COVID-19 and pregnant women – An overview on diagnosis, treatment approach with limitation, and clinical management


  • Laxmi Pattanashetti | Department of Pharmacology, KLE College of Pharmacy, Hubli (A constituent unit of KLE Academy of Higher Education and Research, Belagavi), Karnataka, India.
  • Santosh B. Patil Department of Pharmacology, KLE College of Pharmacy, Hubli (A constituent unit of KLE Academy of Higher Education and Research, Belagavi), Karnataka, India.
  • Sanath Nyamgouda Department of Pharmacy Practice, KLE College of Pharmacy, Hubli (A constituent unit of KLE Academy of Higher Education and Research, Belagavi, Karnataka, India.
  • Mahendrakumar Bhagiratha Department of Pharmacy Practice, KLE College of Pharmacy, Hubli (A constituent unit of KLE Academy of Higher Education and Research, Belagavi, Karnataka, India.
  • Pramod C. Gadad Department of Pharmacology, KLE College of Pharmacy, Hubli (A constituent unit of KLE Academy of Higher Education and Research, Belagavi), Karnataka, India.


Coronavirus disease or more popularly called COVID-19 is known to be caused by a novel coronavirus 2. The COVID-19 has been identified to be originated from Wuhan, Hubei, China. This pandemic started in December 2019, and since then it has spread across the world within a short period. The health and family welfare ministry of the Government of India reported 227,546 active, 9,997,272 discharged cases, and 150,114 deaths due to COVID-19 as of 06 January 2021. Indian Council of Medical Research (ICMR) reports that the cumulative testing status of SARS-CoV-2 (COVID-19) was 931,408 up to November 03, 2020. Currently, no specific anti-viral drug for COVID-19 management is recommended in the current scenario. Vulnerable populations such as pregnant women affected by COVID-19 infection need to be recognized and followed up for effective handling concerning morbidity and mortality. At present, very few case reports on COVID-19 infected pregnant women have been published in India and there is no proven exclusive treatment protocol. This article summarizes a review of signs and symptoms, etiopathogenesis, risk factors, diagnosis, and possible management of COVID-19 infection in pregnant women. This overview may be useful for health care providers for practical approach and limitation of drugs used in the current management and considers the choice of drugs with their special attention given to adverse effects to improvise maternal health, pregnancy, and birth outcomes.




PlumX Metrics


Download data is not yet available.


Phoswa WN, Khaliq OP. Is pregnancy a risk factor of COVID-19? Eur J Obstet Gynecol Reprod Biol 2020;252:605–9. DOI:

World Health Organization. COVID-19 Dashboard. 2020. Accessed 25 July 2020. Available from:

Dennison Himmelfarb CR, Baptiste D. Coronavirus Disease (COVID-19): Implications for cardiovascular and socially at-risk populations. J Cardiovasc Nurs 2020;35:318-21. DOI:

Government of India. Aarogya Setu mobile application. Available from:

Government of India, Ministry of Health and Family Welfare. COVID-19 Statewise Status. Accessed 3 Novermber 2020. Available from:

Rasmussen SA, Smulian JC, Lednicky JA, et al. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020;222:415–26. DOI:

Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20. DOI:

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. DOI:

Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433. DOI:

Ryan GA, Purandare NC, McAuliffe FM, et al. Clinical update on COVID-19 in pregnancy: A review article. J Obstet Gynaecol Res 2020;46:1235–45. DOI:

Dashraath P, Wong JLJ, Lim MXK, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020;9378:303434.

Yu N, Li W, Kang Q et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID19 in Wuhan, China: A retrospective, single centre, descriptive study. Lancet Infect Dis 2020;20:559–64. DOI:

Zhao W, Zhang J, Meadows ME, et al. A systematic approach is needed to contain COVID-19 globally. Sci Bull 2020;65:876–8. DOI:

Juusela A, Nazir M, Gimovsky M. Two cases of coronavirus 2019‐related cardiomyopathy in pregnancy. Am J Obstet Gynecol MFM 2020;2:100113. DOI:

Ren L-L, Wang Y-M, Wu Z-Q, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J 2020;133:1015-24. DOI:

Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019 nCoV) in Wuhan, China. J Med Virol 2020;92:441-7. DOI:

Carlos WG, Dela Cruz CS, Cao B, et al. Novel Wuhan (2019-nCoV) coronavirus Am J Respir Crit Care Med 2020;201:7-8. DOI:

Pal M, Berhanu G, Desalegn C, Kandi V. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): An Update. Cureus 2020;12;e7423. DOI:

Cheng B, Jiang T, Zhang L, et al. Clinical characteristics of pregnant women with coronavirus disease 2019 in Wuhan, China. Open Forum Infect Dis 2020;7:ofaa294. DOI:

Chen Y, Liu Q, Guo D. Emerging coronaviruses: genome structure, replication, and pathogenesis J Med Virol 2020;92:418-23. DOI:

Wan Y, Shang J, Graham R, et al. Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol 2020;94:e00127-20. DOI:

Shereen MA, Khan S, Kazmi A, et al. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses J Adv Res 2020;24:91-8. DOI:

Koyasu S, Moro K. Role of innate lymphocytes in infection and inflammation. Front Immunol 2012;3:101. DOI:

Kühnert M, Strohmeier R, Stegmüller M, Halberstadt E. Changes in lymphocyte subsets during normal pregnancy. Eur J Obstet Gynecol Reprod Biol 1998;76:147-51. DOI:

Hanna N, Hanna M, Sharma S. Is pregnancy an immunological contributor to severe or controlled COVID-19 disease? Am J Reprod Immunol 2020;84:e13317. DOI:

Thachil J, Tang N, Gando S. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 2020;18:1023-6. DOI:

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study Lancet 2020;395:1054-62. DOI:

Zhou Y, Fu B, Zheng X, et al. Pathogenic T cells and inflammatory monocytes incite inflammatory storm in severe COVID-19 patients. Natl Sci Rev 2020;7:998-1002. DOI:

Ruan Q, Yang K, Wang W, et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020;46:846-8. DOI:

Bandyopadhyay D, Akhtar T, Hajra A, et al. COVID-19 pandemic: Cardiovascular complications and future implications. Am J Cardiovasc Drugs 2020;20:311–24. DOI:

Alberca RW, Pereira NZ, Oliveira LMDS, et al. Pregnancy, viral infection, and COVID-19. Front Immunol 2020;11:1672. DOI:

Pringle KG, Tadros MA, Callister RJ, Lumbers ER. The expression and localization of the human placental prorenin/renin-angiotensin system throughout pregnancy: roles in trophoblast invasion and angiogenesis? Placenta 2011;32:956–62. DOI:

Levy A, Yagil Y, Bursztyn M, et al. ACE2 expression and activity are enhanced during pregnancy. Am J Physiol Regul Integr Comp Physiol 2008;295:R1953–61. DOI:

Neves LA, Stovall K, Joyner J, et al. ACE2 and ANG-(1-7) in the rat uterus during early and late gestation. Am J Physiol Regul Integr Comp Physiol 2008;294:R151–61. DOI:

Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020;181:271–80. DOI:

Zmora P, Moldenhauer AS, Hofmann-Winkler H, Pöhlmann S. TMPRSS2 isoform 1 activates respiratory viruses and is expressed in viral target cells. PLoS One 2015;10:e0138380. DOI:

Vaarala MH, Porvari KS, Kellokumpu S, et al. Expression of transmembrane serine protease TMPRSS2 in mouse and human tissues. J Pathol 2001;193:134–40. DOI:<::AID-PATH743>3.0.CO;2-T

Lin B, Ferguson C, White JT, et al. Prostate-localized and androgen-regulated expression of the membrane-bound serine protease TMPRSS2. Cancer Res 1999;59:4180–4.

Li M, Chen L, Zhang J, et al. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study. PLoS One 2020;15:e0230295. DOI:

Pique-Regi R, Romero R, Tarca AL, et al. Does the human placenta express the canonical cell entry mediators for SARS-CoV-2? Elife 2020;9:e58716. DOI:

Wang K, Chen W, Zhou Y-S, et al. 2020. SARS-CoV-2 invades host cells via a novel route: CD147-spike protein. Accessed on: March 23, 2021. bioRxiv 2020. DOI:

Brosnihan KB, Neves LAA, Anton L, et al. Enhanced expression of Ang-(1-7) during pregnancy. Braz J Med Biol Re. 2004;37:1255–62. DOI:

West CA, Sasser JM, Baylis C. The enigma of continual plasma volume expansion in pregnancy: Critical role of the renin-angiotensin-aldosterone system. Am J Physiol Renal Physiol 2016;311:F1125–34. DOI:

Emanuele N, Ren J, Lapaglia N, et al. Angiotensin-(1-7) in normal and preeclamptic pregnancy. Endocrine 2002;18:239–45. DOI:

Garovic VD, White WM, Vaughan L, et al. Incidence and long-term outcomes of hypertensive disorders of pregnancy. J Am Coll Cardiol 2020;75:2323–34. DOI:

Glowacka I, Bertram S, Herzog P, et al. Differential downregulation of ACE2 by the spike proteins of severe acute respiratory syndrome coronavirus and human coronavirus NL63. J Virol 2010;84:1198–205. DOI:

Ferrario CM, Trask AJ, Jessup JA. Advances in biochemical and functional roles of angiotensin-converting enzyme 2 and angiotensin-(1-7) in regulation of cardiovascular function. Am J Physiol Heart Circ Physiol 2005;289:H2281-90. DOI:

Berghella V, Hughes B, Coronavirus disease 2019 (COVID-19): Prenatal issues and care. Available from:

Kotlyar AM, Grechukhina O, Chen A, et al. Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis. Am J Obstet Gynecol 2021;224:35-53. DOI:

Walker KF, O'Donoghue K, Grace N, et al. Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG 2020;127:1324-36. DOI:

Flaherman VJ, Afshar Y, Boscardin J, et al. Infant outcomes following maternal infection with SARS-CoV-2: First report from the PRIORITY Study. Clin Infect Dis 2020;ciaa1411. Online Ahead of print.

Shah PS, Diambomba Y, Acharya G, et al. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand 2020;99:565. DOI:

Dashraath P, Wong JLJ, Lim MXK, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020;78:303434. DOI:

Blanco-Melo D, Nilsson-Payant BE, Liu WC, et al. Imbalanced host response to SARS-CoV-2 drives development of COVID-19. Cell 2020;181:1036–45. DOI:

Ghadhanfar E, Alsalem A, Al-Kandari S, et al. The role of ACE2, angiotensin-(1-7) and Mas1 receptor axis in glucocorticoid-induced intrauterine growth restriction. Reprod Biol Endocrinol 2017;15:97. DOI:

Mahmoud H, Taha MS, Askoura A, et al. Can chest CT improve sensitivity of COVID-19 diagnosis in comparison to RT-PCR? A meta-analysis study. Egypt J Otolaryngol 2020;36:49. DOI:

Bai HX, Hsieh B, Xiong Z, et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 2020;296:E46-54. DOI:

Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology 2020;296:E32-40. DOI:

Fang Y, Zhang H, Xie J, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020;296:115-7. DOI:

Kim H., Hong H., Yoon S. H. Diagnostic performance of CT and reverse transcriptase-polymerase chain reaction for coronavirus disease 2019: a meta-analysis. Radiology 2020;296:E145-55. DOI:

Corman MV, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. EuroSurveill 2020;25:2000045. DOI:

Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow? Acta Obstet Gynecol Scand 2020;99:439–42.

Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:3320. DOI:

Vega M, Hughes F, Bernstein PS, et al. From the trenches: inpatient management of coronavirus disease 2019 in pregnancy. Am J Obstet Gynecol MFM 2020;2:00154. DOI:

Futterman I, Toaff M, Navi L, Clare CA. COVID-19 and HELLP: Overlapping clinical pictures in two gravid patients. AJP Rep 2020;10:e179-82. DOI:

Mendoza M, Garcia-Ruiz I, Maiz N, et al. Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study. BJOG 2020; 127:1374. DOI:

Zitiello A, Grant GE, Ben Ali N, Feki A. Thrombocytopaenia in pregnancy: the importance of differential diagnosis during the COVID-19 pandemic. J Matern Fetal Neonatal Med 2020. Online ahead of print. DOI:

Mahajan NN, Pednekar R, Patil SR, et al. Preparedness, administrative challenges for establishing obstetric services, and experience of delivering over 400 women at a tertiary care COVID‐19 hospital in India. Int J Gynecol Obstet 2020;151:188–96. DOI:

López M, Gonce A, Meler E, et al. Coronavirus disease 2019 in pregnancy: A clinical management protocol and considerations for practice. Fetal Diagn Ther 2020;47:519–28. DOI:

Ashokka B, Loh MH, Tan CH. Care of the pregnant woman with COVID-19 in Labor and Delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. Am J Obstet Gynecol 2020;223:66–74. DOI: [Internet]. Bethesda (MD): National Library of Medicine (US). 2020 May 21 - Identifier NCT04397757. COVID-19 Convalescent plasma for the treatment of hospitalized patients with pneumonia caused by SARS-CoV-2. Available from: [Internet]. Bethesda (MD): National Library of Medicine (US). 2020 May 14 - Identifier NCT04388527. COVID-19 convalescent plasma for mechanically ventilated population. Available from:

Yalcin Bahat P, Aldikactioglu Talmac M, Bestel A, et al. Micronutrients in COVID-19 positive pregnancies. Cureus 2020;12:10–4. DOI:

Maldarelli GA, Savage M, Mazur S, et al. Remdesivir treatment for severe COVID-19 in third-trimester pregnancy: Case report and management discussion. Open Forum Infect Dis 2020;7:1–4. DOI:

Dashraath P, Wong JLJ, Lim MXK, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020;222:521-31. DOI:

Huybrechts KF, Bateman BT, Zhu Y, et al. Hydroxychloroquine early in pregnancy and risk of birth defects. Am J Obstet Gynecol 2020;224:290. DOI:

Ariel M, Gideon K. Low-molecular-weight heparins during pregnancy. Can Fam Physician 2005;51:199–201.

Kim AY, Gandhi RT. COVID-19: Management in hospitalized adults. Accessed on 2020 May 30. Available from: [Internet]. Bethesda (MD): National Library of Medicine (US). 2020 May 14 - Identifier NCT04365231. Hydroxychloroquine azithromycin COVID-19 pregnancy trial (HASCOPT). Available from:

US Food and Drug Administration [Internet]. Ceftriaxone Drug Approval Package. Accessed on 020 May 20. Available from:

Kesmen M, Anlaş C, Bakirel T, Güler EM. COVID-19: Ivermectin; Molecular mechanisms, limitations, suggestions. Bezmialem Sci 2020;8:94–8. DOI:

Stafford IA, Parchem JG, Sibai BM. The coronavirus disease 2019 vaccine in pregnancy: risks, benefits, and recommendations. Am J Obstet Gynecol 2021;224:484-95. DOI:

Skjefte M, Ngirbabul M, Akeju O, et al. COVID-19 vaccine acceptance among pregnant women and mothers of young children: results of a survey in 16 countries. Eur J Epidemiol 2021;36:197-211. DOI:

Taylor MM, Kobeissi L, Kim C, et al. Inclusion of pregnant women in COVID-19 treatment trials: a review and global call to action. Lancet Glob Health 2020;9:e366-71. DOI:

Mulangu S, Dodd LE, Davey RT, Jr, et al. A randomized, controlled trial of Ebola Virus disease therapeutics. N Engl J Med 2019;381:2293–303. DOI:

Chu CM, Cheng VCC, Hung NF, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004;59:252–6. DOI:

Koss CA, Natureeba P, Plenty A, et al. Risk factors for preterm birth among HIV-infected pregnantUgandan women randomized to lopinavir/ritonaviror efavirenz-based antiretroviral therapy. J Acquir Immune Defic Syndr 2014;67:128–35. DOI:

Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy: what clinical recommendations to follow? Acta Obstet Gynecol Scand 2020;99:439-42. DOI:

Sanders JM, Monogue ML, Jodlowski TZ, et al. Pharmacologic treatments for coronavirus disease 2019 (COVID-19). A Review. JAMA 2020;323:1824-36. DOI:

Klumpp TG. Safety of chloroquine in pregnancy. JAMA 1965;191:765. DOI:

Di Renzo GC, Giardina I. COVID-19 in pregnancy: consider thromboembolic disorders and thromboprophylaxis. Am J Obstet Gynecol 2020;20:30465–8.

Poon LC, Yang H, Kapur A, et al. Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: information for healthcare professionals. Int J Gynaecol Obstet 2020;149:273–86. DOI:

Kakoulidis I, Ilias I, Koukkou E. SARS-CoV-2 infection and glucose homeostasis in pregnancy. What about antenatal corticosteroids? Diabetes Metab Syndr 2020;14:519-20. DOI:

US Food and Drug Administration [Internet]. Azithromycin Drug Approval Package. Accessed on 2020 May 20. Available from:

van Griensven J, Edwards T, de Lamballerie X, et al. Efficacy of convalescent plasma in relation to dose of Ebola Virus antibodiesefficacy of convalescent plasma in relation to dose of Ebola Virus antibodies. New Eng J Med 2016;375:2307– 9. DOI:

Weber-Schoendorfer C, Schaefer C. Pregnancy outcome after tocilizumab therapy in early pregnancy-a case series from the German Embryotox Pharmacovigilance Center. Reprod Toxicol 2016;60:29–32. DOI:

Yazdani BP, Matok I, Garcia BF, et al. A systematic review of the fetal safety of interferon alpha. Reprod Toxicol 2012;33:265–8. DOI:

Romero RS, Lunzmann C, Bugge JP. Pregnancy out- € comes in patients exposed to interferon beta-1b. J Neurol Neurosurg Psychiatry 2015;86:587–9. DOI:

Tripathi S, Gogia A, Kakar A. COVID‑19 in pregnancy: A review. J Family Med Prim Care 2020;9:4536‑40. DOI:

Favilli A, Mattei Gentili M, Raspa F, et al. Effectiveness and safety of available treatments for COVID-19 during pregnancy: a critical review. J Matern Neonatal Med 2020;1–14. DOI:


COVID-19 - Collection of articles on the Coronavirus outbreak
Covid-19, pregnant women, pathogenesis, management
  • Abstract views: 13

  • PDF: 8
How to Cite
Pattanashetti, Laxmi, Santosh Patil, Sanath Nyamgouda, Mahendrakumar Bhagiratha, and Pramod Gadad. 2021. “COVID-19 and Pregnant Women – An Overview on Diagnosis, Treatment Approach With Limitation, and Clinical Management”. Monaldi Archives for Chest Disease, June.