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Shmakov RG, Prikhodko A, Polushkina E, Shmakova E, Pyregov A, Bychenko V, Priputnevich TV, Dolgushin GO, Yarotskaya E, Pekarev O, Bolibok N, Degtyarev D, Sukhikh GT. Clinical course of novel COVID-19 infection in pregnant women. J Matern Fetal Neonatal Med 2020; 35:4431-4437. [PMID: 33249969 PMCID: PMC7711745 DOI: 10.1080/14767058.2020.1850683] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Evaluation of clinical course of COVID-19 during pregnancy and maternal and perinatal outcomes of this pregnancy. METHODS 66 women with polymerase chain reaction (PCR) - confirmed SARS-CoV-2 and their 42 neonates were included in the prospective observational study. Demographic, epidemiological, clinical, laboratory and instrumental data of pregnancy, delivery, postpartum period, including pharmacotherapy and neonatal outcomes were analyzed. RESULTS 15 (22.7%) women were asymptomatic, 25 (38%) had mild disease, while moderate and severe forms were detected in 20 (30.2%) and 6 (9.1%) cases, respectively. Additional oxygenation was required in 6 (9%) cases: 4 (6%) received CPAP therapy and 2 (3%) - mechanical ventilation. Main clinical symptoms were cough (51.5%), anosmia (34.9%), and hyperthermia (33.3%). Laboratory changes included increased levels of lactate dehydrogenase (LDH), creatinine, d-dimer, and C-reactive protein (CRP), anemia, and leukopenia. All pregnant women received low molecular weight heparin and interferon alfa-2b according to the National clinical recommendations. Antimicrobial drugs included Amoxicillin/Clavulanic acid (46%) and macrolides (28%) or carbapenems in severe cases of disease. Spontaneous abortion was reported in 6.1% of cases. Eight preterm (19%) and 34 term deliveries (81%) occurred. The mean weight of neonates was (3283 ± 477) g, 1- and 5-min Apgar score was (7.8 ± 0.6) and (8.7 ± 0.5), respectively. No cases of neonatal COVID-19 infection were reported. CONCLUSIONS Mostly, the manifestations of COVID-19 were mild. However, 9% of cases were severe, and could contribute to preterm delivery or maternal morbidity. Main predictors of severe COVID-19 course in pregnant women were a decrease in the levels of erythrocytes and lymphocytes and increase in the levels of alanine aminotransferase and CRP. Elimination of the virus in pregnant women required more time due to altered immunity. No evidence of vertical transmission during pregnancy and delivery was found. However, the possibility of this cannot be excluded.
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Affiliation(s)
- Roman G Shmakov
- Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Andrey Prikhodko
- Department of Maternity, Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Evgeniya Polushkina
- Department of Maternity, Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Elena Shmakova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Aleksey Pyregov
- Institute of Anesthesiology and Intensive Care National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Vladimir Bychenko
- Department of Radiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Tatyana V Priputnevich
- Department of Microbiology and Clinical Pharmacology and Epidemiology National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Grigory O Dolgushin
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Ekaterina Yarotskaya
- Department of International Cooperation National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Oleg Pekarev
- Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Nikolai Bolibok
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Dmitriy Degtyarev
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
| | - Gennady T Sukhikh
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia
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