Is the Course of COVID-19 Different during Pregnancy? A Retrospective Comparative Study

Abstract

The COVID-19 pandemic has challenged health systems around the world. Maternal-foetal medicine, which has been particularly affected, must consider scientific data on the physiological processes occurring in the pregnant woman’s body to develop relevant standards of care. Our study retrospectively compared the clinical and laboratory characteristics of 52 COVID-19 pregnant patients with 53 controls. Most of the pregnant patients required medical attention during the third trimester and therefore we propose that vaccination is needed prior to the 30th week of pregnancy. We found no differences between the 2 groups in the course of illness classification system, days of hospital stay, need for oxygen supplementation, need for mechanical ventilation, and ICU admission. Moreover, clinical manifestations and imaging findings were comparable. Pregnant patients needed a greater oxygen flow rate and required high flow oxygen therapy more frequently. Considering pregnancy-related physiological adaptations, we found that COVID-19 infection in pregnant patients is associated with higher levels of inflammatory markers, apart from serum ferritin, than in non-pregnant women, and concluded that biomarkers of cardiac and muscle injury, as well as kidney function, may not be good predictors of COVID-19 clinical course in pregnant patients at the time of admission, but more research needs to be conducted on this topic.

COVID-19 Infection Complicated by Disseminated Intravascular Coagulation during Pregnancy—Two Cases Report

“…Therefore, it concluded how important it is to vaccinate prior to the 30th week of pregnancy. This may reduce the risk of severe course of the disease [28]. In our both cases, the patients did not receive vaccination, because at that time it was not yet recommended and was not available for pregnant women in our country.…”

Maternal SARS‐CoV‐2 infection: The potential vertical transmission of SARS‐CoV‐2 and impact on neonates: A review

“…Thus, as the uterus expands, the diaphragm is pushed to a higher position; this can create an obstacle for the lungs to expand 7 . The intolerance to hypoxemia makes pregnant women more likely to develop respiratory disease complications 8,9 . Maternal severe acute SARS‐CoV‐2 infection can adversely affect the pregnancy and birth outcomes.…”

“…7 The intolerance to hypoxemia makes pregnant women more likely to develop respiratory disease complications. 8,9 Maternal severe acute SARS-CoV-2 infection can adversely affect the pregnancy and birth outcomes. Fetal complications include abortion, intrauterine growth restriction, and prematurity.…”

Vaccine Protection Through Placenta and Breastfeeding: The Unmet Topic in COVID-19 Pandemic

“…this period, the diaphragm is pushed to a higher position as the uterus expands; this can create an obstacle for the lungs to expand, additionally the upper respiratory tract swells, and the oxygen demand increases. Thus, the intolerance to hypoxemia makes pregnant women more likely to develop respiratory disease complications, including COVID-19 (22,23). In this period, marked by significant hormonal changes, a shift in the balance between T helper 1 (Th1)-mediated and T helper 2 (Th2)mediated immunity can be observed: a decrease in Th1 response leads to a dominant Th2 humoral immune response, which results in a lower secretion of proinflammatory cytokines, such as interleukin-2 (IL-2), interferon-gamma (IFN-g), and tumor necrosis factor-alpha (TNF-a) and an increase in antiinflammatory cytokines (IL-4, IL-10, and IL-13), respectively (24,25).…”

“…Despite this period of women's life being marked mainly by an immunotolerant profile, actually pregnancy involves a triphasic immune modulation, characterized by an alternation between proinflammatory, anti-inflammatory, and a second proinflammatory state, in that order, over the three trimesters (22). Thus, women in the first and third trimester of pregnancy have a proinflammatory profile, and for this reason, when infected with SARS-CoV-2, they are more likely to develop the cytokine storm, leading to bad maternal and fetal prognoses (21,23).…”