Characteristics and Outcomes of COVID-19 in Reproductive-Aged Pregnant and Non-Pregnant Women in Osaka, Japan

A Multicentric Study on Adverse COVID-19 Outcomes Among Pregnant and Nonpregnant Women in Multidisciplinary Hospitals of Kazakhstan

Background and Objectives: The study aimed at identification and analysis of adverse COVID-19 outcomes (admission to intensive care units due to COVID-19, acute respiratory distress syndrome, mechanical ventilation, and death) among hospitalized pregnant and nonpregnant women, which are critical for informed decision-making in obstetric diagnostics and healthcare. Materials and Methods: This was a retrospective observational study conducted on a series of inpatient pregnant women comparatively followed up with nonpregnant women hospitalized between 15 July 2020 to 20 January 2022 across multidisciplinary hospitals in three cities of Kazakhstan. Following group matching with propensity score for COVID-19 disease severity, residence status, and age, the study ultimately included 156 participants, of whom 50% were pregnant, from an initial sample of 314 female inpatients diagnosed with COVID-19. All findings were considered statistically significant at a p-value < 0.05. Results: Laboratory investigations revealed significantly elevated levels of erythrocyte sedimentation rate, creatinine, neutrophils, platelet count, alanine aminotransferase, aspartate aminotransferase, lymphocyte count, and C-reactive protein in pregnant inpatients compared to nonpregnant inpatients. Furthermore, pregnant women exhibited significantly higher levels of D-dimer (2402.97 ng/mL vs. 793.91 ng/mL) and procalcitonin (0.398 ng/mL vs. 0.134 ng/mL) compared to their nonpregnant counterparts. Overall, 16.88% of the pregnant women were admitted to the intensive care unit, whereas among the nonpregnant women, only 2.6% were hospitalized. The most lethal outcomes (8.3%) occurred among pregnant women, while for nonpregnant women, there were two cases (1.3%). Conclusions: Pregnant women diagnosed with COVID-19 may exhibit more severe clinical symptoms and encounter more adverse outcomes compared to their nonpregnant counterparts. Future research should incorporate larger matched samples to comprehensively explore the association between additional factors and clinical conditions.

Impacts of pregnancy and menopause on COVID-19 severity: a systematic review and meta-analysis of 4.6 million women

BACKGROUND

Corona Virus Disease 2019 (COVID-19) pandemic is still a public health emergency of international concern. However, whether pregnancy and menopause impact the severity of COVID-19 remain unclear.

AIM

This study is performed to investigate the truth.

DESIGN

Study appraisal and synthesis follows PRISMA guideline. Meta-analysis is performed in random-effects model.

METHODS

PubMed, Embase, Cochrane database, Central, CINAHL, ClinicalTrials.gov, WHO COVID-19 database and WHO-ICTRP are searched until 28 March 2023.

RESULTS

In total, 57 studies (4 640 275 COVID-19 women) were analyzed. Pregnant women were at a lower risk of severe COVID-19, intensive care unit (ICU) admission and disease mortality compared to those nonpregnant women with comparable comorbidities. In contrast, pregnant women with more prepregnancy comorbidities were at a higher risk of severe COVID-19, ICU admission and invasive mechanical ventilation (IMV). In addition, pregnant women with pregnancy complications had a significantly increased risk of severe COVID-19 and ICU admission. Menopause increased COVID-19 severity, IMV requirement and disease mortality. Hormone replacement therapy inhibited COVID-19 severity in postmenopausal women. Premenopausal and postmenopausal women had a lower chance of severe illness than age-matched men. The impact of pregnancy on COVID-19 severity was significant in Americans and Caucasians, whereas the effect of menopause on COVID-19 severity was only significant in Chinese.

CONCLUSIONS

Pregnancy and menopause are protective and risk factors for severe COVID-19, respectively. The protective role of pregnancy on COVID-19 is minimal and could be counteracted or masked by prepregnancy or pregnancy comorbidities. The administration of estrogen and progesterone may prevent severe COVID-19.

Descriptive epidemiology of COVID-19 in Japan 2020: insights from a multihospital database

BACKGROUND

Epidemiological data are essential for developing strategies against the current coronavirus disease 2019 (COVID-19) pandemic. Data on COVID-19 epidemiology in Japan are limited owing to a focus on specific regions and patient groups, particularly in the early phase of the pandemic.

METHODS

We investigated COVID-19 epidemiology in Japan in 2020 using a large nationwide multihospital database containing insurance claim records and medical records. Inclusion criteria were inpatient and outpatient referrals for COVID-19 in 2020. We analyzed demographic data, comorbidities, drug use, severe COVID-19 risk, and clinical course of hospitalized patients (including death).

RESULTS

We identified 11,868 COVID-19 cases from 56 institutions: 6,440 outpatients and 5,428 inpatients. Of the patients, 53.2% had comorbid conditions, the most common of which was tumor (22.1%), and 56.4% were classed as having a high risk of COVID-19. Pharmacological management patterns were generally consistent between the first and second half of 2020, except for glucocorticoid use. The use of unauthorized medications (hydroxychloroquine, ivermectin, and favipiravir) was infrequent. For hospitalized patients, the median length of stay was 10 days, and 2.4% of patients were admitted to intensive care units. Post-COVID-19 all-cause mortality, all-cause 30-day mortality, and in-hospital deaths were recorded for 7.9%, 5.4%, and 4.6% of patients, respectively. Patients with high-risk conditions had a lower survival probability.

CONCLUSIONS

This descriptive study of COVID-19 in 2020 identified differences in care across outpatient and inpatient settings and changes in care delivery as the pandemic progressed. These findings could inform strategies for future infectious disease pandemics.