Pregnancy-related acute respiratory distress syndrome (ARDS) is fast becoming a growing and clinically relevant subgroup of ARDS amidst global outbreaks of various viral respiratory pathogens that include H1N1-influenza, severe acute respiratory syndrome (SARS), middle east respiratory syndrome (MERS), and the most recent COVID-19 pandemic. Pregnancy is a risk factor for severe viral-induced ARDS and commonly associated with poor maternal and fetal outcomes including fetal growth-restriction, preterm birth, and spontaneous abortion. Physiologic changes of pregnancy further compounded by mechanical and immunologic alterations are theorized to impact the development of ARDS from viral pneumonia. The COVID-19 sub-phenotype of ARDS share overlapping molecular features of maternal pathogenicity of pregnancy with respect to immune-dysregulation and endothelial/microvascular injury (i.e., preeclampsia) that may in part explain a trend toward poor maternal and fetal outcomes seen with severe COVID-19 maternal infections. To date, current ARDS diagnostic criteria and treatment management fail to include and consider physiologic adaptations that are unique to maternal physiology of pregnancy and consideration of maternal-fetal interactions. Treatment focused on lung-protective ventilation strategies have been shown to improve clinical outcomes in adults with ARDS but may have adverse maternal-fetal interactions when applied in pregnancy-related ARDS. No specific pharmacotherapy has been identified to improve outcomes in pregnancy with ARDS. Adjunctive therapies aimed at immune-modulation and anti-viral treatment with COVID-19 infection during pregnancy have been reported but data in regard to its efficacy and safety is currently lacking.

在包括 H1N1 流感、严重急性呼吸系统综合症 (SARS)、中东呼吸系统综合症 (MERS) 在内的各种病毒性呼吸道病原体的全球爆发中，妊娠相关急性呼吸窘迫综合征 (ARDS) 正迅速成为一个不断增长的临床相关 ARDS 亚组，以及最近的 COVID-19 大流行。妊娠是严重病毒性 ARDS 的危险因素，通常与不良母婴结局相关，包括胎儿生长受限、早产和自然流产。从理论上讲，妊娠的生理变化进一步与机械和免疫学改变相结合会影响病毒性肺炎导致 ARDS 的发展。ARDS 的 COVID-19 亚表型在免疫失调和内皮/微血管损伤（即先兆子痫）方面具有妊娠期母体致病性的重叠分子特征，这可能部分解释了严重的母体和胎儿结局不良的趋势COVID-19 产妇感染。迄今为止，当前的 ARDS 诊断标准和治疗管理未能包括和考虑母体妊娠生理特有的生理适应性以及母胎相互作用的考虑。以肺保护性通气策略为重点的治疗已被证明可以改善成人 ARDS 患者的临床结局，但在妊娠相关 ARDS 患者中可能会产生不利的母胎相互作用。尚未确定特定的药物疗法可以改善妊娠合并 ARDS 的结局。