Introduction
SARS-CoV-2 is a rapidly spreading pandemic that was first reported on
December 31, 2019 in Wuhan, China. As of May 8th, 2020
more than 4 million individuals were tested positive and more than
300,000 have died worldwide. Mortality is believed to account for 2% of
patients (1). At risk individuals, include age above 60 years old,
pre-existing conditions, such cardiovascular disease, diabetes and
hypertension. Furthermore, there is strong sex-bias in COVID-19 with
male patients showing more than double the odds of requiring intensive
care unit (ICU) admission (OR 2.5) and higher mortality (OR 1.60) when
compared to females (2). Symptoms include sore throats, fever, cough,
myalgias, chest pain, headache, pneumonia and shortness of breath (3).
Severe cases require hospitalization in intensive care units, which is
already challenging the healthcare capacity in the US. There is no
specific or efficient treatment available, however the US Food and Drug
Administration (FDA) has approved the antiviral medicine remdesivir
following a positive clinical trial showing faster recovery.
Several case reports have observed that pregnant women with absence of
COVID-19 symptoms on admission to obstetrical service escalated symptoms
severity immediately postpartum, which in few cases required unplanned
ICU admission. There is a general consensus that most pregnant women
with COVID-19 appear to experience a milder clinical course (7-9).
The levels of ovarian steroids, including estrogens and progesterone
steadily increase during pregnancy before undergoing an abrupt decrease
postpartum that reaches basal levels days after delivery (10-12). In 1
each 9 women, this is associated with postpartum psychopathology and
sustained inflammation (13). Estrogens, progesterone and its metabolite,
allopregnanolone are anti-inflammatory and allopregnanolone is a
psychotropic agent that was recently approved for the treatment of
postpartum depression (13, 14). Hereinafter, the role of reproductive
steroids, including estradiol, progesterone and allopregnanolone, as
possible protectant against COVID-19 is discussed.