COVID-19 and preeclampsia: The unique and the mutually nonexclusive clinical manifestations

Preeclampsia (PE) is a serious, unpredictable hypertensive disorder of pregnancy present in around 8-10% of all pregnancies resulting in high rate of maternal and fetal morbidity and mortality. With the pathophysiology partially known, delivery is the only cure for PE. The disease sets due to multiple pathologic processes involving endothelial cell activation, inflammation, multiorgan damage and syncytiotrophoblast stress.  Though the primary target organ is lungs in COVID-19, other systemic manifestations which include endothelial dysfunction, dysregulated angiogenesis, thrombosis, liver injury, thrombocytopenia, hypertension and kidney damage overlap with PE. COVID-19 patients show a higher incidence of PE as compared to their noninfected counterparts and vice versa. Similar pathophysiology and clinical features make differential diagnosis challenging. For effective and specific management, it is important to differentiate actual PE from COVID-19 with PE like features. There are contradictory reports about the accuracy of diagnostic tools in distinguishing PE from severe COVID-19 with PE like features. With the available data, it can only be stated that PE is a common adverse pregnancy event, which may be exacerbated by, or may exacerbate, COVID-19. Future research should focus on cohesive understanding of the pathophysiology of the clinical manifestations, and preventive strategies during pregnancy.