The clinical course of COVID-19 in pregnant and non-pregnant women

Yıl 2023, , 263 - 269, 30.08.2023

Fatih Seğmen , Elmas Uysal , Gamze Kılıçarslan , Deniz Erdem , Emine Nilgün Zengin

https://doi.org/10.47582/jompac.1313415

Öz

Aims: Pregnancy is a physiological condition that predisposes women to respiratory complications of viral infections thus, bringing the risk of developing more severe disease. The aim of this research was to elucidate the clinical course of COVID-19 in pregnant and non-pregnant women of childbearing age. Mortality rate, laboratory parameters, the occurence of cytokine storm in both groups and the response to treatment have been investigated.
Methods: A total of 88 women of childbearing age with a diagnosis of COVID-19 disease has been retrospectively analyzed. Age, comorbidity, length of stay in the intensive care unit and treatment regimen of patients have been obtained from hospital database. Ferritin, IL-6, CRP, procalcitonin, D-dimer, urea, creatinine, GFR, ALT, AST, LDH, lymphocyte count, neutrophil count, white blood cell count were evaluated. Clinical response such as reduction in oxygen requirement and vasopressor utilization before and after treatment were examined
Results: The rate of RT - PCR positive results were statistical significantly higher in pregnant women (p=0.003). The median WBC, lymphocyte and leukocyte values of the pregnant patients were higher (p=0.038, p=0.006 and p=0.035, respectively). The median hemoglobin, LDH and ferritin values of pregnant women were lower than those of non-pregnant individuals (p=0.032, p<0.001 and p=0.010, respectively). Mortality has been observed wit a rate of 17.5% in second trimester and 15% in the third trimester while 22.5% of women in the second trimester and 45% of women in the third trimester have survived COVID-19 infection.
Conclusion: Regarding the results of this study, we have observed differences in WBC, lymphocyte and leukocyte, median hemoglobin, LDH and ferritin values of pregnant women and non-pregnant individuals. Additionally, mortality rate was also comparable.

Anahtar Kelimeler

COVID-19, pregnancy, mortality, D-dimer

Gebe olan ve gebe olmayan kadınlarda COVID-19'un klinik seyri

Öz

Amaç: Gebelik, kadınları viral enfeksiyonların solunum yolu komplikasyonlarına yatkınlaştıran ve böylece daha şiddetli hastalık geliştirme riskini getiren fizyolojik bir durumdur. Bu araştırmanın amacı, çocuk doğurma çağındaki gebe olan ve gebe olmayan kadınlarda COVID-19'un klinik seyrini araştırmaktı. Her iki grupta mortalite hızı, laboratuvar parametreleri, sitokin fırtınası oluşumu ve tedaviye yanıt araştırıldı.
Gereç ve Yöntemler: COVID-19 hastalığı tanısı almış doğurganlık çağındaki toplam 88 kadın hastanın dosyası retrospektif olarak incelendi. Hastaların yaşı, ek hastalıkları, yoğun bakımda kalış süreleri ve tedavi rejimleri hastane veri tabanından elde edildi. Ferritin, IL-6, CRP, prokalsitonin, D-dimer, üre, kreatinin, GFR, ALT, AST, LDH, lenfosit sayısı, nötrofil sayısı, beyaz küre sayısı değerlendirildi. Tedavi öncesi ve sonrası oksijen ihtiyacında azalma ve vazopresör kullanımı gibi klinik yanıtlar incelendi.
Bulgular: Gebelerde RT – PCR pozitif sonuç oranı istatistiksel olarak anlamlı derecede yüksekti (p=0,003). Gebe hastaların medyan WBC, lenfosit ve lökosit değerleri daha yüksekti (sırasıyla, p=0,038, p=0,006 ve p=0,035). Gebelerin medyan hemoglobin, LDH ve ferritin değerleri gebe olmayanlara göre daha düşüktü (sırasıyla p=0,032, p<0,001 ve p=0,010). İkinci trimesterde %17,5, üçüncü trimesterde %15 ölüm oranı gözlenirken, ikinci trimesterde kadınların %22,5'i ve üçüncü trimesterde kadınların %45'i COVID-19 enfeksiyonundan kurtuldu.
Sonuç: Bu çalışmanın sonuçlarına bakıldığında, gebe olan ve gebe olmayan hastalar arasında WBC, lenfosit, lökosit, medyan hemoglobin, LDH ve ferritin değerlerinde farklılıklar gözlemlendi. Ek olarak, karşılaştırılabilir ölüm oranı da vardı.

Anahtar Kelimeler

COVID-19, D-dimer, Gebelik, Mortalite

Kaynakça

• Huang C, Wang Y, Li X, et. al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
• World Health Organization. Novel coronavirus ‐ China. Disease outbreak news: Update. 12 January 2020. https://www.who.int/csr/don/12‐january‐2020‐novel‐coronavirus‐china/en/ [Accessed 7 March 2020].
• Zengin M, Baldemir R. Investigation of the global outcomes of acute respiratory distress syndrome with the effect of COVID-19 in publications:a bibliometric analysis between 1980 and 2020. Kırıkkale Üniversitesi Tıp Fakültesi Derg 2021:23:279-292.
• Zengin M, Karcioglu AM. Do not invade, just support. Bratislavske Lekarske Listy 2022:123;218-226.
• Wong SF, Chow KM, Leung TN, et. al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-297.
• Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle east respiratory syndrome coronavirus (mers-cov) infection during pregnancy:Report of two cases & review of the literature. J Microbiol Immunol Infect. 2019;52(3):501-503.
• WHO Director‐General’s opening remarks at the media briefing on COVID‐19 ‐ 3 March 2020. (https://www.who.int/dg/speeches/detail/who‐director‐general‐s‐opening‐remarks‐atthe‐media‐briefing‐on‐covid‐19‐‐‐3‐march‐2020).
• Sutton D, Fuchs K, D’Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med. 2020;382(22) :2163-2164.
• Breslin N, Baptiste C, Gyamfi-Bannerman C, et. al. 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(2):100118.
• Ellington S, Strid P, Tong VT, et. al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):769-775.
• Garg S, Kim L, Whitaker M, et. al. hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 - COVID-NET, 14 States, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458-464.
• Di Mascio D, Khalil A, Saccone G, et. al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy:a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(2):100107.
• Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2:Maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med. 2020;144(7):799-805.
• Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy:a systematic review of reported cases. Am J Obstet Gynecol. 2020;223(1):36-41.
• Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome:systematic review. Ultrasound Obstet Gynecol. 2020;56(1):15-27.
• Khoury R, Bernstein PS, Debolt C, et. al. Characteristics and outcomes of 241 births to women with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection at five New York City Medical Centers. Obstet Gynecol. 2020;136(2):273-282.
• Crovetto F, Crispi F, Llurba E, Figueras F, Gómez-Roig MD, Gratacós E. Seroprevalence and presentation of SARS-CoV-2 in pregnancy. Lancet. 2020;396(10250):530-531.
• Dubey P, Reddy SY, Manuel S, Dwivedi AK. Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;252:490-501.
• Knight M, Bunch K, Vousden N, et. al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK:national population based cohort study. BMJ. 2020;369:m2107.
• Turan O, Hakim A, Dashraath P, Jeslyn WJL, Wright A, Abdul-Kadir R. Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women:A systematic review. Int J Gynaecol Obstet. 2020;151(1):7-16.
• Yan J, Guo J, Fan C, et. al. Coronavirus disease 2019 in pregnant women:a report based on 116 cases. Am J Obstet Gynecol. 2020;223(1):111.e1-111.e14.
• Coronavirus (COVID-19) Infection in Pregnancy. Royal College of Obstetricians and Gynaeacologists Version 6:Published Friday 3 April, 2020. https://www.rcog.org.uk/coronavirus-pregnancy.
• Allotey J, Stallings E, Bonet M, 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.
• Liu D, Li L, Wu X, et. al. Pregnancy and perinatal outcomes of women with Coronavirus Disease (COVID-19) pneumonia:A preliminary analysis. AJR Am J Roentgenol. 2020;215(1):127-132.
• Zhu H, Wang L, Fang C, et. al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51-60.
• Zambrano LD, Ellington S, Strid P, et. al. Update:characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(44):1641-1647.
• Martinez-Portilla RJ, Sotiriadis A, Chatzakis C, et. al. Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia:propensity score matched analysis of a nationwide prospective cohort (COV19Mx). Ultrasound Obstet Gynecol. 2021;57(2):224-231.
• Shek CC, Ng PC, Fung GP, et. al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics. 2003;112(4):e254.
• Chen D, Yang H, Cao Y, et. al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. Int J Gynaecol Obstet. 2020;149(2):130-136.
• Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy:What clinical recommendations to follow? Acta Obstet Gynecol Scand. 2020;99(4):439-442.
• Ai T, Yang Z, Hou H, et. al. Correlation of chest CT and RT-PCR testing for Coronavirus Disease 2019 (COVID-19) in China:A report of 1014 cases. Radiology. 2020;296(2):E32-40.
• ACOG Committee on Obstetric Practice. ACOG Committee opinion. Number 299, September 2004 (replaces no. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004;104:647–651
• Darif D, Hammi I, Kihel A, El Idrissi Saik I, Guessous F, Akarid K. The pro-inflammatory cytokines in COVID-19 pathogenesis:What goes wrong? Microb Pathog. 2021;153:104799.
• Słomka A, Kowalewski M, Żekanowska E. Coronavirus Disease 2019 (COVID-19):A short review on hematological manifestations. Pathogens. 2020;9(6):493.
• COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. https://www.covid19treatmentguidelines.nih.gov/
• RECOVERY Collaborative Group, Horby P, Lim WS, et. al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021;384(8):693-704.
• WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, et. al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19:A meta-analysis. JAMA. 2020;324(13):1330-1341.
• Wastnedge EAN, Reynolds RM, van Boeckel SR, et. al. Pregnancy and COVID-19. Physiol Rev. 2021;101(1):303-318.
• Dorélien A. The effects of in utero exposure to influenza on birth and infant outcomes in the US. Popul Dev Rev. 2019;45(3):489-523.
• Bellos I, Pandita A, Panza R. Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2:A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021;256:194-204.