Can immunity during pregnancy influence SARS-CoV-2 infection? - A systematic review
Ana Luísa Areia1, Anabela Mota-Pinto2
1Obstetrics Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; University of Coimbra, Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Background:
During pregnancy, the maternal immune system must create and sustain tolerance to the allogeneic fetus while maintaining the ability to protect against microbial assaults.
Objectives:
Ascertain the immunological differences in immune cells of pregnant women that may influence SARS-CoV-2 infection.
Study Design:
Systematic review conducted in accordance with PRISMA guidelines and registered within PROSPERO CRD42020189735. A systematic search was undertaken across ISI, PubMed, Scopus, Embase, Cochrane Library and clinical trials.gov from January 2019 up until June 2020. Eligibility criteria included COVID-19 infection, pregnancy, and availability of immune characteristics for the pregnant women. Two authors independently screened for the suitability of inclusion.
Main Outcome Measures:
Information was manually extracted from full-text articles and efforts were made to identify overlapping data. Variables extracted and analysed included the quantification of white blood cells (WBC), lymphocytes, and C-reactive protein (CRP).
Results:
The literature search yielded 162 studies, of which 11 were considered appropriate for selection. Only four were used in this systematic review. Our research showed that pregnant women with COVID-19 only differ from other pregnant women in their lower WBC count. The proportion of reduced lymphocyte cases is similar in both groups, as is the case of C-reactive protein levels.
Conclusions:
In line with previous coronavirus infections, severe maternal morbidity and perinatal death with COVID-19 infection were more likely to be expected in pregnancy. Our research showed that pregnant women with COVID-19 in terms of immunity only differ from other pregnant women in their lower WBC count.
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