Risk factors for obstetric and perinatal complications after COVID-19
Keywords:pregnancy, COVID-19, obstetric and perinatal complications, risk factors
Purpose - to identify risk factors for obstetric and perinatal complications after COVID-19.
Materials and methods. 21 patients with severe course of COVID-19 (the Group 1) and 126 pregnant women with moderate severity of the disease - the Group 2 were comprehensively examined. The odds ratio (OR) was calculated with a 95% confidence interval (CI), significance level - p<0.05.
Results. A high level of inflammation markers demonstrated the highest OR values: the 1st, the 3rd, the 5th place - increased procalcitonin (OR=48.4; 95% CI: 13.5-173.0), interleukin-6 (OR=39.1; 95% CI: 4.3-355.8), C-reactive protein (OR=8.5; 95% CI: 2.6-27.8), which in SARS-CoV-2 indicate a severe course of the disease. The indicator “difficulty of breathing” (OR=8.5; 95% CI: 2.6-27.8), which clearly reflects the severity of the disease in coronavirus disease, was in the 2nd place. The 4th in the indicator “increase in D-dimer to 10,000 ng/ml and above” (OR=13.2; 95% CI: 1.1-152.3), which indicates a high risk of thrombosis. The level of OR is also significantly high in the indicators “III-IV degree obesity” (OR=8.0; 95% CI: 2.3-28.0), “increased aspartate aminotransferase” (OR=6.9; 95% CI 2.4-20.1), “vitamin D deficiency” (OR=5.0; 95% CI: 1.4-17.7).
Conclusions. The pathogenetic mechanisms of the development of perinatal complications in SARS-CoV-2 include: a high level of inflammatory processes mediated by the severity of the course of the disease, a violation of the immune system (hyperreaction - “cytokine storm”), prothrombotic changes in the hemostasis system, vitamin D deficiency, obesity and an increase in transaminases.
The study was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was adopted by the Local Ethics Committee of the institution specified in the work. Informed consent from women was obtained for the study.
No conflict of interests was declared by the authors.
Algarroba GN, Rekawek P, Vahanian SA, Khullar P, Palaia T, Peltier MR et al. (2020). Visualization of severe acute respiratory syndrome coronavirus 2 invading the human placenta using electron microscopy. American Journal of Obstetrics & Gynecology. 223 (2): 275-278. https://doi.org/10.1016/j.ajog.2020.05.023; PMid:32405074 PMCid:PMC7219376
Allotey J, Fernandez S, Bonet M, Stallings E, Yap M, Kew T et al. (2020). Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 370: m3320. https://doi.org/10.1136/bmj.m3320; PMid:32873575 PMCid:PMC7459193
Arakaki T, Hasegawa J, Sekizawa A, Ikeda T, Ishiwata I, Kinoshita K et al. (2022). Risk factors for severe disease and impact of severity on pregnant women with COVID-19: a case-control study based on data from a nationwide survey of maternity services in Japan. BMJ open. 12 (12): e068575. https://doi.org/10.1136/bmjopen-2022-068575; PMid:36585128 PMCid:PMC9808759
Arakaki T, Hasegawa J, Sekizawa A, Ikeda T, Ishiwata I, Kinoshita K. (2021). Clinical characteristics of pregnant women with COVID-19 in Japan: a nationwide questionnaire survey. BMC Pregnancy and Childbirth. 21 (1): 1-8. https://doi.org/10.1186/s12884-021-04113-9; PMid:34536994 PMCid:PMC8449693
Badr DA, Mattern J, Carlin A, Cordier AG, Maillart E, El Hachem L et al. (2020). Are clinical outcomes worse for pregnant women at ≥20 weeks' gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching. American journal of obstetrics and gynecology. 223 (5): 764-768. https://doi.org/10.1016/j.ajog.2020.07.045; PMid:32730899 PMCid:PMC7384420
Baud D. (2020). Calculation Error in Study of Pregnant Women With COVID-19 and Maternal and Neonatal Outcomes in Spain. JAMA. 324 (3): 304-305. https://doi.org/10.1001/jama.2020.12267; PMid:32692383
Collin J, Byström E, Carnahan A, Ahrne M. (2020). Public Health Agency of Sweden's Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden. Acta obstetricia et gynecologica Scandinavica. 99 (7): 819-822. https://doi.org/10.1111/aogs.13901; PMid:32386441 PMCid:PMC7273089
Di Mascio D, Sen C, Saccone G et al. (2020). Risk factors associated with adverse fetal outcomes in pregnancies affected by coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. J Perinat Med. 48: 950-958. https://doi.org/10.1515/jpm-2020-0355; PMid:32975205
Kaminskyi V, Tkachenko R, Kaminskyi A, Zhdanovych O, Vorobei L, Kolomiichenko T et al. (2021). Therapeutic opportunities for improving the course of coronavirus disease and reducing the frequency of gestional complications. Reproductive endocrinology. 62: 8-13. https://doi.org/10.18370/2309-4117.2021.62.8-13
Kaminskyi V, Vorobei L, Zhdanovych O, Korniienko S, Kolomiichenko T, Fastovets О. (2022). Clinical and genetic determinants of severe course of COVID-19 in pregnant women. Reproductive endocrinology. 65: 38-43. https://doi.org/10.18370/2309-4117.2022.65.38-43
Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C et al. (2020). Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 369: m2107. https://doi.org/10.1136/bmj.m2107; PMid:32513659 PMCid:PMC7277610
Mappa I, Distefano FA, Rizzo G. (2020). Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: a prospectic observational study. Journal of Perinatal Medicine. 48 (6): 545-550. https://doi.org/10.1515/jpm-2020-0182; PMid:32598320
Martínez-Perez O, Vouga M, Melguizo SC et al. (2020). Association Between Mode of Delivery Among Pregnant Women With COVID-19 and Maternal and Neonatal Outcomes in Spain. JAMA. 324 (3): 296-299. https://doi.org/10.1001/jama.2020.10125; PMid:32511673 PMCid:PMC7281380
Monteil V, Kwon H, Prado P, Hagelkrüys A, Wimmer RA, Stahl M et al. (2020). Inhibition of SARS-CoV-2 infections in engineered human tissues using clinical-grade soluble human ACE2. Cell. 181 (4): 905-913. https://doi.org/10.1016/j.cell.2020.04.004; PMid:32333836 PMCid:PMC7181998
Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y et al. (2020). Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 369: m1966. https://doi.org/10.1136/bmj.m1966; PMid:32444366 PMCid:PMC7243801
Pierce-Williams RA, Burd J, Felder L, Khoury R, Bernstein PS, Avila K et al. (2020). Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies: a United States cohort study. American journal of obstetrics & gynecology MFM. 2 (3): 100134. https://doi.org/10.1016/j.ajogmf.2020.100134; PMid:32391519 PMCid:PMC7205698
Roberts JM, Taylor RN, Musci TJ, Rodgers GM, Hubel CA, McLaughlin MK. (1990). Preeclampsia: An endothelial cell disorder. International Journal of Gynecology & Obstetrics. 32 (3): 299-299. https://doi.org/10.1016/0020-7292(90)90402-7
Sisman J, Jaleel MA, Moreno W, Rajaram V, Collins RRJ, Savani RC et al. (2020). Intrauterine Transmission of SARS-COV-2 Infection in a Preterm Infant. The Pediatric infectious disease journal. 39 (9): e265-e267. https://doi.org/10.1097/INF.0000000000002815; PMid:32658097
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS et al. (2020). Endothelial cell infection and endotheliitis in COVID-19. The Lancet. 395 (10234): 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5; PMid:32325026
Vivanti AJ, Mattern J, Vauloup-Fellous C, Jani J, Rigonnot L, El Hachem L et al. (2020). Retrospective description of pregnant women infected with severe acute respiratory syndrome coronavirus 2, France. Emerging Infectious Diseases. 26 (9): 2069. https://doi.org/10.3201/eid2609.202144; PMid:32633712 PMCid:PMC7454086
Vouga M, Favre G, Martinez-Perez O, Pomar L, Acebal LF, Abascal-Saiz A et al. (2021). Maternal outcomes and risk factors for COVID-19 severity among pregnant women. Scientific reports. 11 (1): 13898. https://doi.org/10.1038/s41598-021-92357-y; PMid:34230507 PMCid:PMC8260739
Zeng L, Xiao T, Zhou W. (2020). Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From the Mother to the Infant-Reply. JAMA pediatrics. 174 (10): 1008-1009. https://doi.org/10.1001/jamapediatrics.2020.2156; PMid:32687556
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 395 (10229): 1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3; PMid:32171076
Copyright (c) 2023 Ukrainian Journal Health of Woman
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal UKRAINIAN JOURNAL «HEALTH OF WOMAN» is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal UKRAINIAN JOURNAL «HEALTH OF WOMAN» when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.