Pre‐eclampsia‐like syndrome induced by severe COVID‐19: a prospective observational study

Abstract

Objectives To investigate the incidence of clinical, ultrasonographic and biochemical findings related to preeclampsia (PE) in pregnancies with COVID‐19, and to assess their accuracy to differentiate between PE and the PE‐like features associated with COVID‐19. Design A prospective, observational study. Setting Tertiary referral hospital. Participants Singleton pregnancies with COVID‐19 at >20+0 weeks. Methods 42 consecutive pregnancies were recruited and classified into two groups: severe and nonsevere COVID‐19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms‐like tyrosine kinase‐1/placental growth factor [sFlt‐1/PlGF]) were assessed in women with suspected PE. Main outcome measures Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt‐1/PlGF. Results 34 cases were classified as nonsevere and 8 as severe COVID‐19. Six (14.3%) women presented signs and symptoms of PE, all six being among the severe COVID‐19 cases (75.0%). However, abnormal sFlt‐1/PlGF and UtAPI could only be demonstrated in one case. Two cases remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE‐like syndrome. Conclusions Pregnant women with severe COVID‐19 can develop a PE‐like syndrome that might be distinguished from actual PE by sFlt‐1/PlGF, LDH and UtAPI assessment. Health care providers should be aware of its existence and monitor pregnancies with suspected preeclampsia with caution.