Is there a higher incidence of preeclampsia in pregnant women with COVID-19? The symptoms and clinical findings are due to preeclampsia or would they be a complication of COVID-19? In this context, a group of researchers from Vall d'Hebron Barcelona Hospital Campus have described for the first time a syndrome that imitates preeclampsia in pregnant women suffering from severe COVID-19, which can be differentiated from real preeclampsia by the assessment of sFlt-1/PlGF and uterine artery Doppler.
The study, published in the BJOG: An International Journal of Obstetrics and Gynaecology, involved professionals from the Maternal and Fetal Medicine Unit, the Biochemistry Service, the Pediatric Intensive Care Unit and the Infectious Diseases Service of the Vall d'Hebron University Hospital.
Preeclampsia is a severe pregnancy complication that can appear after the 20th week of gestation and can be life-threatening for both the mother and the fetus. It is characterized by high blood pressure and may be accompanied by protein at the urine, decreased platelets and/or elevated liver enzymes, among others. All of these signs and symptoms can also be found in COVID-19 patients.
During the COVID-19 epidemic, an increased incidence of preeclampsia had been reported in pregnant women infected with SARS-CoV-2 compared to healthy pregnant women. However, "the fact that COVID-19 and preeclampsia have overlapping clinical characteristics could lead to misdiagnosis in pregnant women with COVID-19", says Dr Manel Mendoza, a specialist physician in the Obstetrics Service, head of the Placental Insufficiency Unit of the Vall d'Hebron University Hospital and researcher of the Maternal and Fetal Medicine research group at the Vall d'Hebron Research Institute (VHIR).
The objective of the study was to investigate the prevalence of clinical, ultrasound and biochemical findings related to preeclampsia in women with SARS-CoV-2 infection and to assess their precision to differentiate between actual preeclampsia and the preeclampsia-like syndrome induced by COVID-19.
Between March 13 and April 10, 2020, the researchers recruited 42 pregnant women over 20 weeks of gestation who arrived at the Vall d'Hebron Emergency Department with COVID-19 infection confirmed with a PCR test. Patients were classified into two groups: severe and non-severe COVID-19, according to the presence of severe pneumonia. Uterine artery Doppler and angiogenic factors (sFlt-1/PlGF) were evaluated in women with suspected preeclampsia. These markers are highly specific for preeclampsia and abnormal values would indicate a high probability of suffering preeclampsia.
Of these 42 cases, 34 were classified as non-severe and no diagnostic criteria for preeclampsia were found. By contrast, the remaining eight cases were classified as severe (with severe pneumonia) and required admission to the ICU. Six of these eight women (75%) developed signs and symptoms of preeclampsia, but normal sFlt-1/PlGF and uterine artery Doppler were found in five of these six patients. This fact suggests that the preeclampsia signs and symptoms of these five women were probably due to COVID-19 and not preeclampsia.
Therefore, this study shows that "62.5% of pregnant women with severe COVID-19 develop signs and symptoms that mimic preeclampsia but can be distinguished from real preeclampsia by the sFlt-1/PlGF and the Doppler study of the uterine arteries", says Dr. Mendoza.
These findings have important clinical implications, since "it would reduce misdiagnosis and might avoid iatrogenic deliveries in pregnant women with COVID-19” concludes Dr Manel Mendoza. The preeclampsia-like syndrome induced by severe COVID-19 usually resolves spontaneously after recovery from pneumonia, therefore the syndrome in itself should not be an indication of delivery.