COVID-19 in pregnancy - impact on birth and placental outcomes and associations with race.

COVID-19 in pregnancy is associated with higher rates of hypertensive disorders of pregnancy and preterm birth due to severe maternal symptoms, and the infants of such pregnancies also require neonatal intensive care at a higher rate than non-infected preterm births. Studies also suggest an increase in pregnancy associated hypertension may be driven by race. We have shown that placentas from mothers with COVID-19 are damaged resembling placentas from pregnancies with preeclampsia or preterm birth. But we do not know if this finding is more common in pregnant women who identify as black vs. those who don't. The placenta expresses ACE-2, the protein that SARs-CoV-2 uses to infect cells. ACE-2 is part of a regulatory pathway - the Renin-Angiotensin System or RAS, which controls blood pressure. We have shown that placental levels of ACE-2 are lower in Black women. We think that this might make these women more likely to get hypertensive complications of pregnancy. We have brought together a group of experts from Canada and the USA with expertise in viral infection in pregnancy, placental pathology, and babies health. We have collected many placentas and samples from mothers with COVID-19 in pregnancy. We will examine if race makes pregnancies more vulnerable to serious COVID-19 complications and increases the risk for placental damage. We will explore associations between race and the RAS system in the placenta, and pregnancy and birth outcomes in women with COVID-19 infection in pregnancy. This research will identify the mechanisms behind the differential rise in pregnancy complications and placental damage associated with socioeconomic status and race in the COVID-19 pandemic.