As SARS-CoV-2, commonly referred to as COVID-19, continues to make headlines across the globe,
scientists and healthcare providers are working diligently to tease out the
specifics of how this virus affects key physiological functions within the
human body. Though much of this research is geared towards the respiratory
system, we are learning more and more about how other physiological systems are
influenced, with implications spanning various populations both here and
abroad. One population, just starting to be looked at more closely, has the
potential if infected, to have incredibly important short and long-term
outcomes, affecting the generations to come. Namely, pregnant women.
With quarantine mandates still
in effect, many joke about the “COVID Baby Boom” to be expected nine or so
months from now. But, whether this is an urban myth or there’s some truth in
the matter, it does raise the question: How
are pregnant women, or women trying to become pregnant affected by COVID-19?
Pregnant Women: What We Know:
The most important factor in
determining how a virus will affect a person is the same whether they’re young,
old, male, female, pregnant or not pregnant - and that factor is
susceptibility: Are they prone to contracting the virus in the first place?
Unfortunately, the physiological and anatomical changes associated with
pregnancy lead to increased susceptibility to COVID-19, and possibly even late
detection.
Across the board, pregnant women
are thought to be more susceptible to viral infections due in part to the
switch from Th1 to Th2 immune system dominance. This switch to Th2 is a
protective mechanism geared towards reducing maternal immune response to the
fetus’ foreign cells, but ultimately it gives the virus a better chance of
going undetected, resulting in a potentially more severe infection [1].
Anatomical changes beginning as
early as the first trimester could increase susceptibility to a COVID-19
infection as well. Progesterone, a dominant hormone in pregnancy, can lead to a
relaxation in the supporting ligaments of the ribs. This in combination with
the continued growth of the uterus against the diaphragm, eventually leads to a
20-30% reduction in the functional residual capacity of the lung. Progesterone
also stimulates the respiratory center of the brain to increase tidal volume by
up to 50%. This leaves pregnant women prone to hypoxia and an increased
respiratory rate. Simply put: if COVID is in the air, pregnant women are more
susceptible just because they breathe more frequently than non-pregnant women
[1].
But, immune and anatomical
changes aren’t the only factors that increase the susceptibility of a pregnant
woman to COVID-19. Many researchers support the hypothesis that ACE2
(angiotensin-converting enzyme-2), a peptide found predominantly on lung
tissue, is a key entry point for the virus to enter host cells. Pregnant women
have been found in multiple studies to have increased levels of ACE2 in various
organ tissues, including the lung and kidney, which further complicates both
the susceptibility and potential outcome of a SARS-CoV-2 infection [1].
Susceptibility aside, one thing
to keep in mind is that some of the uncomfortable symptoms generally not a
concern in pregnancy mimic the early symptoms of a COVID infection. The
anatomical and physiological pulmonary changes mentioned previously frequently
cause pregnant women to experience shortness of breath. In addition, increased
vascularization in the nasopharynx can result in gestational congestion and
rhinorrhea. The problem here is that this can lead women to postpone contacting
their healthcare provider, attributing their symptoms to just another pregnancy
woe, leading to a delay in detection and treatment of a COVID-19 infection.
Dangerously, pneumonia caused by this virus spreads quickly in lung tissue,
making early detection and treatment in pregnant women essential to a positive
outcome [2].
But what if you’re trying to
conceive? Does COVID-19 affect fertility?
Though much more is known about
the effects of COVID on pregnant women, as the pandemic continues, life
ultimately goes on. What about a woman trying to conceive?. What happens then?
As mentioned earlier, SARS-CoV-2
and ACE2 have a symbiotic relationship. The virus uses ACE2, expressed on the
surface of cells, to enter and infect the host. But, ACE2 isn’t specific to
respiratory cells. It has been found to be expressed on the surface of ovarian,
uterine, vaginal, and placental cells with functional implications on follicle
development, ovulation, luteal angiogenesis and degeneration, and endometrial
development [3]. Unfortunately, not enough is known about how COVID affects
ACE2 in the long term, or potentially how it affects other ACE class peptides,
but what is known is that angiotensin enzymes do play a role in fertility, as
they are frequently associated with PCOS in studies [4]. Much more research is
needed here, but it does raise the question of whether a current or past
infection with COVID-19 could affect ovulation, and therefore fertility.
Though there is almost no
research as of yet on COVID-19 and fertility, one avenue of consideration is to
look at how a similar virus, namely SARS, has affected reproductive health.
Again, research is minimal, but there is some evidence to indicate SARS
increased serum levels of prolactin, follicle-stimulating hormone (FSH), and
luteinizing hormone (LH), while subsequently reducing estradiol and
progesterone levels when compared to healthy controls [5]. Alterations in these hormones subsequently
could affect follicle development, ovulation, pregnancy viability, and uterine health.
But, what does this mean?
Long
story short, pregnancy increases susceptibility to contracting COVID-19, but
more research is needed to elucidate whether contracting the virus alters
female reproductive hormones, potentially affecting fertility status in the
current or long-term. Thankfully, most women that become infected with COVID-19
will recover and go on to have healthy babies, but the potential outcomes are
worth discussing, so if a problem does arise it has the potential to be solved.
In
the meantime, support your immune system function and general health. If you’ve
contracted the virus and are having trouble conceiving, work with your
physician to ensure your hormones are at appropriate levels for a healthy
pregnancy.
AYUMETRIX offers comprehensive and accurate fertility
and wellness testing that can assist you in ensuring your hormone levels are
where they should be. For more information visit ayumetrix.com or contact info@ayumetrix.com.
Mary Hall, ND, LAc
References:
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