Proposed Mechanism by Which SARS-CoV-2 Symptoms Develop both in Mother and Fetus.

Hypothesis: The highly expressed ACE2 receptor serves as the binding site for SARS-CoV-2, which may cause preeclampsia-like syndrome in pregnant women. For the duration of pregnancy, fetal ACE2 is overexpressed; therefore, if SARS-CoV-2 crosses the placenta and engages with fetal ACE2, the virus may induce fetal morbidity and mortality.

The solid arrows indicate known mechanisms; the dashed arrows indicate the hypothesized mechanism.

??, assumed or not yet confirmed; ACE2, angiotensin-converting enzyme 2; Ang, angiotensin; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TMPRSS2, transmembrane protease serine 2.