Interpretation
The association between PE and COVID-19 has been studied since the
beginning of the coronavirus pandemic. Some studies have hypothesized
that the association between PE and COVID-19 may be explained by the
fact that both conditions share common systemic risk factors, such as
obesity, advanced maternal age, diabetes, or hypertension, among
others5,9. However, the potential association between
PE and COVID-19 due to specific placental risk factors has never been
examined.
Giorgione and Thilaganathan suggested that subclinical cardiovascular
dysfunction in general population may induce placental malperfusion and
ischemia, thus increasing PE risk. Therefore, subclinical cardiovascular
dysfunction due to COVID-19 may lead to acquired utero-placental
malperfusion, potentially causing PE. Although we agree that maternal
systemic risk factors may explain the association between COVID-19 and
PE, we believe that the association between both conditions is unlikely
to be due to an abnormal trophoblastic invasion9.
Therefore, our results might partly support the findings of the
INTERCOVID study, which showed that the association between COVID-19 and
PE did not not decrease with aspirin treatment5.
Other studies have demonstrated a clear association between diabetes,
increased BMI and the risk of developing COVID-1915.
Additionally, these studies showed that severe COVID-19 was associated
with higher maternal age, higher BMI, hypertension and
diabetes16. Our results support these findings.
Determining whether the association of PE and COVID-19 is due to shared
risk factors or whether it is driven by placental predisposition is
crucial to provide appropriate treatment and surveillance. Our data
provide evidence that PE and COVID-19 share systemic risk factors that
may account for the association between these two conditions. However,
our data suggest that placental insufficiency is unlikely to be involved
in the development of COVID-19 or its severity. Given that aspirin’s
mechanism of action for PE prevention primarily involves the improvement
of trophoblastic invasion10, aspirin treatment is
unlikely to be effective for reducing COVID-19 risk in pregnancies at a
high risk for PE in the first trimester; nevertheless, more research is
needed to ascertain the role of aspirin in pregnant women with COVID-19.