Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Possible Vertical Transmission of SARS-CoV-2 during the Third Trimester of Pregnancy, a Mini-Review

Asmaa Haseeb Hwaid*, Afak Rasheed Salman Zaidi, Ansam Dawod Salman

Department of Biology, College of Education for Pure Science, Diyala University, Diyala, Iraq

Abstract: The recent emergence of the COVID-19 pandemic was the reason why the effects and consequences of its transmission from pregnant women to their fetuses were not understood. However, recent studies have tried to decipher this virus by first confirming its vertical transmission and then identifying its pathogenesis and teratogenicity, if any. The objective of this mini-review is to conduct a review of recent studies for confirming the vertical transmission of SARS-CoV-2 during the third trimester of pregnancy. The literature search was performed using PubMed, Scopus, and Web of Science and Google Scholar databases. The research was conducted from September 1, 2021 to May 1, 2022 and the research was based on the following keywords: “(“Coronavirus” COVID-19”, “Vertical transmission”, “pregnancy” and “Third trimester”). Studies have shown that the occurrence of vertical transmission is possible, and this is confirmed by the presence of virus receptors in birth products such as the placenta, in addition to the appearance of IgM antibodies in neonates. Their mothers were positive for the SARS-CoV-2 PCR test, as well as the presence of viral RNA in the placenta, since the third trimester of pregnancy appears to be the most vulnerable period of viral infection, most cases of vertical transmission have been documented during this period. More studies are required to confirm vertical transmission during the first and second trimesters of pregnancy, in addition, study the effect of the virus on fetuses at the immunological, pathological and teratological levels during all periods of pregnancy and investigating the role of new variants of this virus in the incidence of vertical transmission and the consequences of infection with it.

Keywords: SARS-CoV-2, pregnant women, vertical transmission, third trimester

Received April 11, 2022; Revised May 16, 2022; Accepted May 25, 2022

Citation: Asmaa Haseeb Hwaid, Afak Rasheed Salman Zaidi, Ansam Dawod Salman, Possible Vertical Transmission of SARS-CoV-2 during the Third Trimester of Pregnancy, a Mini-Review. American Journal of Epidemiology and Infectious Disease, 10 (1). 19-23. January 2022. doi:10.12691/ajeid-10-1-3

1. Main Text

At the end of 2019, specifically the month of December, the world witnessed the emergence of a pandemic that caused a complete closure of various life activities for people in different countries of the world. The pivotal of this pandemic was a virus that originated in Hubei Province, Wuhan, China. On January 7th, 2020, the new coronavirus was identified in a throat swab sample of one patient, Chinese Center for Disease Control and Prevention [CCDC] then recognized it as a novel virus belong to the family of Coronaviridae, beta-coronavirus genus and named it as (2019-nCoV). Because of the high rate of spread of this virus, WHO announced this outbreak is a public health emergency of international concern [1]. On the 11th February 2020, the International Committee on Classification of Viruses officially renamed it with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the disease caused by SARS-CoV-2 has been declared by the WHO as coronavirus disease 2019 (COVID-19). Coronaviruses are a group of viruses that have a corona or crown (corona) shape when viewed under an electron microscope, the SARS-CoV-2 genome includes single-stranded RNA, containing 29,903 nt, this positive sense RNA acts directly as mRNA, which translates the tow open reading frames (ORF1a and ORF1b]) into proteins [2,3], Figure 1, [35].

Direct transmission of SARS-CoV-2 from human-to-human mainly occurs by the respiratory droplets with size (>10 μm) of virus exhaled [within one meter] from an infected person. The transmission of this virus also occurs by contact with contamination surfaces, such as skin to skin, and by touching the infected non-living objects and then transmitting it to the eyes and nose or mouth. Other studies show that the virus can remain in the air for a long time [4]. Clinical manifestations of COVID-19 are variable, and may include asymptomatic infection, acute respiratory illness, and pneumonia of varying severity [5]. In addition, some studies have indicated that the overall mortality rate as a result of infection with the Covid-19 virus among people show obvious symptoms and those asymptomatic has been around 5% [6].

Figure 1. SARS-CoV-2 structure, Ref. [35]

The consequences of COVID-19 infection in pregnant women and their fetuses remain unexplored and unknown primarily due to the novel nature of the virus and its outbreak. Most cases of pregnant women infections are asymptomatic, but when symptoms appear, similar to non-pregnant patients, the most common symptoms are fever, cough and shortness of breath [7]. However, pregnant women and their newborns should therefore receive special attention because they are particularly vulnerable, and are in a unique state of immunosuppression [8]. Because of congenital malformations and fetal infection that occur as a result of infection with other viruses like cytomegalovirus, Zika, Parvovirus B19 and Rubella, in addition to epidemiological data collected from previous pandemics, such as Influenza and Ebola, suggest that pregnant women are more susceptible to severe complications and mortality from viral infection, and with the spread of the COVID-19 pandemic in the world. Infection among pregnant women with the SARS-CoV-2 and the possible risks of vertical transmission to the fetuses has become a major concern.

The characteristics of the anatomical structure of the respiratory system and the immune system and the accompanying physiological changes during pregnancy and the puerperium play a role in increasing this risk [9]. High levels of estrogen and progesterone lead to oedema of the upper respiratory tract, and also cause an increased risk of infection. The enlargement and expansion of the uterus causes the displacement of the diaphragm, which makes the expansion of the lung difficult and thus reduces the respiratory capacity and causes shortness of breath, for the pathogens mentioned above, the passage of these pathogens across the placenta tends to increase with increasing gestational age, while the adverse effects on the fetus increase with the early stages of pregnancy. Accordingly, Kotlyar and his colleagues [10] assume that the infection with COVID-19 during the early stages of pregnancy has adverse consequences and effects on the fetus. The bad history that linked infections with other members of the coronavirus family (such as SARS and MERS) to the morbidity and mortality of pregnant women, fetuses, newborns and to severe outcomes of pregnancy, such as miscarriages, premature births and stillbirth has raised potentially significant new concerns about the exposure of pregnant women to the novel coronavirus-19 [11]. The first and third trimesters of pregnancy are periods when there is an increase in inflammatory activity, while immune activity decreases during the second trimester [12]. Despite the evidence of vertical transmission of many infectious pathogens between the mother and her fetus before birth and during childbirth, the possibility of transmission from the infected mother to the fetus or newborn was considered a recent point of discussion in most of the published literature reviews, at a time when a limited number of studies showed evidence to prove vertical transmission is not possible [13,14,15].

The fear of vertical transmission, which was denied by early studies, like a meta-review published clinical evidence that vertical transmission of SARS-CoV-2 did not occur from pregnant women to fetuses/newborns, and in the other hand, was confirmed by some other studies, came for strong reasons [16], including what was mentioned, let's know from the start that SARS-CoV-2 has always shown a viral tropism to the tissues that show receptors on their cell surfaces through which the virus binds and enters the cells, these are known as angiotensin-converting enzyme 2 [ACE2] receptor. The placenta, in particular, as well as the ovaries, vagina and uterus, are important sources of angiotensin-converting enzyme 2, as the placenta is the main source of expression for these receptors, as the activity of its expression increases during pregnancy [17,18] Figure 2, [34]. In addition, reports from other studies have been shown that the viral RNA and proteins of SARS-CoV-2 were detected in placenta and umbilical cord blood and vaginal mucosa, and the presence of anti-SARS-CoV-2-IgM antibodies in Chinese neonates were born to women with positive COVID-19 results, confirmed the transmission of the virus during pregnancy [19,20,21,22]. Besides transplacental transmission, vertical intrauterine transmission of viruses can occur during aspiration or swallowing of fetuses of cervical-vaginal secretions [23]. An interesting recent study indicated that ACE-2-receptor-expressing immune cells in the mother's circulation may play a major role in the transmission of SARS-CoV-2 to the placenta, which contributes to an increased risk of vertical transmission to the fetus [24].

Figure 2. Vertical transmission of SARS-CoV-2, Ref. [34]

Since the outbreak of the COVID-19 pandemic, several scientific studies conducted on infected pregnant women and the fetal or neonatal outcomes of COVID-19 infection have confirmed vertical transmission and most of these cases are in the third trimester of pregnancy. Salem, [25] indicated that the third trimester of pregnancy appears to be the most vulnerable period for viral infections. This is a possibility for several reasons, including high shortness of breath (dyspnea), as a result of increased oxygen consumption by the fetus, which leads to an increase in the oxygen requirements of the pregnant mother, in addition to the occurrence of gestational anemia in most pregnant women, which causes aggravation of breathing difficulties [26]. Altogether, Fenizia et al., [19], in current data indicate that vertical transmission of utero SARS-CoV-2, in spite of the fact that at a low rate, but is possible. A systematic review conduct by Kotlyar et al., [27] shows that vertical transmission of SARS-CoV-2 infection in the third trimester of pregnancy can occurrence with a low rate and is approximately 3.2%.In a recent study, He and his colleagues [28], discovered for the first time that infection with SARS-CoV-2 during the third trimester of pregnancy actually occurred and had serious complications on the renal development of the fetus, as the study showed elevated levels of cystatin C and β2-microglobulin in newborns, which is further evidence of Vertical transmission from the pregnant mother to the fetus. Confirming that the susceptibility to infection with SARS-CoV-2 is greater during the third trimester of pregnancy, a retrospective analytical study [29] was conducted to investigate the role of care strategies that reduce and prevent nosocomial infections with COVID-19 and its complications. Those strategies that were implemented, it was enough to prevent this infection and its transmission to pregnant women who are in their third trimester, and because the expression of ACE2 receptors in maternal-fetal interface cells changes significantly in the three different trimesters of pregnancy, according to the study [19]. Most case studies and literature review studies have shown that most cases of vertical transmission of SARS-CoV-2 from pregnant women to their fetuses were during the third trimester of pregnancy [30]. In a case study conducted by Vivanti et al [31] of a pregnant woman in the third trimester, the study showed potential occurrence of maternal viremia of SARS-CoV-2, which was followed by the virus reaching the placenta, the viral load was much higher in placental tissue compared to maternal blood or amniotic fluid. The study showed vertical transmission of SARS-CoV-to her neonate resulting in neonatal viremia after infection of the placenta.

The emergence of evidence of vertical transmission from pregnant mothers to fetuses in the uterus and during childbirth, especially during the last third of pregnancy shown by most recently published studies. One of the reasons for it, as indicated by a previous study, maybe the increased expression of ACE2 receptors in various organs such as the placenta and gravid uterus are twice as high compared to non-pregnant women, and thus it is one of the risk factors that are responsible for increasing the severity of SARS-CoV-2 infection [32,33], in addition to other factors such as those women in this period are free to move and go out compared to the first and second trimesters, and therefore are more susceptible to infection, and therefore the possibility of vertical transmission is greater. This encouraged researchers to conduct more studies on pregnant women during this period, a study conducted by Al-Taie, [35], to estimate the seroprevalence rate of antibodies in Iraq that the prevalence of these antibodies was much higher among pregnant women in the third trimester compared to the first and second trimesters of pregnancy. However, it is necessary to conduct further studies to investigate the teratogenic consequences that may occur as a result of vertical transmission of the virus during the third trimester of pregnancy, as well as in the first and second trimesters of pregnancy, and to identify the most important factors that increase the severity of infection. More studies are required to confirm vertical transmission during the first and second trimesters of pregnancy, in addition to studying the effect of the virus on fetuses at the immunological, pathological and teratological levels during all periods of pregnancy.

2. Conclusion

Considering all the points discussed in this current mini-review, we conclude that vertical transmission is very possible, and because the third trimester of pregnancy is the period most susceptible to viral infection, the possibility of infection of SARS-CoV-2 and the occurrence of vertical transmission were high during this period of pregnancy compared to the first and second trimesters, which the researchers did not adequately address. However, there are many questions that still require scientific answers about the role of the last period of pregnancy in infecting fetuses with the virus at the immunological, pathological and teratogenic level, in addition to investigating the role of new variants of this virus in the incidence of vertical transmission and the consequences of infection with it.

Abbreviation

SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus-2;

CCDC: Chinese Centre for Disease Control;

WHO: World Health Organization;

COVID-19: Coronavirus Disease 2019;

ACE2: Angiotensin-Converting Enzyme 2.

Acknowledgments

The authors would like to give a big thanks to the people who helped to complete this project.

Funding

The authors have not received financial support for the study, either for research or publication.

Authors’ Contribution

All authors equally contributed to the study and confirmed its submission.

Competing Interest

The authors declare that they have no competing interest.

References

[1]   | Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X. and Cheng, Z., 2020. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet, 395[10223], pp.497-506.
[2]   | Zhu N , Zhang D , Wang W , Li X , Yang B , Song J , Zhao X , Huang B , Shi W , Lu R , et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733.
[3]   | Kim, D., Lee, J.Y., Yang, J.S., Kim, J.W., Kim, V.N. and Chang, H., 2020. The architecture of SARS-CoV-2 transcriptome. Cell, 181[4], pp.914-921.
[4]   | Qu, G., Li, X., Hu, L. and Jiang, G., 2020. An imperative need for research on the role of environmental factors in transmission of novel coronavirus [COVID-19]. Environ Sci Technol. 54: 3730-2.

[5]  
Lai, C.C., Liu, Y.H., Wang, C.Y., Wang, Y.H., Hsueh, S.C., Yen, M.Y., Ko, W.C. and Hsueh, P.R., 2020. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]: Facts and myths. Journal of Microbiology, Immunology and Infection, 53[3], pp.404-412.

[6]   | Li, L.Q., Huang, T., Wang, Y.Q., Wang, Z.P., Liang, Y., Huang, T.B., Zhang, H.Y., Sun, W. and Wang, Y., 2020. COVID‐19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. Journal of medical virology, 92[6], pp.577-583.
[7]   | Dashraath, P., Wong, J.L.J., Lim, M.X.K., Lim, L.M., Li, S., Biswas, A., Choolani, M., Mattar, C. and Su, L.L., 2020. Coronavirus disease 2019 [COVID-19] pandemic and pregnancy. American journal of obstetrics and gynecology, 222[6], pp.521-531.
[8]   | Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonatesborn to mothers with 2019-nCoV pneumonia. Transl Pediat. 2020; 9[1]: 51-60.
[9]   | Vale, A.J.M., Fernandes, A.C.L., Guzen, F.P., Pinheiro, F.I., De Azevedo, E.P. and Cobucci, R.N., 2021. Susceptibility to COVID-19 in pregnancy, labor, and postpartum period: immune system, vertical transmission, and breastfeeding. Frontiers in Global Women's Health, 2, p.8.
[10]   | Kotlyar, A.M., Grechukhina, O., Chen, A., Popkhadze, S., Grimshaw, A., Tal, O., Taylor, H.S. and Tal, R., 2021. Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis. American journal of obstetrics and gynecology, 224[1], pp.35-53.
[11]   | Rasmussen, S.A., Smulian, J.C., Lednicky, J.A., Wen, T.S. and Jamieson, D.J., 2020. Coronavirus disease 2019 [COVID-19] and pregnancy: what obstetricians need to know. American journal of obstetrics and gynecology, 222[5], pp.415-426.
[12]   | Mor G, Aldo P, Alvero AB. The unique immunological and microbial aspects of pregnancy. Nature Reviews Immunology. 2017 Aug; 17[8]: 469-82.
[13]   | Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, Bao Y, Sun Y, Huang J, Guo Y, Yu Y. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry?. Clinical infectious diseases. 2020 Mar 17.
[14]   | Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. American journal of obstetrics and gynecology. 2020 Jul 1; 223[1]: 36-41.
[15]   | Yang Z, Liu Y. Vertical transmission of severe acute respiratory syndrome coronavirus 2: a systematic review. American journal of perinatology. 2020 Aug; 37[10]: 1055-60.

[16]  
Thomas P, Alexander PE, Ahmed U, Elderhorst E, El-Khechen H, Mammen MJ, Debono VB, Aponte Torres Z, Aryal K, Brocard E, Sagastuy B. Vertical transmission risk of SARS-CoV-2 infection in the third trimester: a systematic scoping review. The Journal of Maternal-Fetal & Neonatal Medicine. 2020 Jul 1: 1-8.

[17]   | Levy A, Yagil Y, Bursztyn M, Barkalifa R, Scharf S, Yagil C. ACE2 expression and activity are enhanced during pregnancy. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 2008 Dec; 295[6]: R1953-61.
[18]   | Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study. PLoS One. 2020 Apr 16; 15[4]: e0230295.
[19]   | Fenizia C, Biasin M, Cetin I, Vergani P, Mileto D, Spinillo A, Gismondo MR, Perotti F, Callegari C, Mancon A, Cammarata S. Analysis of SARS-CoV-2 vertical transmission during pregnancy. Nature communications. 2020 Oct 12; 11[1]: 1-0.
[20]   | Chen S, Huang B, Luo DJ, Li X, Yang F, Zhao Y, Nie X, Huang BX. Pregnancy with new coronavirus infection: clinical characteristics and placental pathological analysis of three cases. Zhonghuabing li xuezazhi= Chinese journal of pathology. 2020 Mar 1; 49[5]: 418-23.
[21]   | Algarroba GN, Rekawek P, Vahanian SA, Khullar P, Palaia T, Peltier MR, Chavez MR, Vintzileos AM. Visualization of severe acute respiratory syndrome coronavirus 2 invading the human placenta using electron microscopy. American Journal of Obstetrics & Gynecology. 2020 Aug 1; 223[2]: 275-8.
[22]   | Hosier H, Farhadian SF, Morotti RA, Deshmukh U, Lu-Culligan A, Campbell KH, Yasumoto Y, Vogels CB, Casanovas-Massana A, Vijayakumar P, Geng B. SARS–CoV-2 infection of the placenta. The Journal of clinical investigation. 2020 Aug 17; 130[9].
[23]   | Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, Bao Y, Sun Y, Huang J, Guo Y, Yu Y. Perinatal Transmission of 2019 Coronavirus Disease–Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry?. Clinical Infectious Diseases. 2021 Mar 1; 72[5]: 862-4.
[24]   | Lye P, Dunk C, Zhang J, Wei Y, Nakpu J, Hamada H, Imperio G, Bloise E, Matthews SM, Lye SJ. SARS-CoV-2 cell entry gene ACE2 expression in immune cells that infiltrate the placenta in infection-associated preterm birth. MedRxiv. 2020 Jan 1.
[25]   | Salem D, Katranji F, Bakdash T. COVID-19 infection in pregnant women: Review of maternal and fetal outcomes. International Journal of Gynecology & Obstetrics. 2021 Mar; 152[3]: 291-8.
[26]   | Dashraath P, Wong JL, Lim MX, Lim LM, Li S, Biswas A, Choolani M, Mattar C, Su LL. Coronavirus disease 2019 [COVID-19] pandemic and pregnancy. American journal of obstetrics and gynecology. 2020 Jun 1; 222[6]: 521-31.
[27]   | Kotlyar AM, Grechukhina O, Chen A, Popkhadze S, Grimshaw A, Tal O, Taylor HS, Tal R. Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis. American journal of obstetrics and gynecology. 2021 Jan 1; 224[1]: 35-53.
[28]   | He Z, Fang Y, Zuo Q, Huang X, Lei Y, Ren X, Liu D. Vertical transmission and kidney damage in newborns whose mothers had coronavirus disease 2019 during pregnancy. International Journal of Antimicrobial Agents. 2021 Feb 1; 57[2]: 106260.
[29]   | Liu J, Cao Y, Xu C, Zhou C, Wei W, Yuan J, Wang L, Kang L, Qu X. Midwifery and Nursing Strategies to protect against COVID-19 during the third trimester of pregnancy. Midwifery. 2021 Jan 1; 92: 102876.
[30]   | Bellos I, Pandita A, Panza R. Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021 Jan 1; 256: 194-204.
[31]   | Vivanti AJ, Vauloup-Fellous C, Prevot S, Zupan V, Suffee C, Do Cao J, Benachi A, De Luca D. Transplacental transmission of SARS-CoV-2 infection. Nature communications. 2020 Jul 14; 11[1]: 1-7.
[32]   | Dhaundiyal A, Kumari P, Jawalekar SS, Chauhan G, Kalra S, Navik U. Is highly expressed ACE 2 in pregnant women “a curse” in times of COVID-19 pandemic?. Life sciences. 2021 Jan 1; 264: 118676.
[33]   | Brosnihan KB, Neves LA, Anton L, Joyner J, Valdes G, Merrill DC. Enhanced expression of Ang-[1-7] during pregnancy. Brazilian Journal of Medical and Biological Research. 2004; 37: 1255-62.
[34]   | Vale AJ, Fernandes AC, Guzen FP, Pinheiro FI, de Azevedo EP, Cobucci RN. Susceptibility to COVID-19 in pregnancy, labor, and postpartum period: immune system, vertical transmission, and breastfeeding. Frontiers in Global Women's Health. 2021 Feb 17; 2: 8.
[35]   | Safiabadi Tali SH, LeBlanc JJ, Sadiq Z, Oyewunmi OD, Camargo C, Nikpour B, Armanfard N, Sagan SM, Jahanshahi-Anbuhi S. Tools and techniques for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]/COVID-19 detection. Clinical microbiology reviews. 2021 May 12; 34[3]: e00228-20.
[36]   | Al-Taie SQ, Seroprevalence of IgM and IgG antibodies to SARS-COV-2 virus among pregnant women in Diyala Governorate. Diploma thesis. College of Education for Pure Science. Department of biology. County Diyala. Iraq. 2021.
[37]   | T. Eckes, The Developmental Social Psychology of Gender, LawrenceErlbaum, 2000. [E-book] Available: netLibrary e-book.