Cause-and-effect relationship between COVID-19 infection during pregnancy and developing preeclampsia
SARS-CoV-2 and the subsequent development of preeclampsia and preterm birth: evidence of a dose-response relationship supporting causality
Early in the COVID-19 pandemic, there were reports of worse COVID-19 disease in pregnant persons compared to non-pregnant persons. As the pandemic continues, we are learning more about the effects of COVID-19 infection during pregnancy on not only the severity of the COVID-19 disease but also pregnancy health too. Researchers for this study asked if COVID-19 infection may cause preeclampsia. To answer research questions about “cause and effect” in research, one scientific approach is to look at dose-response relationships (meaning, if the higher the dose is, the higher the response is- that could support the “dose” causing the “response”). For example, when asking if COVID-19 causes preeclampsia, perhaps a group of patients without any COVID-19 infection during pregnancy would have the lowest occurrence of preeclampsia, pregnant persons who had severe COVID-19 illness would have the highest occurrence of preeclampsia, and then occurrence of preeclampsia in a group with a mild COVID-19 infection would be in-between. This is exactly what researchers in this study did using medical record data from 1,223 patients that had COVID-19 infection during pregnancy across 14 hospitals in the United Kingdom. Researchers classified patients with either asymptomatic, mild, moderate, or severe COVID-19 disease. The study found an increased occurrence of preeclampsia in each of these groups as COVID-19 disease was more severe- with 1.9% of the asymptomatic group having preeclampsia, 2.2% of the mild COVID-19 group having preeclampsia, 5.7% of the moderate group having preeclampsia, and 11.1% of the severe group having preeclampsia.
Take home message: Showing a increasing occurrence of preeclampsia among groups of patients with increasing severity of COVID-19 disease is evidence for a possible cause-and-effect relationship between COVID-19 and preeclampsia. Future research should focus on understanding the possible ways COVID-19 could lead to preeclampsia in pregnant persons.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387567/
Citation: Lai J, Romero R, Tarca AL, Iliodromiti S, Rehal A, Banerjee A, Yu C, Peeva G, Palaniappan V, Tan L, Mehta M, Nicolaides KH. SARS-CoV-2 and the subsequent development of preeclampsia and preterm birth: evidence of a dose-response relationship supporting causality. Am J Obstet Gynecol. 2021 Dec;225(6):689-693.e1. doi: 10.1016/j.ajog.2021.08.020. Epub 2021 Aug 26. PMID: 34454898; PMCID: PMC8387567.
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