AUTHOR=Liu Anna , Raja xavier Janet , Singh Yogesh , Brucker Sara Y. , Salker Madhuri S. TITLE=Molecular and Physiological Aspects of SARS-CoV-2 Infection in Women and Pregnancy JOURNAL=Frontiers in Global Women's Health VOLUME=3 YEAR=2022 URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2022.756362 DOI=10.3389/fgwh.2022.756362 ISSN=2673-5059 ABSTRACT=
Whilst scientific knowledge about SARS-CoV-2 and COVID-19 is rapidly increasing, much of the effects on pregnant women is still unknown. To accommodate pregnancy, the human endometrium must undergo a physiological transformation called decidualization. These changes encompass the remodeling of endometrial immune cells leading to immunotolerance of the semi-allogenic conceptus as well as defense against pathogens. The angiotensin converting enzyme 2 (ACE2) plays an important regulatory role in the renin-angiotensin-system (RAS) and has been shown to be protective against comorbidities known to worsen COVID-19 outcomes. Furthermore, ACE2 is also crucial for decidualization and thus for early gestation. An astounding gender difference has been found in COVID-19 with male patients presenting with more severe cases and higher mortality rates. This could be attributed to differences in sex chromosomes, hormone levels and behavior patterns. Despite profound changes in the female body during pregnancy, expectant mothers do not face worse outcomes compared with non-pregnant women. Whereas mother-to-child transmission through respiratory droplets during labor or in the postnatal period is known, another question of