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Z Geburtshilfe Neonatol 2024; 228(01): 17-31
DOI: 10.1055/a-2180-7715
Review

COVID-19, Pregnancy, and Diabetes Mellitus

The SARS-CoV-2 Pandemic and the Impact on Diabetes Mellitus in PregnancyCOVID-19, Schwangerschaft und Diabetes mellitusDie SARS-CoV-2-Pandemie und ihr Einfluss auf den Diabetes mellitus in der Schwangerschaft
Helmut J. Kleinwechter 
1   diabetologikum kiel, Diabetes Center and Diabetes Education Center, Kiel, Germany
,
Katharina S. Weber
2   Institute of Epidemiology, Kiel University, Kiel, Germany
,
Tatjana P Liedtke
2   Institute of Epidemiology, Kiel University, Kiel, Germany
,
Ute Schäfer-Graf 
3   Department of Obstetrics, Berlin Diabetes Center for Pregnant Women, St. Joseph Hospital, Berlin, Germany
,
Tanja Groten 
4   Department of Obstetrics, Competence Center for Diabetic Women, Jena University Hospital, Jena, Germany
,
Mario Rüdiger
5   Saxony Center for Fetal-Neonatal Health, University Hospital Carl Gustav Carus, Dresden, Germany
,
Ulrich Pecks
6   Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
7   Department of Obstetrics, University Hospital Würzburg, Maternal Health and Midwifery Science, Würzburg, Germany
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Abstract

During the severe acute respiratory distress virus coronavirus type 2 (SARS-CoV-2) pandemic, many women were infected during their pregnancies. The SARS-CoV-2-induced coronavirus disease 19 (COVID-19) has an impact on maternal health and pregnancy outcomes; peripartum and perinatal morbidity and mortality are increased. Pregnancy is considered a risk factor for severe COVID-19 course. Additional risk factors during pregnancy are diabetes mellitus, gestational diabetes mellitus (GDM), and obesity. Systemic inflammation can lead to severe metabolic dysregulation with ketoacidosis. The endocrine pancreas is a target organ for SARS-CoV-2 and the fetal risk depends on inflammation of the placenta. Up to now there is no evidence that SARS-CoV-2 infection during pregnancy leads to permanent diabetes in mothers or their offspring via triggering autoimmunity or beta cell destruction. The frequently observed increased prevalence of GDM compared to the years before the pandemic is most likely due to changed lifestyle during lockdown. Furthermore, severe COVID-19 may be associated with the development of GDM due to worsening of glucose tolerance. Vaccination with a mRNA vaccine is safe and highly effective to prevent infection and to reduce hospitalization. Registries support offering evidence-based recommendations on vaccination for pregnant women. Even with the current omicron virus variant, there are increased risks for symptomatic and unvaccinated pregnant women.

Zusammenfassung

Während der Pandemie mit dem Severe acute respiratory distress virus coronavirus type 2 (SARS-CoV-2) infizierten sich viele schwangere Frauen. Die SARS-CoV-2 induzierte Corona virus disease 19 (COVID-19) beeinflusst die mütterliche Gesundheit und die Schwangerschaft; peripartale und perinatale Morbidität und Mortalität sind erhöht. Die Schwangerschaft gilt als Risikofaktor für einen schweren COVID-19-Verlauf. Darüber hinaus sind Diabetes mellitus, Gestationsdiabetes mellitus (GDM) und Adipositas weitere Risiken. Die systemische Inflammation kann zu schweren Stoffwechselentgleisungen mit Ketoazidose führen. Das endokrine Pancreas ist Zielorgan für SARS-CoV-2 und die fetale Gefährdung ist mit Placenta-Inflammation assoziiert. Bis jetzt gibt es keine Beweise, dass eine SARS-CoV-2-Infektion in der Schwangerschaft via Autoimmunität-Triggerung oder β-Zell-Destruktion zu permantem Diabetes bei den Müttern oder ihren Kindern führt. Die oft beobachtete erhöhte GDM-Prävalenz im Vergleich zu den Jahren vor der Pandemie ist am ehesten auf veränderten Lebensstil während des Lockdowns zurückzuführen. Ein schwerer COVID-19-Verlauf ist mit einer Verschlechterung der Glukosetoleranz assoziiert und kann somit einen GDM induzieren. Die Impfung mit einem mRNA-Impfstoff ist sicher und hoch effektiv zur Infektionsprophylaxe und Reduktion von Hospitalisierungen. Register haben dazu beigetragen, für schwangere Frauen faktengestützte Impfempfehlungen auszusprechen. Auch unter der aktuellen Omikron Virusvariante bestehen für symptomatisch erkrankte und ungeimpfte schwangere Frauen erhöhte Risiken.

Key words

SARS-CoV-2 - Pregnancy - Diabetes mellitus - Pandemic

Schlüsselwörter

SARS-CoV-2 - Schwangerschaft - Diabetes mellitus - Pandemie


Publication History

Received: 24 June 2023

Accepted after revision: 06 September 2023

Article published online:
02 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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