COVID-19 enfeksiyonu doğurganlık çağındaki kadınlar için risk oluşturur mu?

Yıl 2023, Cilt: 7 Sayı: 3, 104 - 116, 19.01.2024

Kazım Kıratlı , Mustafa Şengül

https://doi.org/10.33716/bmedj.1406040

Öz

Amaç: Bu çalışma, hem yatan hem de ayakta tedavi vakalarından elde edilen laboratuvar bulgularını değerlendirerek, çocuk doğurma çağındaki hamile olmayan bireylerle karşılaştırıldığında, COVID-19 enfeksiyonunun hamile kadınlar üzerindeki potansiyel farklı etkisini araştırmayı amaçlamaktadır.
Gereç ve Yöntemler: Türkiye'de COVID-19’un ortaya çıktığı Mart 2020'den aşılamanın başlamasına kadar toplam 94 COVID-19 hastası üç ayrı gruba dahil edildi: hamile kadınlar ve hamile olmayan COVID-19'lu bireyler (pnömonisi olan ve olmayanlar) . Sosyodemografik veriler ve muayene bulguları hastane bilgi sisteminden geriye dönük olarak elde edildi.
Bulgular: Araştırmada yaş ortalaması 28,87±1,38 olan gebelerin diğer gruplara göre anlamlı olarak daha kısa ortalama hastanede kalış süresi (5,03±0,49 gün) yaşadığı ortaya çıktı (p<0,001). Özellikle gebelerde üre, kreatinin, beyaz küre sayısı, nötrofil sayısı, hemoglobin ve hematokrit değerlerinde diğer gruplara göre anlamlı farklılıklar görüldü (p<0,001). Ayrıca nötrofil ve lenfosit yüzde değerleri açısından da üç grup arasında anlamlı fark vardı (p<0,001).
Sonuç: Çalışma, hamile kadınlarda COVID-19 enfeksiyonunun, hamileliğin neden olduğu değişiklikler hesaba katıldığında daha olumlu klinik sonuçlar, daha kısa hastanede kalış süresi ve laboratuvar bulgularında nispeten orta düzeyde değişikliklerle ilişkili olduğunu öne sürüyor. Gebeliğin ciddi COVID-19 enfeksiyonu açısından ileri yaş veya diyabet, astım, KOAH ve malignite gibi altta yatan kronik durumlar kadar önemli bir risk faktörü oluşturmayabileceği düşünülmektedir.

Anahtar Kelimeler

Covıd-19, Enfeksiyon, Gebelik, Pnömoni

Does COVID-19 Infection Pose a Risk to Women of Childbearing Age?

Öz

Objectives: This study aims to investigate the potential differential impact of COVID-19 infection on pregnant women compared to non-pregnant individuals of childbearing age by evaluating laboratory findings from both inpatient and outpatient cases.
Material and Methods: From the onset of COVID-19 in Turkey in March 2020 until the commencement of vaccination, a total of 94 COVID-19 patients were included in three separate groups: pregnant women and non-pregnant individuals with COVID-19 (with and without pneumonia). Sociodemographic data and examination findings were retrospectively retrieved from the hospital information system.
Results: The study revealed that pregnant women, with a mean age of 28.87±1.38, experienced a significantly shorter mean length of hospital stay of 5.03±0.49 days compared to the other groups (p<0.001). Notably, pregnant women exhibited significant variations in urea, creatinine, white blood cell count, neutrophil count, hemoglobin, and hematocrit values in comparison to the other groups (p<0.001). Moreover, there were significant differences among the three groups concerning neutrophil and lymphocyte percentage values (p<0.001).
Conclusion: The study suggests that COVID-19 infection in pregnant women is associated with more favorable clinical outcomes, shorter length of hospital stay, and relatively moderate alterations in laboratory findings when accounting for pregnancy-induced changes. It is implied that pregnancy might not pose as substantial a risk factor for severe COVID-19 infection as advanced age or underlying chronic conditions such as diabetes, asthma, COPD, and malignancy.

Anahtar Kelimeler

COVID-19, Infection, Pregnancy, Pneumonia

Kaynakça

• Madjunkov M, Dviri M and Librach C. A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective. J Ovarian Res 2020;13(1):140. https://doi.org/10.1186/s13048-020-00737-1
• Lu Q and Shi Y. Coronavirus disease (COVID-19) and neonate: What neonatologist need to know. J Med Virol 2020;92:564-567. https://doi.org/10.1002/jmv.25740
• World Health Organization Q&A on coronaviruses (COVID-19)- April 12, 2020. https://www.who.int/emergencies/diseases/novelcoronavirus-2019/question-and-answe rs-hub/q-a-detai l/qa-coronaviruses. Accessed on July 2020. In: WHO, editor.
• Liu M, Wang T, Zhou Y, Zhao Y, Zhang Y, Li J. Potential Role of ACE2 in Coronavirus Disease 2019 (COVID-19) Prevention and Management. J Transl Int Med 2020;8(1):9-19. https://doi.org/10.2478/jtim-2020-0003 Weiss SR, Navas-Martin S. Coronavirus pathogenesis and the emerging pathogen severe acute respiratory syndrome coronavirus. Microbiol Mol Biol Rev 2005;69(4):635–664. https://doi.org/10.1128/mmbr.69.4.635-664.2005
• Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol 2020;215:108427. https://doi.org/10.1016/j.clim.2020.108427
• Levy A, Yagil Y, Bursztyn M, Barkalifa R, Scharf S, Yagil C. ACE2 expression and activity are enhanced during pregnancy. Am J Physiol Regul Integr Comp Physiol 2008;295(6):R1953-R1961. https://doi.org/10.1152/ajpregu.90592.2008
• Selim M, Mohamed S, Abdo M, Abdelhaffez A. Is COVID-19 similar in pregnant and non-pregnant women? Cureus 2020;12(6):e8888. https://doi.org/10.7759/cureus.8888
• Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study. PLoS One 2020;15(4):e0230295. https://doi.org/10.1371/journal.pone.0230295
• Engjom H, Aabakke AJM, Klungsøyr K, Svanvik T, Äyräs O, Jonasdottir E, et al. COVID-19 in pregnancy-characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries. Acta Obstet Gynecol Scand 2021;100(9):1611-1619. https://doi.org/10.1111/aogs.14160
• Rebutini PZ, Zanchettin AC, Stonoga ETS, Prá DMM, de Oliveira ALP, Dezidério FDS, et al. Association Between COVID-19 Pregnant Women Symptoms Severity and Placental Morphologic Features. Front Immunol 2021;12:685919. https://doi.org/10.3389/fimmu.2021.685919
• Tang P, Wang J, Song Y. Characteristics and pregnancy outcomes of patients with severe pneumonia complicating pregnancy: a retrospective study of 12 cases and a literature review. BMC Pregnancy Childbirth 2018;18:434. https://doi.org/10.1186/s12884-018-2070-0
• Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020;323(13):1239. https://doi.org/10.1001/jama.2020.2648
• Vakili S, Savardashtaki A, Jamalnia S, Tabrizi R, Nematollahi MH, Jafarinia M, et al. Laboratory Findings of COVID-19 Infection are Conflicting in Different Age Groups and Pregnant Women: A Literature Review. Arch Med Res 2020;51(7):603-607. https://doi.org/10.1016/j.arcmed.2020.06.007
• Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol 2009;114(6):1326-1331. https://doi.org/10.1097/aog.0b013e3181c2bde8
• Chen YH, Keller J, Wang IT, Lin CC, Lin HC. Pneumonia and pregnancy outcomes: a nationwide population-based study. Am J Obstet Gynecol 2012;207:288.e1-7. https://doi.org/10.1016/j.ajog.2012.08.023 Vlachodimitropoulou Koumoutsea E, Vivanti AJ, Shehata N, Benachi A, Le Gouez A, Desconclois C, et al. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost 2020;18(7):1648-1652. https://doi.org/10.1111/jth.14856
• Burke RM, Killerby ME, Newton S, Ashworth CE, Berns AL, Brennan S, et al. Symptom profiles of a convenience sample of patients with COVID-19 — united states, January–April 2020. Morb Mortal Wkly Rep 2020;69(28):904–908. https://doi.org/10.15585/mmwr.mm6928a2
• Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020;222(6):521-531. https://doi.org/10.1016/j.ajog.2020.03.021
• Matar R, Alrahmani L, Monzer N, Debiane LG, Berbari E, Fares J, et al. Clinical Presentation and Outcomes of Pregnant Women With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Clin Infect Dis 2021;72(3):521-533. https://doi.org/10.1093/cid/ciaa828
• Hirshberg JS, Stout MJ, Raghuraman N. Coronavirus disease 2019 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020;2(3):100162. https://doi.org/10.1016/j.ajogmf.2020.100162
• Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020;370:m3320. https://doi.org/10.1136/bmj.m3320
• Liu Y, Chen H, Tang K, Guo Y. Withdrawn: Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect 2020:S0163-4453(20)30109-2. https://doi.org/10.1016/j.jinf.2020.02.028
• Kasraeian M, Zare M, Vafaei H, Asadi N, Faraji A, Bazrafshan K et al. COVID-19 pneumonia and pregnancy; a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020;1-8. https://doi.org/10.1080/14767058.2020.1763952
• Wang CL, Liu YY, Wu CH, Wang CY, Wang CH, Long CY. Impact of COVID-19 on Pregnancy. Int J Med Sci 2021;18(3):763-767. https://doi.org/10.7150/ijms.49923
• Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-Ncov infected patients linked to viral loads and lung injury. Sci China Life Sci 2020;63(3):364-374. https://doi.org/10.1007/s11427-020-1643-8
• Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J Infect 2020;80(5):e7-e13. https://doi.org/10.1016/j.jinf.2020.03.007
• Zhang ZL, Hou YL, Li DT, Li FZ. Laboratory findings of COVID-19: a systematic review and meta-analysis. Scand J Clin Lab Invest 2020;80(6):441–447. https://doi.org/10.1080/00365513.2020.1768587
• Xie Y, Wang Z, Liao H, Marley G, Wu D, Tang W. Epidemiologic, clinical, and laboratory findings of the COVID-19 in the current pandemic: systematic review and meta-analysis. BMC Infect Dis 2020;20(1):640. https://doi.org/10.1186/s12879-020-05371-2
• Wang Z, Wang Z, Xiong G. Clinical characteristics and laboratory results of pregnant women with COVID-19 in Wuhan, China. Int J Gynecol Obstet 2020;150(3):312–317. https://doi.org/10.1002/ijgo.13265