Short-term outcomes of COVID-19 in pregnant women unvaccinated for SARS-CoV-2 in the first, second, and third trimesters: a retrospective study

Guleroglu, Filiz Yarsilikal; Atalmis, Hatice Argun; Bafali, Icten Olgu; Dikdere, Gulser Bingol; Dikdere, Irfan; Ekmez, Murat; Kaban, Alpaslan; Karasabanoglu, Fatma; Atas, Busra Seker; Selvi, Esra; Sumnu, Gulay; Topaktas, Merve; Dayan, Merve Yasti; Dogu, Sevilay Yavuz; Cetin, Ali

doi:10.1590/1516-3180.2022.0323.R1.19082022

Acessibilidade / Reportar erro

Brasil

Sao Paulo Medical Journal

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Sao Paulo Med. J. 141 (4) • 2023 • https://doi.org/10.1590/1516-3180.2022.0323.R1.19082022 copy

Short-term outcomes of COVID-19 in pregnant women unvaccinated for SARS-CoV-2 in the first, second, and third trimesters: a retrospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) may be asymptomatic or symptomatic in pregnant women. Compared to non-pregnant reproductive-aged women, symptomatic individuals appear to have a higher risk of acquiring severe illness sequelae.

OBJECTIVES:

We assessed the clinical and laboratory characteristics and outcomes of pregnant COVID-19 patients unvaccinated for severe acute respiratory syndrome coronavirus 2 according to the trimester of pregnancy.

DESIGN AND SETTING:

This was a retrospective observational study conducted in a tertiary-level hospital in Turkey.

METHODS:

This retrospective study reviewed the clinical and laboratory characteristics and outcomes of 445 pregnant COVID-19 patients hospitalized during the first, second, and third trimesters of pregnancy and 149 other pregnant women as controls in a tertiary center from April 2020 to December 2021. All participants were unvaccinated.

RESULTS:

Overall, the study groups were comparable in terms of baseline clinical pregnancy characteristics. There was no clear difference among the study participants with COVID-19 in the first, second, and third trimesters of pregnancy. However, a considerably high number of clinical and laboratory findings revealed differences that were consistent with the inflammatory nature of the disease.

CONCLUSIONS:

The study results reveal the importance of careful follow-up of hospitalized cases as a necessary step by means of regular clinical and laboratory examinations in pregnant COVID-19 patients. With further studies, after implementing vaccination programs for COVID-19 in pregnant women, these data may help determine the impact of vaccination on the outcomes of pregnant COVID-19 patients.

KEY WORDS (MeSH terms):
COVID-19; SARS-CoV-2; Pregnancy; Intensive care units; Intensive care units, neonatal

AUTHORS’ KEY WORDS:
Outcome; Computed tomography; Intensive care unit; Neonatal intensive care unit

	Pregnant COVID-19 patients			Pregnant healthy controls	Significance
	First trimester (n = 45)	Second trimester (n = 120)	Third trimester (n = 280)	Thirdtrimester (n = 149)	Significance
Maternal age (years)	29 (21–43)	30 (18–42)	29 (17–47)	28 (17–43)	NS
Gravidity	3 (1–9)	3 (1–10)	3 (1–9)	3 (1–12)	NS
Parity	1 (0–7)	1 (0–7)	1 (0–7)	2 (0–6)	NS
Ethnicity, n (%)					P = 0.001
Native	41 (91.1%)	111 (92.5%)	236 (84.3%)	106 (71.1%)
Arabic	4 (8.9%)^a	9 (7.5%)^a	44 (15.7%)^a	43 (28.9%)^b
Smoking, n (%)					NS
Yes	2 (4.4%)	2 (1.7%)	11 (3.9%)	2 (1.3%)
No	43 (95.6%)	110 (98.3%)	269 (96.1%)	148 (98.7%)
ART pregnancy, n (%)					NS
Yes	0 (0%)	4 (3.3%)	7 (2.5%)	2 (1.3%)
No	45 (100%)	116 (96.7%)	273 (97.5%)	147 (98.7%)
Pre-pregnancy BMI (kg/m ²2. Proal AD, VanElzakker MB. Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Front Microbiol. 2021;12:698169. PMID: 34248921; https://doi.org/10.3389/fmicb.2021.698169. https://doi.org/https://doi.org/10.3389/... )	24.3 (20.1–26.2)	23.7 (21.3–27.4)	25.8 (22.4–37.3)	28.3 (19.9–45.7)	NS
Mode of delivery, n (%)
Vaginal	22 (53.7%)	52 (44.4%)	109 (39.1%)	77 (52.7%)	NS
Cesarean	19 (46.3%)	65 (55.6%)	170 (60.9%)	69 (47.3%)
Gestational age at diagnosis (weeks)	10 (6–14)	23 (15–28)	36 (29–42)
Gestational age at delivery (weeks)	38 (34–40)^a,b	38 (23–41)^b	38 (30–42)^a,b	38.5 (30–41)^a	P = 0.001
Maternal comorbidities, n (%)					NS
DM	5 (11.1%)	5 (4.2%)	17 (6.1%)	9 (6%)
HT	0 (0%)	3 (2.5%)	8 (2.9%)	11 (7.4%)
Renal disease	0 (0%)	1 (0.8%)	2 (0.7%)	1 (0.7%)
Asthma	2 (4.4%)	7 (5.8%)	10 (3.6%)	6 (4%)
Thyroid disease	2 (4.4%)	12 (10%)	15 (5.4%)	7 (4.7%)

	Pregnant COVID-19 patients			Pregnant healthy controls	Significance
	First trimester (n = 45)	Second trimester (n = 120)	Third trimester (n = 280)	Thirdtrimester (n = 149)	Significance
WBC (103 μL)	6.1 (2.6–22.3)^c	7.5 (2.7–23.1)^c	8.2 (3.2–20.8)^b	10.7 (5.5–20.2)^a	P = 0.001
NEU (103 μL)	4.1 (1.5–18.8)^c	5.6 (0.9–21.6)^b	6.3 (1.7–19.6)^b	7.9 (3.7–20)^a	P = 0.001
LYM (103 μL)	1.6 (0.3–3.1)^a	1.2 (0.4–4.1)^b	1.3 (0.2–3.8)^b	1.8 (0.4–4.4)^a	P = 0.001
MONO (103 μL)	0.4 (0.1–0.9)	0.4 (0.1–1.5)	0.4 (0.1–1.8)	0.5 (0.1–1.5)	NS
Hb (g/dL)	12.6 (8.8–14.8)^b	11.1 (8.5–13.3)^a	11.3 (5.6–15.6)^a	11.6 (7–14.8)^a	P = 0.001
Hct (%)	36.1 ± 3.4^b	32.9 ± 3.1^a	33.6 ± 3.8^a	34.1 ± 3.9^a	P = 0.001
PLT (103 μL)	207 (30–329)^b	199 (67–412)^b	197 (29–473)^b	232 (110–441)^a	P = 0.001
PCT (%)	0.2 (0.04–0.4)^a	0.2 (0.07–0.38)^b	0.2 (0.03–0.5)^b	0.23 (0.09–0.41)^a	P = 0.001
CRP (mg/L)	7.9 (0.3–159)^b	31.7 (0.5–224)^c	23.6 (0.7–197)^c	3.4 (0.6–4.9)^a	P = 0.001
Ferritin (ng/mL)	50 (10.7–778)^a	50.9 (3.4–480)^a	30.8 (3.5–900)^b	–	P = 0.002
BUN (mg/dL)	15 (8–37)^a	11.9 (5–77)^b	11.3 (4.2–32)^b	14 (9–31)^a	P = 0.001
Creatinine (mg/dL)	0.46 (0.3–0.81)^a	0.43 (0.25–2.38)^b	0.46 (0.25–0.85^)a	0.48 (0.34–0.72)^a	P = 0.003
AST (IU/L)	24 (11–110)^b	25 (8–169)^b	22 (8–168)^b	18 (12–35)^a	P = 0.001
ALT (IU/L)	20.5 (8–145)^b	16 (5–241)^b	12 (4–222)^c	11 (4–36)^a	P = 0.001
Direct bilirubin (mg/dL)	0.1 (0.1–0.3)	0.2 (0.1–2.1)	0.2 (0.1–2.6)	–	NS
Indirect bilirubin (mg/dL)	0.2 ± 0.16	0.3 ± 0.16	0.3 ± 0.15	–	NS
Total bilirubin (mg/dL)	0.21 (0.1–0.7)	0.49 (0.2–2.1)	0.47 (0.2–2.7)	–	NS
LDH (IU/L)	190 (139–455)^b	204 (100–679)^b	236 (111–968)^a	266 (244–481)^a	P = 0.002
D-dimer (mg/L)	0.54 (0.3–33.9)^a	1.1 (0.4–11.2)^a	1.5 (0.3–36)^b	–	P = 0.001
Fibrinogen (mg/dL)	410 (284–680)	437 (111–674)	446 (134–773)	559 (349–660)	NS
Maternal arterial pH	7.4 ± 0.1	7.4 ± 0.1	7.4 ± 0.1	–	NS
Bicarbonate (mmol/L)	24 ± 0.4	22.7 ± 2.8	21.7 ± 4.1	–	NS

	Pregnant COVID-19 patients			Pregnant healthy controls	Significance
	First trimester (n = 45)	Second trimester (n = 120)	Third trimester (n = 280)	Third trimester (n = 149)	Significance
Intrahepatic cholestasis of pregnancy, n (%)	2 (4.4%)^b	7 (5.8%)^b	2 (0.7%)^a	1 (0.7%)^a	P = 0.003
Preeclampsia, n (%)	9 (20%)^b	19 (15.8%)^b	34 (12.1%)^b	4 (2.7%)^a	P = 0.001
Preterm birth, n (%)	4 (8.9%)^a	23 (19.2%)^b	45 (16.1%)^b	13 (8.7%)^a	P = 0.048
PPROM, n (%)	0 (0 %)^a	11 (9.2%)^b	16 (5.7%)^b	2 (1.3%)^a	P = 0.009
Stillbirth, n (%)	0 (0 %)	4 (3.3%)	4 (1.4%)	4 (2.7%)	NS
Placental abruption, n (%)	0 (0%)	4 (3.3%)^a	19 (6.8%)^b	2 (1.3%)^a	P = 0.02
Oligohydramnios, n (%)	4 (8.9%)^a	12 (10%)^a	17 (6.1%)^b	0 (0%)	P = 0.002
IUGR, n (%)	5 (11.1%)^b	16 (13.3%)^b	20 (7.1%)^a	2 (1.3%)^a	P = 0.002
Length of hospitalization (days)	4 (1–13)^c	6 (1–45)^b	5 (1–45)^b	2 (1–8)^a	P = 0.001
Time from onset of symptoms to hospitalization (days)	2 (1–10)	2 (1–10)	2 (1–10)	–	NS
Disease severity, n (%)				–	NS
Mild	33 (73.3%)	79 (65.8%)	207 (73.9%)
Moderate	12 (26.7%)	30 (25%)	55 (19.6%)
Severe	0 (0%)	10 (8.3%)	15 (5.3%)
Critical	0 (0%)	1 (0.8%)	3 (1.2%)
Need for oxygen, n (%)				–	NS
No	27 (60%)	51 (42.5%)	158 (56.4%)
Non-invasive	18 (40%)	63 (52.5%)	111 (39.6%)
Mechanical ventilation	0 (0%)	6 (5%)	11 (4%)
Treatment, n (%)				–	P = 0.03
No drugs	28 (62.2%)^a	49 (40.8%)^b	158 (56%)^a
Steroids	3 (6.7%)	15 (12.5%)	28 (10.1%)
Chloroquine	1 (2.2%)	4 (3.3%)	20 (7.2%)
Antiviral drugs	10 (22.2%)^a	40 (33.3%)^b	58 (20.9%)^a
Steroids plus antiviral drugs	3 (6.7%)	12 (10%)	16 (5.8%)
CT imaging, n (%)				–	P = 0.003
No CT imaging	44 (97.8%)^a	103 (85.8%)^b	212 (75.7%)^b
No diagnosis of pneumonia on CT	0 (0%)	1 (0.8%)	12 (4.2%)
Diagnosis of pneumonia on CT	1 (2.2%)^a	16 (13.3%)^b	56 (20.1%)^b
Admission to the ICU, n (%)	0 (0%)	8 (6.7%)	18 (6.5%)	–	NS
Admission to the ICU in terms of hospitalization (days)	None	2 (1–3)	3 (1–8)	–	NS
Length of stay in the ICU (days)	None	6 (2–43)	6 (1–30)	–	NS
Mortality, n (%)	0 (0%)	2 (1.7%)	3 (1.1%)	–	NS
Birth weight (g)	2700 (2645–3030)	3110 (670–3950)	3121 (1578–4248)	3227 (1438–4410)	NS
Apgar score					NS
At 1 minute	9 (8–9)	9 (5–9)	9 (1–9)	9 (5–9)
At 5 minutes	10 (9–10)	10 (8–10)	10 (3–10)	10 (6–10)
Cord blood pH	7.4 (7.32–7.41)	7.32 (7.25–7.43)	7.35 (7.15–7.56)	7.35 (7.1–7.57)	NS
Need for NICU admission, n (%)	4 (8.9%)^a	20 (16.7%)^a	113 (40.4%)^b	46 (30.9%)^b	P = 0.001

Associação Paulista de Medicina - APM APM / Publicações Científicas, Av. Brigadeiro Luís Antonio, 278 - 7º and., 01318-901 São Paulo SP - Brazil, Tel.: +55 11 3188-4310 / 3188-4311, Fax: +55 11 3188-4255 - São Paulo - SP - Brazil
E-mail: revistas@apm.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence: Filiz Yarsilikal Guleroglu Department of Obstetrics and Gynecology, Haseki Training and Research Hospital, Health Sciences University Sultangazi, Istanbul, Turkey Tel. 905309682476 E-mail: filizyarsilikal@gmail.com