechanism for adverse complications, warranting rigorous pregnancy monitoring.
Understanding how COVID-19 affects pregnant women is critical for safeguarding maternal and infant health during viral outbreaks. Identifying the immunological mechanisms, particularly T-cell imbalances and systemic inflammation, helps explain why severe infections lead to adverse outcomes. This insight reinforces the clinical necessity of closely monitoring infected pregnant patients to recognise, prevent, and treat both maternal and perinatal complications early.
The abstract describes early-stage conceptual research and literature analysis rather than a direct technological solution. In the longer term, these immunological insights could inform the development of targeted diagnostics or anti-inflammatory therapies by biopharmaceutical researchers and clinicians managing maternal health. However, because no specific clinical intervention or product was developed or tested, the work is at a very early research stage with no near-term commercial application indicated.
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Abstract Caused by a novel type of virus, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), coronavirus disease 2019 (COVID‐19) constitutes a global public health emergency. Pregnant women are considered to have a higher risk of severe morbidity and even mortality due to their susceptibility to respiratory pathogens and their particular immunologic state. Several studies assessing SARS‐CoV‐2 infection during pregnancy reported adverse pregnancy outcomes in patients with severe conditions, including spontaneous abortion, preterm labor, fetal distress, cesarean section, preterm birth, neonatal asphyxia, neonatal pneumonia, stillbirth, and neonatal death. However, whether these complications are causally related to SARS‐CoV‐2 infection is not clear. Here, we reviewed the scientific evidence supporting the contributing role of Treg/Th17 cell imbalance in the uncontrolled systemic inflammation characterizing severe cases of COVID‐19. Based on the recognized harmful effects of these CD4 + T‐cell subset imbalances in pregnancy, we speculated that SARS‐CoV‐2 infection might lead to adverse pregnancy outcomes through the deregulation of otherwise tightly regulated Treg/Th17 ratios, and to subsequent uncontrolled systemic inflammation. Moreover, we discuss the possibility of vertical transmission of COVID‐19 from infected mothers to their infants, which could also explain adverse perinatal outcomes. Rigorous monitoring of pregnancies and appropriate measures should be taken to prevent and treat early eventual maternal and perinatal complications.
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DOI: 10.1111/aji.13304
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