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Cardiovascular Complications of Pregnancy-Associated COVID-19 Infections

Joan E Briller1, Niti R Aggarwal2, Melinda B Davis3

  • 1Division of Cardiology, Department of Medicine and Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA.

JACC. Advances
|August 15, 2022
PubMed

Insights

Pregnant women with coronavirus disease 2019 (COVID-19) face increased cardiovascular risks, including thrombotic events and heart issues. This review details these unique pregnancy-related COVID-19 cardiac complications.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Maternal-Fetal Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) frequently causes cardiovascular complications in the general population, including thrombotic events and myocardial injury.
  • Pregnant women with COVID-19 exhibit a higher risk of severe outcomes compared to non-pregnant individuals, necessitating intensive care and advanced life support.
  • Existing guidelines on COVID-19 cardiac complications overlook pregnancy-specific conditions that can mimic viral effects, such as peripartum cardiomyopathy and preeclampsia.

Purpose of the Study:

  • To review and summarize the current understanding of cardiovascular complications associated with COVID-19 in pregnant individuals.
  • To highlight the unique challenges and considerations for managing COVID-19 in pregnancy, particularly concerning cardiac manifestations.
  • To address the intersection of COVID-19, pregnancy, and cardiovascular health, considering conditions often excluded from research.

Main Methods:

  • Literature review synthesizing existing research on COVID-19 and cardiovascular complications in pregnancy.
  • Analysis of reported cases and observational data concerning pregnant women with COVID-19.
  • Comparison of COVID-19-related cardiovascular issues with pregnancy-specific cardiovascular conditions.

Main Results:

  • COVID-19 in pregnancy is linked to increased risks of arterial and venous thromboembolism, myocardial injury, heart failure, and arrhythmias.
  • Pregnant women with COVID-19 are more likely to require intensive care, mechanical ventilation, and extracorporeal membrane oxygenation.
  • COVID-19 can precipitate preterm delivery and alter standard pregnancy management protocols.

Conclusions:

  • Cardiovascular complications of COVID-19 present unique challenges during pregnancy, distinct from but sometimes mimicking conditions like peripartum cardiomyopathy and preeclampsia.
  • Pregnancy itself can modify the presentation and impact of COVID-19 cardiovascular complications, necessitating tailored clinical approaches.
  • Further research is crucial to understand and manage the complex interplay between COVID-19, pregnancy, and cardiovascular health, especially given historical exclusion criteria in studies.

Keywords:
CDC, Centers for Disease ControlCOVID-19, coronavirus-2019ECG, electrocardiogramECMO, extracorporeal membrane oxygenationLV, left ventricularMI, myocardial injuryPASC, postacute sequelae of SARS-CoV-2 infectionPPCM, peripartum cardiomyopathySCAD, spontaneous coronary artery dissectionTn, cardiac troponinarrhythmiascardio-obstetricsperipartum cardiomyopathypreeclampsiathromboembolic diseasevaccine induced thrombocytopenia

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