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.