The ongoing coronavirus disease 2019 (COVID‐19) pandemic has led to a global public health emergency with the need to identify vulnerable populations who may benefit from increased screening and healthcare resources. Initial data suggest that overall, pregnancy is not a significant risk factor for severe coronavirus disease 2019 (COVID‐19). However, case series have suggested that maternal obesity is one of the most important comorbidities associated with more severe disease. In obese individuals, suppressors of cytokine signaling are upregulated and type I and III interferon responses are delayed and blunted leading to ineffective viral clearance. Obesity is also associated with changes in systemic immunity involving a wide range of immune cells and mechanisms that lead to low‐grade chronic inflammation, which can compromise antiviral immunity. Macrophage activation in adipose tissue can produce low levels of pro‐inflammatory cytokines (TNF‐α, IL‐1β, IL‐6). Further, adipocyte secretion of leptin is pro‐inflammatory and high circulating levels of leptin have been associated with mortality in patients with acute respiratory distress syndrome. The synergistic effects of obesity‐associated delays in immune control of COVID‐19 with mechanical stress of increased adipose tissue may contribute to a greater risk of pulmonary compromise in obese pregnant women. In this review, we bring together data regarding obesity as a key co‐morbidity for COVID‐19 in pregnancy with known changes in the antiviral immune response associated with obesity. We also describe how the global burden of obesity among reproductive age women has serious public health implications for COVID‐19.

中文翻译：

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肥胖是 COVID-19 孕妇和非孕妇免疫病理学的一个因素。

持续的 2019 年冠状病毒病 (COVID‐19) 大流行已导致全球公共卫生紧急情况，需要确定可能从增加的筛查和医疗保健资源中受益的弱势人群。初步数据表明，总体而言，怀孕并不是 2019 年严重冠状病毒病 (COVID‐19) 的重要危险因素。然而，病例系列表明，孕产妇肥胖是与更严重疾病相关的最重要的合并症之一。在肥胖个体中，细胞因子信号的抑制因子被上调，I 型和 III 型干扰素反应被延迟和减弱，导致病毒清除无效。肥胖还与全身免疫的变化有关，涉及广泛的免疫细胞和机制，导致低度慢性炎症，这可能会损害抗病毒免疫。脂肪组织中的巨噬细胞活化可产生低水平的促炎细胞因子（TNF-α、IL-1β、IL-6）。此外，瘦素的脂肪细胞分泌是促炎性的，高循环瘦素水平与急性呼吸窘迫综合征患者的死亡率有关。肥胖相关的 COVID-19 免疫控制延迟与脂肪组织机械应力增加的协同作用可能导致肥胖孕妇肺部受损的风险增加。在这篇综述中，我们汇集了关于肥胖作为妊娠期 COVID-19 的关键合并症的数据，以及与肥胖相关的抗病毒免疫反应的已知变化。我们还描述了全球育龄妇女的肥胖负担如何对 COVID-19 产生严重的公共卫生影响。