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.