Obstetric and perinatal risks after new coronavirus infection

Abstract

BACKGROUND: Numerous studies indicate that pregnant women are at risk for severe morbidity, adverse gestational outcomes, and mortality following COVID-19. These patients have a higher frequency of miscarriage at various stages of gestation, premature birth, preeclampsia, cesarean section, and birth of children with low body weight. Other publications have suggested that the clinical characteristics of the disease detected in pregnant women with confirmed COVID-19 are similar to those in the general population.

AIM: The aim of this study was to determine obstetric and perinatal risks in women who have had COVID-19 during pregnancy.

MATERIALS AND METHODS: We conducted an open prospective continuous cross-sectional study in which 114 patients were examined after suffering from COVID-19. Depending on the severity of the new coronavirus infection, they were divided into groups: group I (n = 36) included patients with mild disease, group II (n = 56) – with moderate disease, group III (n = 22) – with heavy. The control group consisted of 93 pregnant women who were hospitalized during the specified period without COVID-19 and signs of acute respiratory viral infection.

RESULTS: Gestational diabetes mellitus is associated with a risk of the moderate and severe new coronavirus infections during pregnancy. Placental deficiency is significantly more often recorded in moderate and severe COVID-19 cases. Severe COVID-19 in pregnant women determines a high probability of fetal growth restriction. Preeclampsia complicates pregnancy in all patients with either mild, moderate, or severe COVID-19. The risk of premature birth with a high probability is determined by the moderate and severe courses of the disease. Only moderate COVID-19 during pregnancy is associated with the risk of induced labor. The risk of operative delivery by cesarean section is significantly increased in moderate and severe COVID-19. Moderate and severe courses of the underlying disease during pregnancy determine a high probability of low body weight of children at birth. The risk of hospitalization in the resuscitation unit is associated with moderate and severe COVID-19 during pregnancy.

CONCLUSIONS: Maternal mortality among women with COVID-19 who were hospitalized in an obstetric hospital was 3,636 per 100,000 live births. Perinatal mortality in patients who suffered a new coronavirus infection during pregnancy was 52.6‰.

Keywords

SARS-CoV-2 / COVID-19 / pregnancy / obstetric complications / perinatal complications

References

[1] Schwartz DA, Graham AL. Potential maternal and infant outcomes from (Wuhan) Coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses. 2020;12(2):194. DOI: 10.3390/v12020194

[2] Schwartz D.A., Graham A.L. Potential maternal and infant outcomes from (wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections // Viruses. 2020. Vol. 12. No. 2. P. 194. DOI: 10.3390/v12020194

[3] Liu H, Wang LL, Zhao SJ, et al. Why are pregnant women susceptible to COVID-19? An immunological viewpoint. J Reprod Immunol. 2020;139. DOI: 10.1016/j.jri.2020.103122

[4] Liu H., Wang L.L., Zhao S.J., et al. Why are pregnant women susceptible to COVID-19? An immunological viewpoint // J. Reprod. Immunol. 2020. Vol. 139. DOI: 10.1016/j.jri.2020.103122

[5] Westgren M, Pettersson K, Hagberg H, et al. Severe maternal morbidity and mortality associated with COVID-19: the risk should not be downplayed. Acta Obstet Gynecol Scand. 2020;99(7):815–816. DOI: 10.1111/aogs.13900

[6] Westgren M., Pettersson K., Hagberg H., et al. Severe maternal morbidity and mortality associated with COVID-19: the risk should not be downplayed // Acta Obstet. Gynecol. Scand. 2020. Vol. 99. No. 7. P. 815–816. DOI: 10.1111/aogs.13900

[7] Khan MA, Khan N, Mustagir G, et al. COVID-19 infection during pregnancy: a systematic review to summarize possible symptoms, treatments, and pregnancy outcomes. medRxiv. 2020. DOI: 10.1101/2020.03.31.20049304

[8] Khan M.A., Khan N., Mustagir G., et al. COVID-19 infection during pregnancy: a systematic review to summarize possible symptoms, treatments, and pregnancy outcomes // medRxiv. 2020. DOI: 10.1101/2020.03.31.20049304

[9] 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. DOI: 10.1016/j.ajog.2020.04.014

[10] 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. Vol. 223. No. 1. P. 111.e1–111.e14. DOI: 10.1016/j.ajog.2020.04.014

[11] Chen L, Li Q, Zheng D, et al. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China. N Engl J Med. 2020;382(25):e100. DOI: 10.1056/NEJMc2009226

[12] Chen L., Li Q., Zheng D., et al. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China // N. Engl. J. Med. 2020. Vol. 382. No. 25. P. e100. DOI: 10.1056/NEJMc2009226

[13] Gregg WE, Brown AA. Cognitive and physical disabilities and aging-related complications of diabetes. Clin Diabetes. 2003;21(3):113–118. DOI: 10.2337/diaclin.21.3.113

[14] Gregg W.E., Brown A.A. Cognitive and physical disabilities and aging-related complications of diabetes // Clin. Diabetes. 2003. Vol. 21. No. 3. P. 113–118. DOI: 10.2337/diaclin.21.3.113

[15] Priputnevich TV, Achkasova EN, Chubarov VV, Gordeev AB. Acute respiratory diseases and influenza in modern obstetrics: epidemiological features and diagnostic problems: literature review. epidemiology and vaccinal prevention. 2019;18(3):89–97. (In Russ.) DOI: 10.31631/2073-3046-2019-18-3-89-97

[16] Припутневич Т.В., Ачкасова Е.Н., Чубаров В.В., и др. Острые респираторные заболевания и грипп в современном акушерстве: эпидемиологические особенности и проблемы диагностики: обзор литературы // Эпидемиология и вакцинопрофилактика. 2019. Т. 18. № 3. С. 89–97. DOI: 10.31631/2073-3046-2019-18-3-89-97

[17] Malik A, El Masry KM, Ravi M, et al. Middle east respiratory syndrome coronavirus during pregnancy, Abu Dhabi, United Arab Emirates, 2013. Emerg Infect Dis. 2016;22(3):515–517. DOI: 10.3201/eid2203.151049

[18] Malik A., El Masry K.M., Ravi M., et al. Middle east respiratory syndrome coronavirus during pregnancy, Abu Dhabi, United Arab Emirates, 2013 // Emerg. Infect. Dis. 2016. Vol. 22. No. 3. P. 515–517. DOI: 10.3201/eid2203.151049

[19] Mathad JS, Gupta A. Pulmonary Infections in pregnancy. Semin Respir Crit Care Med. 2017;38(2):174–184. DOI: 10.1055/s-0037-1602375

[20] Mathad J.S., Gupta A. Pulmonary infections in pregnancy // Semin. Respir. Crit. Care Med. 2017. Vol. 38. No. 2. P. 174–184. DOI: 10.1055/s-0037-1602375

[21] Bezhenar VF, Zazerskaya IE, Bettikher OA, et al. Controversial issues in obstetric management of women with novel coronavirus disease COVID-19 during pregnancy and childbirth. Obstetrics and Gynecology. 2020;(5):13–21. DOI: 10.18565/aig.2020.5.13-21

[22] Беженарь В.Ф., Зазерская И.Е., Беттихер О.А., и др. Спорные вопросы акушерской тактики при ведении беременности и родоразрешении пациенток с новой коронавирусной инфекцией COVID-19 // Акушерство и гинекология. 2020. № 5. C. 13–21. DOI: 10.18565/aig.2020.5.13-21

[23] Priputnevich TV, Gordeev AB, Lyubasovskaya LA, et al. The novel coronavirus SARS-COV-2 and pregnancy: literature review. Obstetrics and Gynecology. 2020;(5):6–12. (In Russ.) DOI: 10.18565/aig.2020.5.6-12

[24] Припутневич Т.В., Гордеев А.Б., Любасовская Л.А., и др. Новый коронавирус SARS-COV-2 и беременность: обзор литературы // Акушерство и гинекология. 2020. № 5. C. 6–12. DOI: 10.18565/aig.2020.5.6-12

[25] Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809–815. DOI: 10.1016/S0140-6736(20)30360-3

[26] Chen H., Guo J., Wang C., et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records // Lancet. 2020. Vol. 395. No. 10226. P. 809–815. DOI: 10.1016/S0140-6736(20)30360-3

[27] Tam PCK, Ly KM, Kernich ML, et al. Detectable severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in human breast milk of a mildly symptomatic patient with coronavirus disease 2019 (COVID-19). Clin Infect Dis. 2021;72(1):128–130. DOI: 10.1093/cid/ciaa673

[28] Tam P.C.K., Ly K.M., Kernich M.L., et al. Detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human breast milk of a mildly symptomatic patient with coronavirus disease 2019 (COVID-19) // Clin. Infect. Dis. 2021. Vol. 72. No. 1. P. 128–130. DOI: 10.1093/cid/ciaa673

[29] Novoa RH, Quintana W, Llancarí P, et al. Maternal clinical characteristics and perinatal outcomes among pregnant women with coronavirus disease 2019. A systematic review. Travel Med Infect Dis. 2021;39. DOI: 10.1016/j.tmaid.2020.101919

[30] Novoa R.H., Quintana W., Llancarí P., et al. Maternal clinical characteristics and perinatal outcomes among pregnant women with coronavirus disease 2019. A systematic review // Travel Med. Infect. Dis. 2021. Vol. 39. DOI: 10.1016/j.tmaid.2020.101919

[31] Diriba K, Awulachew E, Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis. Eur J Med Res. 2020;25(1):39. DOI: 10.1186/s40001-020-00439-w

[32] Diriba K., Awulachew E., Getu E. The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis // Eur. J. Med. Res. 2020. Vol. 25. No. 1. P. 39. DOI: 10.1186/s40001-020-00439-w

[33] Belokrinitskaya TE, Artymuk NV, Filippov OS, et al. Clinical course, maternal and perinatal outcomes of 2019 novel coronavirus infectious disease (COVID-19) in pregnant women in Siberia and Far East. Obstetrics and Gynecology. 2021;(2):48–54. (In Russ.) DOI: 10.18565/aig.202L2.48-54

[34] Белокриницкая Т.Е., Артымук Н.В., Филиппов О.С., и др. Клиническое течение, материнские и перинатальные исходы новой коронавирусной инфекции COVID-19 у беременных Сибири и Дальнего Востока // Акушерство и гинекология. 2021. № 2. C. 48–54. DOI: 10.18565/aig.202L2.48-54

[35] Jafari M, Pormohammad A, Sheikh Neshin SA, et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: a systematic review and meta-analysis. Rev Med Virol. 2021;31(5):1–16. DOI: 10.1002/rmv.2208

[36] Jafari M., Pormohammad A., Sheikh Neshin S.A., et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: a systematic review and meta-analysis // Rev. Med. Virol. 2021. Vol. 31. No. 5. P. 1–16. DOI: 10.1002/rmv.2208

[37] Stow LR, Jacobs ME, Wingo CS, et al. Endothelin-1 gene regulation. FASEB J. 2011;25(1):16–28. DOI: 10.1096/fj.10-161612

[38] Stow L.R., Jacobs M.E., Wingo C.S., et al. Endothelin-1 gene regulation // FASEB J. 2011. Vol. 25. No. 1. P. 16–28. DOI: 10.1096/fj.10-161612

[39] Karakus S, Bozoklu Akkar O, Yildiz C, et al. Serum levels of ET-1, M30, and angiopoietins-1 and -2 in HELLP syndrome and preeclampsia compared to controls. Arch Gynecol Obstet. 2016;293(2):351–359. DOI: 10.1007/s00404-015-3803-1

[40] Karakus S., Bozoklu Akkar O., Yildiz C., et al. Serum levels of ET-1, M30, and angiopoietins-1 and -2 in HELLP syndrome and preeclampsia compared to controls // Arch. Gynecol. Obstet. 2016. Vol. 293. No. 2. P. 351–359. DOI: 10.1007/s00404-015-3803-1

[41] Zdravookhranenie v Rossii. 2019: statisticheskiy sbornik / Rosstat. Moscow; 2019. (In Russ.) [cited 2023 May 20]. Available from: https://rosstat.gov.ru/storage/mediabank/Zdravoohran-2019.pdf

[42] Росстат. Здравоохранение в России. 2019: статистический сборник. Москва, 2019 [дата обращения 20.05.2023]. Доступ по ссылке: https://rosstat.gov.ru/storage/mediabank/Zdravoohran-2019.pdf

[43] Vallejo V, Ilagan JG. A Postpartum death due to coronavirus disease 2019 (COVID-19) in the United States. Obstet Gynecol. 2020;136(1):52–55. DOI: 10.1097/AOG.0000000000003950

[44] Vallejo V., Ilagan J.G. A postpartum death due to coronavirus disease 2019 (COVID-19) in the United States // Obstet. Gynecol. 2020. Vol. 136. No. 1. P. 52–55. DOI: 10.1097/AOG.0000000000003950

[45] Lokken EM, Walker CL, Delaney S, et al. Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State. Am J Obstet Gynecol. 2020;223(6):911.e1–911.e14. DOI: 10.1016/j.ajog.2020.05.031

[46] Lokken E.M., Walker C.L., Delaney S., et al. Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State // Am. J. Obstet. Gynecol. 2020. Vol. 223. No. 6. P. 911.e1–911.e14. DOI: 10.1016/j.ajog.2020.05.031

[47] De Jong A, Chanques G, Jaber S. Mechanical ventilation in obese ICU patients: from intubation to extubation. Crit Care. 2017;21(1):63. DOI: 10.1186/s13054-017-1641-1

[48] De Jong A., Chanques G., Jaber S. Mechanical ventilation in obese ICU patients: from intubation to extubation // Crit. Care. 2017. Vol. 21. No. 1. P. 63. DOI: 10.1186/s13054-017-1641-1

[49] Ouchi N, Parker JL, Lugus JJ, et al. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011;11(2):85–97. DOI: 10.1038/nri2921

[50] Ouchi N., Parker J.L., Lugus J.J., et al. Adipokines in inflammation and metabolic disease // Nat. Rev. Immunol. 2011. Vol. 11. No. 2. P. 85–97. DOI: 10.1038/nri2921

[51] Koumoutsea EV, Vivanti AJ, Shehata N, et al. COVID-19 and acute coagulopathy in pregnancy. J Thromb Haemost. 2020;18(7):1648–1652. DOI: 10.1111/jth.14856

[52] Koumoutsea E.V., Vivanti A.J., Shehata N., et al. COVID-19 and acute coagulopathy in pregnancy // J. Thromb. Haemost. 2020. Vol. 18. No. 7. P. 1648–1652. DOI: 10.1111/jth.14856

[53] 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. DOI: 10.2214/AJR.20.23072

[54] 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. Vol. 215. No. 1. P. 127–132. DOI: 10.2214/AJR.20.23072

[55] Davidova YuV, Limanskaya AYu. The safety of use of interferon preparations in the treatment of acute respiratory viral infections in high risk pregnant women. Perinatologiya i Pediatriya. 2016;1(65):27–32. (In Russ.) DOI: 10.15574/PP.2016.65.27

[56] Давыдова Ю.В., Лиманская А.Ю. Безопасность применения препаратов интерферона в лечении ОРВИ у беременных высокого риска // Перинатология и педиатрия. 2016. Т. 1. № 65. С. 27–32. DOI: 10.15574/PP.2016.65.27

[57] 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). DOI: 10.1016/j.ajogmf.2020.100107

[58] 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. Vol. 2. No. 2. DOI: 10.1016/j.ajogmf.2020.100107

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