Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study

BJOG. 2020 Oct;127(11):1374-1380. doi: 10.1111/1471-0528.16339. Epub 2020 Jun 21.


Objectives: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre-eclampsia (PE) in pregnancies with COVID-19, and to assess their accuracy to differentiate between PE and the PE-like features associated with COVID-19.

Design: A prospective, observational study.

Setting: Tertiary referral hospital.

Participants: Singleton pregnancies with COVID-19 at >20+0 weeks.

Methods: Forty-two consecutive pregnancies were recruited and classified into two groups: severe and non-severe COVID-19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor [sFlt-1/PlGF]) were assessed in women with suspected PE.

Main outcome measures: Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt-1/PlGF.

Results: Thirty-four cases were classified as non-severe and 8 as severe COVID-19. Five (11.9%) women presented signs and symptoms of PE, all five being among the severe COVID-19 cases (62.5%). However, abnormal sFlt-1/PlGF and UtAPI could only be demonstrated in one case. One case remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE-like syndrome.

Conclusions: Pregnant women with severe COVID-19 can develop a PE-like syndrome that might be distinguished from actual PE by sFlt-1/PlGF, LDH and UtAPI assessment. Healthcare providers should be aware of its existence and monitor pregnancies with suspected pre-eclampsia with caution.

Tweetable abstract: This study shows that a pre-eclampsia-like syndrome could be present in some pregnancies with severe COVID-19.

Keywords: Angiogenic factors; COVID-19; PlGF; SARS; SARS-CoV-2; pre-eclampsia; pre-eclampsia-like syndrome; pregnancy; sFlt-1.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Alanine Transaminase / metabolism
  • Aspartate Aminotransferases / metabolism
  • Betacoronavirus
  • Blood Pressure
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / metabolism
  • Coronavirus Infections / physiopathology*
  • Female
  • HELLP Syndrome / etiology
  • HELLP Syndrome / metabolism
  • HELLP Syndrome / physiopathology*
  • Humans
  • L-Lactate Dehydrogenase / metabolism
  • Pandemics
  • Placenta Growth Factor / metabolism*
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / metabolism
  • Pneumonia, Viral / physiopathology*
  • Pre-Eclampsia / etiology
  • Pre-Eclampsia / metabolism
  • Pre-Eclampsia / physiopathology*
  • Pregnancy
  • Pregnancy Complications, Infectious / metabolism
  • Pregnancy Complications, Infectious / physiopathology*
  • Proteinuria / etiology
  • Proteinuria / physiopathology
  • Pulsatile Flow
  • SARS-CoV-2
  • Severity of Illness Index
  • Tertiary Care Centers
  • Thrombocytopenia / etiology
  • Thrombocytopenia / physiopathology
  • Uterine Artery / diagnostic imaging*
  • Vascular Endothelial Growth Factor Receptor-1 / metabolism*


  • PGF protein, human
  • Placenta Growth Factor
  • L-Lactate Dehydrogenase
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • FLT1 protein, human
  • Vascular Endothelial Growth Factor Receptor-1