COVID-19 and pregnancy: is a "forgotten" disease still a threat?

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has significantly affected global health, including maternal and perinatal outcomes. Although the acute phase of the pandemic has subsided, the continued emergence of new viral variants, waning population immunity, and suboptimal vaccination coverage among women of reproductive age suggest that COVID-19 in pregnancy may remain a clinically relevant problem. This review summarizes current evidence regarding the clinical course, complications, and prevention of SARS-CoV-2 infection during pregnancy, addressing whether COVID-19 should be considered a "forgotten" obstetric disease. Most pregnant women develop asymptomatic or mild infection; however, pregnancy is associated with an increased risk of severe disease, intensive care unit admission, mechanical ventilation, and maternal mortality, particularly among women of advanced maternal age, with obesity, comorbidities, or without vaccination. SARS-CoV-2 infection during pregnancy is consistently linked with a higher incidence of preeclampsia, including severe forms such as eclampsia and HELLP syndrome, increased rates of cesarean delivery and, in many populations, preterm birth. Vertical transmission is uncommon but documented. Severe placental involvement, referred to as COVID-19 placentitis, may result in placental insufficiency, fetal hypoxia, and stillbirth. Expression of angiotensin-converting enzyme 2 within the placenta provides a biological basis for viral tropism and potential disruption of placental defense mechanisms, contributing to adverse perinatal outcomes. COVID-19 vaccination before conception, during pregnancy, and throughout breastfeeding is safe and effective. Immunization significantly reduces the risk of severe maternal disease, preterm birth, emergency cesarean delivery, stillbirth, and neonatal hospitalization, while also conferring passive protection to infants. Maintaining up-to-date vaccination remains essential for preventing maternal and perinatal complications associated with SARS-CoV-2 infection.