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Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 68-75

Gestational diabetes mellitus and preeclampsia: An increased risk to COVID-19?

1 Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences, University of Kwazulu-Natal, Durban, Kwazulu-Natal, South Africa
2 Department of Basic Medical Sciences, Faculty of Health Sciences, Ritson Campus, Durban University of Technology, Durban, Kwazulu-Natal, South Africa

Correspondence Address:
Prof. Thajasvarie Naicker
Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, KwaZulu-Natal, 4013
South Africa
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amhs.amhs_288_21

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Both gestational diabetes and preeclampsia (PE) are characterized by anti-angiogenic response, endothelial injury, and dysfunction of the maternal vasculature. The ensuing high blood pressure emanates from a renin-angiotensin-system imbalance. The angiotensin-converting enzyme 2 (ACE2) receptor has been implicated in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) entry, and emerging data are in favor of PE development in pregnant women with COVID-19 infection. This review examines the effects of SARS-CoV-2 infection in pregnant women with gestational diabetes mellitus and/or preeclampsia (PE). An online search of all published literature was done through PubMed, Google Scholar, Medline complete, The Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science, using the MeSH terms “COVID-19,” “SARS-CoV-2,” “coronavirus,” “gestational diabetes,” “hyperglycemia” and “preeclampsia.” Only articles that were directly applicable to gestational diabetes and PE in COVID-19 was reviewed. We report that up-regulation of ACE2 leads to the overexpression of angiotensin II and AT1 receptor activity (Ang II/AT1). As the damaging effects of Ang II are intensified, SARS-CoV-2 stimulates ACE2 placental activity and Ang II-mediated sFlt-1 expression may contribute to the endothelial damage in SARS-CoV-2 infection through increasing Ang II/AT1 receptor interaction and/or hypoxia-inducible factor-1. This review provides an insight into the association between SARS-CoV-2 infection, gestational diabetes, and PE. As a result of the shared pathogenic traits, we assume that the anti-angiogenic milieu in high-risk pregnancies aggravates the susceptibility of a pregnant woman to high COVID-19 morbidity and mortality. In light of the growing burden of COVID-19 on global health-care systems, we highlight the urgency for appropriate management, treatment, and educational strategies to effectively control glycemic index in pregnancy.

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