Dear editor,
More than one year has been passed since the first report of COVID-19
from Wuhan city of China. Soon this virus was spread around the world
and became a pandemic and till now, over 122 million people have been
infected and over 2.69 million of them have been dead due to COVID-19
infection. Many efforts have been done regarding different aspects of
COVID-19 pharmacotherapy and its challenges
[1-3]. Coronavirus can negatively
affect the immune system. This complication can be exaggerated in
pregnant women with micronutrient and elemental deficiencies. Also,
coronavirus itself can induce micronutrients malabsorption and result in
their severe deficiencies that can lead to increased risk of infection
in these group of patients. The most important micronutrients that can
support the immune system are zinc, selenium, iron, vitamin A, C, D, and
E. So, it has been suggested that administration of supplemental
micronutrients would be helpful to prevent the severe complications of
COVID-19 infection in pregnant women
[4]. Vitamin A deficiency during
pregnancy can result in congenital defects, anorectal malformation,
schizophrenia, gestational diabetes, and diabetes mellitus. Also,
excessive administration of supplemental vitamin A should be avoided
during pregnancy [4]. Vitamin C
deficiency during pregnancy could be accompanied by several pregnancy
complications including gestational diabetes, gestational hypertension,
and preeclampsia. So, administration of supplemental vitamin C would be
promising in pregnant women who are infected with new coronavirus to
prevent these complications during pregnancy and boosting of the
immunity system. Vitamin D can play an important role in protection
against viral respiratory tract infection through the modulation of the
process of cytokine release and activation
[5]. Vitamin D deficiency during
pregnancy would be associated with the risk of preeclampsia, preterm
birth, and low weight birth, and viral respiratory tract infection. So,
vitamin D administration would be essential to prevent maternal and
neonatal complications and reduce the severity of COVID-19 infection
during pregnancy by enhancing the potential of the immunity system
against viral infection [4,
5]. Also, it has been reported that
administration of supplemental doses of vitamin E during pregnancy would
be associated with immunity system amplification, improves resistance
against COVID-19 infection, and better pregnancy outcomes
[4]. Myo-inositol (vitamin B8), the
precursor of inositol-3-phosphate, with the potential mechanism of
anti-inflammatory, antioxidant, surfactant regeneration, and immune
response regulation through the IL-6 cascade reduction can induce
protective effects against COVID-19 especially in pregnant women
[5]. Iron supplementation during
pregnancy could be associated with a lower risk of low birth weight, a
strengthened immunity system, and higher resistance against COVID-19
infection. Also, iron supplementation can prevent maternal/neonatal
mortality and complications. So, iron is one of the most essential
micronutrients that should be administered in pregnant women especially
those who are infected with COVID-19. Selenium, as an anti-oxidant
agent, can prevent oxidative stress during pregnancy and induce an
immunity system. So, selenium administration during pregnancy would be
accompanied by reduced severity of COVID-19 infection and complications
during pregnancy [4]. Severe zinc
deficiency during pregnancy can result in limited fetal growth and
teratogenic effects. So, administration of supplemental zinc during
pregnancy would be valuable to boost the immune system, reduce
coronavirus replication, and avoidance of maternal/neonatal
complications during the COVID-19 era
[4]. Results of a recent study
revealed the impaired zinc-copper balance (Zn/Cu ratio) in pregnant
women infected with COVID-19. Serum zinc level has been decreased in the
mentioned pregnant women with COVID-19 during all their three semesters.
Also, it has been shown that serum zinc level was inversely correlated
with the inflammatory markers of COVID-19 including IL-6, ESR, and CRP
[6]. In these pregnant women with
COVID-19 administration of supplemental zinc would be helpful to prevent
COVID-19 severe complications and reduce the duration of
hospitalization. COVID-19 in pregnant women can result in higher serum
copper levels in first and third trimesters. In this regard, a
diminished Zn/Cu ratio would be predicted in pregnant women with
COVID-19. Serum magnesium level has been significantly enhanced in
COVID-19 patients during pregnancy. Also, it has been reported that
higher serum magnesium level during COVID-19 was associated with worsen
outcome and more complications.
So, according to our clinical practice and previous researches
administration of these essential micronutrients including zinc,
selenium, and iron and vitamins including vitamin A, B8, C, D, and E
with optimum recommended dietary allowances (RDAs) during pregnancy
would be promising and suggestive to improve maternal/neonatal
complications during COVID-19 infection due to the enhanced immunity
system against viral infection and COVID-19 pneumonia
[4-6].