Background Whilst the impact of Covid-19 infection in pregnant women has been examined, there is a scarcity of data on pregnant women in the Middle East. Thus, the aim of this study was to examine the impact of Covid-19 infection on pregnant women in the United Arab Emirates population. Methods A case-control study was carried out to compare the clinical course and outcome of pregnancy in 79 pregnant women with Covid-19 and 85 non-pregnant women with Covid-19 admitted to Latifa Hospital in Dubai between March and June 2020. Results Although Pregnant women presented with fewer symptoms such as fever, cough, sore throat, and shortness of breath compared to non-pregnant women; yet they ran a much more severe course of illness. On admission, 12/79 (15.2%) Vs 2/85 (2.4%) had a chest radiograph score [on a scale 1-6] of ≥3 (p-value = 0.0039). On discharge, 6/79 (7.6%) Vs 1/85 (1.2%) had a score ≥3 (p-value = 0.0438). They also had much higher levels of laboratory indicators of severity with values above reference ranges for C-Reactive Protein [(28 (38.3%) Vs 13 (17.6%)] with p < 0.004; and for D-dimer [32 (50.8%) Vs 3(6%)]; with p < 0.001. They required more ICU admissions: 10/79 (12.6%) Vs 1/85 (1.2%) with p=0.0036; and suffered more complications: 9/79 (11.4%) Vs 1/85 (1.2%) with p=0.0066; of Covid-19 infection, particularly in late pregnancy. Conclusions Pregnant women presented with fewer Covid-19 symptoms but ran a much more severe course of illness compared to non-pregnant women with the disease. They had worse chest radiograph scores and much higher levels of laboratory indicators of disease severity. They had more ICU admissions and suffered more complications of Covid-19 infection, such as risk for miscarriage and preterm deliveries. Pregnancy with Covid-19 infection, could, therefore, be categorised as high-risk pregnancy and requires management by an obstetric and medical multidisciplinary team.
Our study reinforces the critical role of the PAMG-1 biomarker test to aid in risk assessment of imminent spontaneous preterm delivery in patients with symptoms of PTL. The PAMG-1 test was found to be statistically superior to standard clinical assessment alone, with respect to specificity. Based on our data, the introduction of a PAMG-1 test result into clinical decision making could reduce up to 91% of unnecessary admissions for women presenting with threatened preterm labor.
Background: Whilst the impact of Covid-19 infection in pregnant women has been examined, there is a scarcity of data on pregnant women in the Middle East. Thus, the aim of this study was to examine the impact of Covid-19 infection on pregnant women in the United Arab Emirates population. Methods: A case-control study was carried out to compare the clinical course and outcome of pregnancy in 79 pregnant women with Covid-19 and 85 non-pregnant women with Covid-19 admitted to Latifa Hospital in Dubai between March and June 2020. Results: On admission, most pregnant women (69/79; 87%) were either asymptomatic or suffered mild respiratory symptoms, much like non-pregnant women. The main symptoms, observed in both groups, were fever, cough, headache, runny nose and myalgia. In early pregnancy four women had spontaneous miscarriages. However, severe Covid-19 illness, ICU admission, intubation and complications were observed in late pregnancy in 10/79 (13%) women with prior comorbidities. During the study period, 31/79 women delivered: 22 (70%) had a lower segment Caesarean section, 16 for obstetric reasons and 6 for severe Covid-19 pneumonia; and 12 had a preterm delivery. Postoperatively, none showed significant improvement on account of early delivery. Sepsis, acute renal failure and acute respiratory distress syndrome were the most common complications observed. The neonatal outcome was comparable to that of the general obstetric population, even though 12/31 (38%) were preterm and had to be admitted to the neonatal ICU. Two neonates, born by vaginal delivery, tested positive for Covid-19 after delivery. Both were asymptomatic and tests were negative within 72 hours. It was not possible to ascertain whether vertical transmission occurred in utero.Conclusions: Severe Covid-19 illness, ICU admission, intubation, complications and preterm deliveries were observed in late pregnancy in women with comorbidities. Pregnancy with Covid-19 infection, could, therefore, be categorised as high-risk pregnancy. It was not possible to confirm whether vertical transmission of Covid-19 had occurred during the third trimester of pregnancy.
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