Annals of Clinical and Medical

Case Reports

Review Paper ISSN 2639-8109 Volume 14

Coronavirus Infection During Pregnancy and Fetal Growth: How Should We Monitor These
Pregnancies? A Literature Review
Alessandro Messina1*, Alessia Mariani1, Eleonora Dalmasso1 Livio Leo2, Paolo Manzoni3 and Bianca Masturzo1
1
Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infer-
mi”,13875, Ponderano, Italy
2
Department of Obstetrics and Gynecology, Hospital Beauregard, AUSL Valleè d’Aoste, Aosta, Italy
3
Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”,
13875, Ponderano, Italy
Received: 05 Oct 2024 Copyright:
*
Corresponding author:
Accepted: 07 Nov 2024 ©2024 Alessandro Messina. This is an open access arti-
Alessandro Messina,
Published: 12 Nov 2024 cle distributed under the terms of the Creative Commons
Division of Obstetrics and Gynecology, Department
J Short Name: ACMCR Attribution License, which permits unrestricted use, dis-
of Maternal, Neonatal and Infant Medicine, Univer-
tribution, and build upon your work non-commercially
sity Hospital “Degli Infermi”,13875, Ponderano,
Italy
Citation:
Alessandro Messina, Coronavirus Infection During Preg-
Keywords: nancy and Fetal Growth: How Should We Monitor These
COVID; Pregnancy; Fetal growth restriction; Pregnancies? A Literature Review. Ann Clin Med Case
Fetal ultrasound Rep. 2024; V14(6): 1-6

1. Abstract ID-19) by the World Health Organization (WHO) in February

During pregnancy, coronavirus infection affects about 15% of 2020. After the first case was described in Wuhan (China) in De-
women, more than half of whom remain asymptomatic. Pregnant cember 2019, there have been thousands of fatalities, and to date,
women who show symptoms and have risk factors represent the there are approximately 776 million cases worldwide [1]. The virus
portion of the population most at risk of adverse outcomes. The belongs to the Beta-Coronavirus family and shares some similar-
aim of this re-view is to analyze and summarize the current data ities with the viruses causing Middle East Respiratory Syndrome
regarding fetal ultrasound monitoring in pregnancies affected by (MERS-CoV) and severe acute respiratory syndrome (SARS-
coronavirus and to understand what the most appropriate care CoV), however, it is more contagious and aggressive [2,3]. The
pathway is. The effects of coronavirus on the fetus and newborn virus undergoes various mutations, evolving into variants classi-
have been extensively inves-tigated, along with the role of biom- fied based on changes observed in the Spike protein (S-protein)
etry, and the recommendations have long been uncertain. At the [1]. Coronavirus can spread from the mouth or nose of an infected
beginning of the pandemic, guidelines for pregnant women with person through small liquid particles. These particles range from
suspected COVID-19 infection recommended bimonthly biome- larger respiratory droplets to smaller aerosols [4]. During the pan-
tric and Doppler flowmetry monitoring. In the later years of the demic, it has been observed that most people infected with the vi-
pandemic, the most recent literature data have scaled back the con- rus experience mild to moderate respiratory symptoms and recover
cept of per-forming serial ultrasound checks in pregnancies affect- without special treatment. Howev-er, older people and those with
ed by COVID-19, especially after con-stant comparison with clin- preexisting medical conditions such as cardiovascular disease, di-
ical practice. It is necessary to continue collecting data to improve abetes, chronic respiratory disease, or cancer are more likely to
clinical decisions for mothers and their newborns. develop complications from the infection and thus severe disease
[4]. Complications associated with COVID-19 disease include se-
2. Introduction
vere interstitial pneumonia, hypoxemia, and respiratory distress
Coronavirus disease was named Coronavirus Disease 19 (COV- syndrome, which often lead to intensive care unit admis-sions and
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Volume 14 Issue 6 -2024 Review Paper

deaths [5]. During pregnancy, coronavirus infection affects about in pregnancies affected by coronavirus and to understand what the
15% of women, fortunately, more than half of the pregnant wom- most appro-priate care pathway is, in terms of maternal-fetal safe-
en infected with the virus remain asymptomatic [6]. In Ameri-ca, ty, in order to prevent adverse obstetric outcomes.
data on coronavirus infection in pregnancy report over 225,000 3. Materials and Methods
cases of infection during pregnancy, a total of 306 deaths, and over
For the bibliographic search, two biomedical databases, PubMed
34,000 hospitalizations up to 2022 [7]. Pregnant women with co-
and Embase, were consulted. The search strategy did not include
morbidities such as preexisting diabetes, body mass index (BMI)
time limits; however, to draw clinically relevant conclusions, the
>25 kg/m², and gestational diabetes treated with insulin are at
focus was placed on studies from the last two years. The following
higher risk of contracting COVID-19 infection [8]. Most patients
keywords were used: COVID, pregnancy, fetal growth restriction,
who develop symptoms during pregnancy are in the third trimes-
fetal ultrasound.
ter [9,10] and constitute the portion of the population most at risk
for adverse outcomes [9]. The risk factors that appear to be asso- 4. Results
ciated with hospitalization for severe COVID-19 symp-toms are 3.1. ACE2 Receptor and Intrauterine Growth Restriction in
non-vaccination, being from a Black, Asian, or other minority eth- COVID Pregnancies: is There Really this Connection?
nic background, body mass index (BMI) ≥ 25 kg/m², pre-pregnan- Numerous studies conducted during the years of the pandem-
cy comorbidities (preexisting diabetes or chronic hypertension), ic have focused on the possible association between COVID-19
maternal age ≥ 35, and living in areas or households with high during pregnancy and the risk of intrauterine growth restriction
socio-economic deprivation [8]. One-quarter of pregnant women (IUGR), affirming its potential existence [17-20]. Additionally, a
with coronavirus pneumonia re-quire mechanical ventilation and/ sys-tematic review that included 42 studies reported an increased
or intensive care unit admission [11], and infection con-tracted risk of low-birth-weight associ-ated with COVID-19 infection
during pregnancy appears to be associated with a range of adverse [21]. Among the causes attributed to the association between coro-
obstetric events [12-14]. Of 2,888 infants born from pregnancies navirus infection and IUGR, the role of ACE2 receptors has been
complicated by infection, 11.6% were admitted to intensive care, studied. Severe acute respiratory syndrome coro-navirus 2 (SARS-
while the stillbirth rate was 0.7% [15]. Vertical transmission of CoV-2), the virus responsible for COVID-19, as well as its ana-
coronavirus infection during pregnancy or delivery is uncom-mon. logue SARS-CoV, uses the ACE2 receptor as a functional receptor
If it occurs, it seems to be influenced by the type of delivery, de- to infect human cells. This receptor is a car-boxypeptidase of the
layed cord clamping, skin-to-skin contact, breastfeeding, or the Renin-Angiotensin-Aldosterone System (RAAS), which degrades
mother and baby staying together (rooming-in). However, trans- Angio-tensin II into Angiotensin 1-7, allowing optimal perfusion
placental transmission of antibodies against COVID-19 following of many tissues and organs [22]. ACE2 is expressed in endocrine
maternal in-fection appears to be effective [8]. Several studies tissues, particularly in the ovaries, oocytes, uterus, and vagina [23].
have shown the presence of immunoglobu-lin G (IgG) in umbil- The spike protein of SARS-CoV-2 uses ACE2 receptors as bind-
ical cord blood samples, suggesting that passive immunity could ing receptors on the host cell membrane [22], allowing the virus
be trans-ferred to the newborn. The maximum maternal antibody to enter cells following the proteolytic cleavage of the S protein
response during pregnancy (over 70% IgG positivity) was record- by transmembrane serine protease 2 (TMPRSS2). This process re-
ed between 15 and 30 days after infection, while in sera col-lected sults in the exposure of a fusogenic peptide that promotes the fu-
at delivery, the maximum response was detected for both mother sion of the viral envelope with the host cell mem-brane, followed
and newborn be-tween 31 and 60 days from the infection diagno- by endocytosis and viral replication [24]. The main entry factors
sis (again with over 70% IgG positivity) [16]. Six months after of SARS-CoV-2, including ACE2, TMPRSS2, and furin, are also
birth, IgG antibodies against COVID-19 were detected in newborn expressed in placental trophoblasts [25]. Protective factors against
blood samples following infection during pregnancy [8]. From the the coronavirus entry mechanism are also present in placental tis-
beginning of the pandemic to date, numerous studies have been sue. Epap-1, for instance, affects the binding of the spike protein
conducted with the aim of evaluating the possible outcomes of during early pregnancy, protecting against SARS-CoV-2 infection
COVID-19 infection in pregnant women. It is im-portant to clarify [23]. The entry of the virus into the human body through the ACE2
whether special obstetric surveillance protocols should be imple- receptor leads to the de-pletion of this receptor in tissues where it
mented for this particular population; in particular, it is crucial to is normally present in large quantities; this results in a state of hy-
understand whether these fetuses are indeed at higher risk of intra- poperfusion and chronic hypoxia, including at the placental level
uterine growth restriction and whether more frequent ultrasound [26]. Numer-ous studies have definitively highlighted the role of
checks are necessary compared to the general population of preg- the ACE2 receptor in the pathogenesis of placental hypoxemia and
nant women. In summary, the aim of this review is to analyze and the consequent intrauterine growth restriction [27]. The state of
summarize the current data regarding fetal ultrasound monitoring placental hypoperfusion and chronic hypoxia not only increases

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Volume 14 Issue 6 -2024 Review Paper

the risk of fetal growth altera-tion [24], [13] but also poses threats considered a fundamental part of managing these pregnancies to
of miscarriage, oligohydramnios, neonatal death (28), and preterm predict potential growth defects and the risk of maternal preec-
birth [12]. However, recent studies indicate the absence of an as- lampsia [39]. Some obstetric outcomes, such as preeclampsia, late
sociation be-tween SARS-CoV-2 infection during pregnancy and FG restriction, and intrauterine fetal death, are indeed preceded by
fetal growth restriction [28-31]. increased resistance values in the uterine arteries, reflecting pla-
3.2. The Placenta: its Role in COVID Infection cental dysfunction [40]. Some authors have suggested personal-
izing fetal surveillance in general and, in pregnancies affected by
The placenta not only ensures the transport of blood to the fetus
SARS-CoV-2, particularly in the third trimester, to consider closer
but also serves as a barrier against infections, including corona-
an-tenatal and neonatal surveillance [41]. For pregnant patients
virus [32]. Since human placental trophoblasts are directly im-
with risk factors, the recommendation was for closer follow-up,
mersed in maternal blood and a significant portion of the cardiac
specifically an ultrasound to assess FG within a month of infection,
output reaches the human placenta, it is likely that hematogenous
considering the association between SARS-CoV-2 infection and
spread of bloodborne viruses to the placenta occurs [25]. Severe
placental disorders, mainly FG restriction [42]. These recommen-
placental alterations have been reported in various case reports
dations were based on preliminary studies, some of which evalu-
published since the beginning of the pandemic [33]. However, an
ated the presence of fetal vascular malperfusion and multiple pla-
Italian study that analysed 975 placentas from women who con-
cental thromboses in women with COVID-19, whose pathogenesis
tracted coronavirus infection during pregnancy highlights that the
was attributed to the fact that Coronavirus is a pro-inflammatory
analysed placentas did not show pathological findings attributable
disease [43]. Additionally, the similarity in levels of pro-inflamma-
to COVID-19 infection and do not appear to be a preferential tar-
tory cyto-kines (IL-6, INF gamma, TNF alpha, etc.) in the mesen-
get for coronavirus infection. The study found a high incidence
chymal stromal cells of the placentas of pregnancies complicated
of inflammation signs, including chorioamnionitis, funisitis, vil-
by COVID-19 led to the hypothesis that maternal cardiovascular
litis, and inter-villous fibrin deposition, which could be attributed
and immunological changes could affect fetal circulation in the
to a possible immune response induced by the virus [34]. Some
presence of infection [44]. In the later years of the pandemic, the
studies have also shown the virus’s ability to infect the placenta
most recent literature data have scaled back the concept of per-
[35-32] This can sometimes result in sudden and severe placental
forming serial ultrasound checks in pregnancies affected by COV-
dysfunction, associated with a coagulopathy similar to disseminat-
ID-19, especial-ly after constant comparison with clinical practice,
ed intravascular coagulation, characterized by low platelets and
with numerous COVID-19-affected preg-nancies, and after fol-
low fibrinogen, a condition strongly linked to adverse perinatal
lowing up on newborns born to coronavirus-positive mothers over
outcomes [8].
time. These latter do not, in fact, require different ultrasound moni-
3.3 Role of Fetal Biometry Control and Dopplerfluximetry in toring compared to newborns of pregnant women not infected with
COVID Pregnancies the virus, as there is no association between perinatal COVID-19
The assessment of fetal growth (FG) is one of the main objectives infection and intrauterine growth restriction [30]. Il tasso di basso
of prenatal care. FG depends on various factors, including prop- peso alla nascita (<10th e <5th percentile) studiato su una coorte di
er uteroplacental function and the absence of re-lated maternal 513 pazienti risulta simile in pazienti in gravidanza con e senza in-
pathologies. Impaired FG is associated with an increased risk of fezione da Covid-19. The rate of low birth weight (<10th and <5th
perinatal mor-tality and morbidity, as well as long-term adverse percentile) studied in a cohort of 513 patients is similar in pregnant
outcomes for the newborn. Prenatal recognition of FG restriction patients with and without COVID-19 infection. Additionally, there
is a crucial factor identified in strategies aimed at preventing in- is no association between the trimester of COVID-19 diagnosis
trauterine death [37]. Pregnant women who contract coronavirus and the severity of the disease in low-risk patients [45]. The higher
infection represent a high-risk population, mainly due to physi- rates of low birth weight found among women with COVID-19
ological changes in the immune system and the potential ability infection do not affect newborns defined as small for gestational
of the virus to affect the mechanisms of a normally progressive age, probably due to the high rate of prematurity [46]. Ultrasound
pregnancy, including FG. The effects of the virus on the fetus and surveillance to assess intrauterine growth restriction in low-risk
newborn have been extensively investigated, along with the role pregnan-cies with a COVID-19 diagnosis is not justified [45] nor
of biometry, and the recommendations have long been uncertain. is additional FG ultrasound assessment supported solely due to the
At the beginning of the pan-demic, guidelines for pregnant women infection [28].
with suspected SARS-CoV-2 infection recommended bimonthly
4. Discussion and Implications for Practice
biometric and Doppler flowmetry monitoring due to the potential
Since the early years of the pandemic and continuing to this day,
risk of intrauterine growth restriction [38]. Doppler flowmetry of
scientific literature and obstetricians worldwide have questioned
the uterine arteries and serial biometric assessments were to be

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Volume 14 Issue 6 -2024 Review Paper

the role of fetal biometry in pregnant women affected by COV- 4. World Health Organization. Coronavirus disease (COVID-19).
ID-19 and, more generally, whether these pregnancies should be 2024.
managed differently from others. Numerous doubts and concerns 5. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. Clinical features
have plagued obstetric staff regarding the possible negative effects of patients infected with 2019 novel coronavirus in Wuhan, China.
of coronavirus infection on the mother-baby dyad. Fortunately, Lancet. 2020; 395: 497-506.
scientific literature and clinical practice have provided some, albe- 6. Sutton D, Fuchs K, D’Alton M, Goffman D. Universal Screening
it limited, answers to the initial ques-tions. Regarding the role of for SARS-CoV-2 in Women Admitted for Delivery. N Engl J Med.
fetal biometry and obstetric ultrasound in patients diagnosed with 2020; 382: 2163-4.
COVID-19 during pregnancy, the current guidelines recommend 7. Centers for Disease Control and Prevention (CDC). Data on
performing an ultrasound as-sessment of fetal growth, scheduled COVID-19 during pregnancy: weekly COVID-19 pregnancy data.
in the third trimester (30-32 weeks of gestation) or at least 14 days 2021.
after symptom resolution or more than 21 days after the last fetal 8. Royal College of Obstetricians and Gynaecologists. Coronavirus
biometric ul-trasound, depending on the timing of maternal infec- (COVID-19) infection in Pregnancy. Information for healthcare-
tion. For those who contracted the infec-tion in the first or early professional. 2024.
second trimester, the standard fetal anatomy scan is performed be- 9. Crovetto F, Crispi F, Llurba E, Pascal R, Larroya M. Impact of Se-
tween 18 and 23 weeks of gestation [47]. Specific, although lim- vere Acute Respiratory Syndrome Coronavirus 2 Infection on Preg-
ited, data on the association between COVID-19 and fetal growth nancy Outcomes: A Population-based Study. Clin Infect Dis. 2021;
are reassuring [48, 31], as extensively described in the previous 73: 1768-75.
chapter. The Royal College of Obstetricians and Gynaecologists 10. Pineles BL, Alamo IC, Farooq N, Green J, Blackwell SC, Sibai BM,
(RCOG) guidelines also recommend an ultrasound to assess fetal et al. Racial-ethnic disparities and pregnancy outcomes in SARS-
biometry within the first 14 days of recovery and to consider ad- CoV-2 infection in a universally-tested cohort in Houston, Texas.
ditional ultrasound monitoring on an individual basis for women Eur J Obstet Gynecol Reprod Biol. 2020; 254: 329-30.
who were severely or critically ill due to COVID-19 [49]. At the 11. Donati S, Corsi E, Maraschini A, Salvatore MA. ItOSS-COVID-19
time of delivery, it is useful to perform a histological examination Working Group. SARS-CoV-2 infection among hospitalised preg-
of the placenta in pregnant women infected with coronavirus to nant women and impact of different viral strains on COVID-19
severity in Italy: a national prospective population-based cohort
determine long-term effects, conduct fol-low-up on these children,
study. BJOG. 2022; 129: 221-31.
and continue research to better define the clinical implications of
placental morphology in SARS-CoV-2 infections [34]. A long- 12. Yee J, Kim W, Han JM, Yoon HY, Lee N, Lee KE, et al. Clinical
manifestations and perinatal outcomes of pregnant women with
term follow-up of mothers infected with COVID-19 could also be
COVID-19: a systematic review and meta-analysis. Sci Rep. 2020;
useful to exam-ine the impact of the pandemic on long-term neu-
10: 18126.
rodevelopmental issues in children [32].
13. Zaigham M, Andersson O. Maternal and perinatal outcomes with
5. Conclusions COVID‐19: A systematic review of 108 pregnancies. Acta Obstet
The COVID-19 pandemic has raised urgent questions among Gynecol Scand. 2020; 99: 823-9.
obstetricians regarding the optimal management of pregnancies 14. Rodriguez‐Wallberg KA, Nilsson HP, Røthe EB, Zhao A, Shah PS,
complicated by Sars-CoV-2 infection. In this article, we focused Acharya G. Outcomes of SARS‐CoV‐2 infection in early pregnan-
on ultrasound monitoring and summarized the currently available cy—A systematic review and meta‐analysis. Acta Obstet Gynecol
data, concluding that pregnancies affected by COVID-19 do not Scand. 2024; 103: 786-98.
require different treatment compared to those not complicated by 15. Donati S, Corsi E, Maraschini A, Salvatore MA. ItOSS COVID-19
the infection. Since the COVID-19 pandemic is not yet over, it is Working Group, ItOSS COVID-19 WORKING GROUP. The first
necessary to continue collecting additional data to improve clinical SARS-CoV-2 wave among pregnant women in Italy: results from
decisions for mothers and their newborns. a prospective population-based study. Ann Ist Super Sanita. 2021;
57: 272-85.
References
16. Corsi Decenti E, Salvatore MA, Mancon A, Portella G, Rocca A,
1. World Health Organization. WHO COVID-19 dashboard. 2024. Vocale C. A large series of molecular and serological specimens to
2. Favre G, Pomar L, Musso D, Baud D. 2019-nCoV epidemic: what evaluate mother-to-child SARS-CoV-2 transmission: a prospective
about pregnancies? Lancet. 2020; 395: e40. study from the Italian Obstetric Surveillance System. Int J Infect
3. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes Dis. 2023; 126: 1-9.
from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant 17. Abedzadeh-Kalahroudi M, Sehat M, Vahedpour Z, Talebian P. Ma-
Women: Lessons from SARS, MERS, and Other Human Coronavi- ternal and neonatal outcomes of pregnant patients with COVID-19:
rus Infections. Viruses. 2020; 12: 194. A prospective cohort study. Int J Gynaecol Obstet. 2021; 153: 449-
56.
United Prime Publications LLC., https://acmcasereport.org/ 4
Volume 14 Issue 6 -2024 Review Paper

18. Taghavi S-A, Heidari S, Jahanfar S, Amirjani S, Aji-Ramkani A, 31. Narang K, Miller M, Trinidad C, Wick M, Theiler R, Weaver AL,
Azizi-Kutenaee M, et al. Obstetric, maternal, and neonatal out- et al. Impact of asymptomatic and mild COVID-19 infection on
comes in COVID-19 compared to healthy pregnant women in Iran: fetal growth during pregnancy. Eur J Obstet Gynecol Reprod Biol.
a retrospective, case-control study. Middle East Fertil Soc J. 2021; 2023; 281: 63-7.
26: 17. 32. Wardhana MP, Kuntaman K, Utomo B, Aryananda RA, Rifdah SN,
19. Vizheh M, Allahdadian M, Muhidin S, Valiani M, Bagheri K, Bo- Wafa IA, et al. Evidence of Placental Villous Inflammation and
randegi F. Impact of COVID-19 Infection on Neonatal Birth Out- Apoptosis in Third-Trimester Symptomatic SARS-CoV-2 Maternal
comes. J Trop Pediatr. 2021; 67. Infection. Yonsei Med J. 2024; 65: 202.
20. Rashidi BH, Bandarian F, Bandarian M. Maternal and neonatal 33. Moltner S, de Vrijer B, Banner H. Placental infarction and intra-
outcomes of pregnancies of infertile women during the COVID-19 uterine growth restriction following SARS-CoV-2 infection. Arch
pandemic: a real world evidence. JBRA Assist Reprod. 2022; 26: Gynecol Obstet. 2021; 304: 1621-2.
594-8. 34. Salvatore MA, Corsi Decenti E, Bonasoni MP, Botta G, Castiglione
21. Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N. The impact of F, D’Armiento M, et al. Placental Characteristics of a Large Italian
COVID-19 on pregnancy outcomes: a systematic review and me- Cohort of SARS-CoV-2-Positive Pregnant Women. Microorgan-
ta-analysis. Can Med Assoc J. 2021; 193: E540-8. isms. 2022; 10: 1435.
22. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W. A pneu- 35. Hosier H, Farhadian SF, Morotti RA, Deshmukh U, Lu-Culligan A,
monia outbreak associated with a new coronavirus of probable bat Campbell KH, et al. SARS-CoV-2 infection of the placenta. J Clin
origin. Nature. 2020; 579: 270-3. Invest. 2020; 130: 4947-53.
23. Voina VC, Swain S, Kammili N, Mahalakshmi G, Muttineni R, 36. Algarroba GN, Rekawek P, Vahanian SA, Khullar P, Palaia T, Pel-
Chander Bingi T, et al. Effect of Early pregnancy associated pro- tier MR, et al. Visualization of severe acute respiratory syndrome
tein-1 on Spike protein and ACE2 interactions: Implications in coronavirus 2 invading the human placenta using electron micros-
SARS Cov-2 vertical transmission. Placenta. 2024; 152: 39-52. copy. Am J Obstet Gynecol. 2020; 223: 275-8.
24. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, 37. Lees CC, Stampalija T, Baschat AA, da Silva Costa F, Ferrazzi E,
Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and Figueras F, et al. ISUOG Practice Guidelines: diagnosis and man-
TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibi- agement of small‐for‐gestational‐age fetus and fetal growth restric-
tor. Cell. 2020; 181: 271-280.e8. tion. Ultrasound Obstet Gynecol. 2020; 56: 298-312.
25. Ouyang Y, Bagalkot T, Fitzgerald W, Sadovsky E, Chu T, 38. Favre G, Pomar L, Qi X, Nielsen-Saines K, Musso D, Baud D.
Martínez-Marchal A, et al. Term Human Placental Trophoblasts Guidelines for pregnant women with suspected SARS-CoV-2 in-
Express SARS-CoV-2 Entry Factors ACE2, TMPRSS2, and Furin. fection. Lancet Infect Dis. 2020; 20: 652-3.
MSphere. 2021; 6. 39. Anuk AT, Tanacan A, Yetiskin FDY, Buyuk GN, Senel SA, Keskin
26. Chen S, Huang B, Luo DJ, Li X, Yang F, Zhao Y. Pregnancy with HL, et al. Doppler assessment of the fetus in pregnant women re-
new coronavirus infection: clinical characteristics and placental covered from COVID-19. J Obstet Gynaecol Res. 2021; 47: 1757-
pathological analysis of three cases. Chinese J Pathol 2020; 49: 62.
418-23. 40. Monaghan C, Binder J, Thilaganathan B, Morales-Roselló J, Khalil
27. Dang D, Wang L, Zhang C, Li Z, Wu H. Potential effects of SARS‐ A. Perinatal loss at term: role of uteroplacental and fetal Doppler
CoV2 infection during pregnancy on fetuses and newborns are wor- assessment. Ultrasound Obstet Gynecol. 2018; 52: 72-7.
thy of attention. J Obstet Gynaecol Res. 2020; 46: 1951-7. 41. Mei JY, Mok T, Cambou MC, Fuller T, Fajardo VM, Kerin T, et
28. Mitta M, Holt L, Chandrasekaran S, Dude C. The association be- al. Can prenatal ultrasound predict adverse neonatal outcomes in
tween parental SARS-CoV-2 infection in pregnancy and fetal SARS-CoV-2–affected pregnancies? Am J Obstet Gynecol MFM.
growth restriction. J Perinat Med. 2024; 52: 317-21. 2023; 5: 101028.
29. Smith ER, Oakley E, Grandner GW, Ferguson K, Farooq F, Afshar 42. Di Girolamo R, Khalil A, Rizzo G, Capannolo G, Buca D, Libera-
YAdverse maternal, fetal, and newborn outcomes among pregnant ti M, et al. Systematic review and critical evaluation of quality of
women with SARS-CoV-2 infection: an individual participant data clinical practice guidelines on the management of SARS-CoV-2 in-
meta-analysis. BMJ Glob Heal. 2023; 8. fection in pregnancy. Am J Obstet Gynecol MFM. 2022; 4: 100654.
30. Rizzo G, Mappa I, Maqina P, Bitsadze V, Khizroeva J, Makatsarya 43. Mulvey JJ, Magro CM, Ma LX, Nuovo GJ, Baergen RN. Analysis
A. Effect of SARS-CoV-2 infection during the second half of preg- of complement deposition and viral RNA in placentas of COVID-19
nancy on fetal growth and hemodynamics: A prospective study. patients. Ann Diagn Pathol. 2020; 46: 151530.
Acta Obstet Gynecol Scand. 2021; 100: 1034-9. 44. Todros T, Masturzo B, De Francia S. COVID-19 infection: ACE2,
pregnancy and preeclampsia. Eur J Obstet Gynecol Reprod Biol.
2020; 253: 330.

United Prime Publications LLC., https://acmcasereport.org/ 5

Volume 14 Issue 6 -2024 Review Paper

45. Foster HS, Forkpa M, Van Tienhoven XA, Schwartz N, Srinivas S,

Parry S, et al. Are Neonatal Birth Weights Reduced in Low-Risk Pa-
tients Diagnosed with COVID-19 during Pregnancy? Am J Perinatol.
2024.
46. Eskenazi B, Rauch S, Iurlaro E, Gunier RB, Rego A, Gravett MG,
et al. Diabetes mellitus, maternal adiposity, and insulin-dependent
gestational diabetes are associated with COVID-19 in pregnancy: the
INTERCOVID study. Am J Obstet Gynecol. 2022; 227: 74.e1-74.
e16.
47. Brenna L Hughes VB. COVID-19: Antepartum care of pregnant pa-
tients with symptomatic infection. UptoDate. 2024.
48. Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M,
et al. Outcome of coronavirus spectrum infections (SARS, MERS,
COVID-19) during pregnancy: a systematic review and meta-analy-
sis. Am J Obstet Gynecol MFM. 2020; 2: 100107.
49. Morris RK, Johnstone E, Lees C, Morton V, Smith G. Investigation
and Care of a <scp>Small‐for‐Gestational‐Age</scp> Fetus and a
Growth Restricted Fetus (Green‐top Guideline No. 31). BJOG An Int
J Obstet Gynaecol. 2024; 131.

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