Clinical Manifestation and Neonatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Clinical manifestation and neonatal outcomes of pregnant women with Corona Virus Disease 2019(COVID-19) were unclear in Wuhan, China.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We retrospectively analyzed clinical characteristics of pregnant and non-pregnant women with COVID-19 aged from 20 to 40, admitted between January 15 and March 15, 2020 at Union Hospital, Wuhan, and symptoms of pregnant women with COVID-19 and compared the clinical characteristics and symptoms to historic data previously reported for H1N1.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 64 patients, 34 (53.13%) were pregnant, with higher proportion of exposure history (29.41% vs 6.67%) and more pulmonary infiltration on CT test (50% vs 10%) comparing to non-pregnant women. Of pregnant patients, 27 (79.41%) completed pregnancy, 5 (14.71%) had natural delivery, 18 (52.94%) had cesarean section, and 4 (11.76%) had abortion, and 5 (14.71%) were asymptomatic. All 23 newborns had negative RT-PCR results and an average 1-minute Apgar Score was 8-9 points. Pregnant and non-pregnant patients show differences on symptoms like fever, expectoration, and fatigue, and on laboratory tests like: neutrophils, fibrinogen, D-dimer, and erythrocyte sedimentation rate. Pregnant patients with COVID-19 tend to have more mild symptoms than those with H1N1.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Clinical characteristics of pregnant patients with COVID-19 are less serious than non-pregnant. No evidence indicated that pregnant women may have fetal infection through vertical transmission of COVID-19. Pregnant patients with H1N1 had more serious condition than those with COVID-19.</jats:p> </jats:sec>

Dysregulated immunity in SARS-CoV-2 infected pregnant women

“…There is growing evidence that SARS-CoV-2 infected pregnant women face greater risk of hospitalization, intensive care unit admission, and invasive ventilation compared to non-pregnant women, but experience comparable or even lower risk of mortality 23–28 . Studies in SARS-CoV-2 positive pregnant and non-pregnant women report higher frequencies of neutrophils and D-dimer concentrations and lower percentages of lymphocytes, CD4+/CD8+ ratios, and IgG levels in pregnant than non-pregnant women infected with SARS-CoV-2 29–32 . Thus, our study adds to the growing literature demonstrating enhanced inflammatory responses and reduced adaptive immune responses during SARS-CoV-2 infection of pregnant compared to non-pregnant women.…”

A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19

“…Concerns over disease potential for mother and fetus led some to consider pregnancy termination in the first and second trimesters when the knowledge base for COVID-19 was rudimentary [ 22 , 23 , 43 , 46 ]. Gastrointestinal illness occurs in a minority of pregnancies [ 3 , 47 ].…”

“…Some complications may depend on the nature of the symptomatic and asymptomatic state [ 56 ]. Preterm delivery is relatively common, but the frequency has been considerably influenced by concerns for the pregnancy and hence by iatrogenic intervention [ 2 , 13 , 23 , 29 – 31 , 34 , 35 , 37 , 39 – 42 , 46 , 55 , 56 , 59 – 61 , 66 , 68 , 77 , 83 , 90 , 94 , 95 , 101 – 110 ]. Overall, the preterm delivery rate generally approaches 14–37%, but the frequency is as high as 75% when the maternal illness is severe.…”

“…Co-morbidities are very common, however, in those with more aggressive illnesses, and these have especially included obesity and diabetes [ 1 , 2 , 12 , 14 , 19 , 28 , 30 , 31 , 33 , 34 , 38 – 40 , 42 , 68 , 79 – 81 , 88 , 89 , 94 , 96 , 105 , 110 , 116 ]. The anticipation of potential complications or the advanced nature of disease has led to a high rate of Caesarean section [ 1 – 3 , 10 , 21 – 23 , 25 , 29 – 32 , 35 , 38 – 42 , 51 , 55 , 56 , 59 , 60 , 68 , 74 – 77 , 82 , 87 , 94 , 101 , 105 , 107 , 109 – 115 , 117 – 129 ]. The frequencies of the latter have ranged 20–100%.…”

COVID-19 e gestação: manifestações clínicas, alterações laboratoriais e desfechos maternos, uma revisão sistemática de literatura/COVID-19 and pregnancy: clinical manifestations, laboratorial alterations and maternal endpoints, a systematic review of the literature

“…Em gestantes, febre e tosse são os sintomas mais comuns. Além desses, também estão descritos fadiga, dispneia, cefaleia, mialgia, diarreia, náuseas e vômitos, dor abdominal e aperto no peito, porém em menor proporção (XU, et al, 2020).…”