Coronavirus Disease 2019 in Pregnant and Non-Pregnant Women: A Retrospective Study
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a global health crisis affecting individuals of all ages and genders. Pregnant women, in particular, face unique challenges due to the physiological changes associated with pregnancy, which may influence the progression and prognosis of infectious diseases. This study aims to explore the impact of pregnancy on the progression of COVID-19 by retrospectively analyzing clinical data from women of childbearing age admitted to Tongji Hospital in Wuhan, China, during the early stages of the pandemic.
Study Design and Population
This retrospective, single-center cohort study included women aged 15 to 45 years with confirmed COVID-19 pneumonia who were admitted to Tongji Hospital between January 19 and April 1, 2020. The study population was divided into two groups: a pregnancy group and a non-pregnancy group, based on whether the patients were pregnant at the time of admission. The pregnancy group was further categorized into a continued pregnancy group and a terminated pregnancy group, depending on whether the pregnancy was terminated during hospitalization. Ethical approval was obtained from the Ethics Committee of Tongji Hospital, and the requirement for informed consent was waived.
Data Collection and Analysis
The study collected and reviewed a comprehensive set of clinical data, including demographics, medical history, pre-admission information, symptoms at disease onset, laboratory findings, chest computed tomography (CT) scans, SARS-CoV-2 RT-PCR results, treatments, complications, and prognosis. Laboratory findings within seven days after pregnancy termination were compared with those at admission. The severity of COVID-19 and hospital discharge standards were defined according to the New Coronavirus Pneumonia Prevention and Control Program (5th edition).
Clinical Characteristics and Laboratory Findings
The study included 285 women of childbearing age with COVID-19, comprising 30 pregnant women and 255 non-pregnant women. The median ages of the pregnant and non-pregnant groups were 31 and 36 years, respectively. Fever, cough, and sputum production were the most common initial symptoms in both groups. Notably, 23.3% of pregnant women presented with diarrhea at disease onset, compared to 11.8% of non-pregnant women.
Laboratory findings revealed distinct characteristics in pregnant patients. The pregnancy group had higher leukocyte counts (8.72 x 10^9/L vs. 5.36 x 10^9/L), higher neutrophil percentages (77.55% vs. 58.90%), and lower percentages of lymphocytes (15.50% vs. 29.60%) and monocytes (6.15% vs. 8.10%) compared to the non-pregnancy group. Additionally, pregnant women exhibited higher levels of D-dimer (1.31 mg/mL vs. 0.32 mg/mL), high-sensitivity C-reactive protein (16.65 mg/L vs. 2.50 mg/L), erythrocyte sedimentation rate (29.00 mm/1 h vs. 16.00 mm/1 h), and interleukin-6 (14.50 pg/mL vs. 4.46 pg/mL).
Complications and Treatments
The pregnancy group had a lower percentage of respiratory system injury (76.7% vs. 92.5%) and a lower rate of antiviral therapy (70.0% vs. 86.7%) compared to the non-pregnancy group. However, the pregnancy group had a higher rate of oxygen support (86.7% vs. 67.1%). No deaths occurred in the pregnancy group, while seven deaths were reported in the non-pregnancy group. The median symptom-to-discharge duration was significantly shorter in the pregnancy group (24 days vs. 31 days).
Continued vs. Terminated Pregnancy
Comparisons between the continued pregnancy group (n = 8) and the terminated pregnancy group (n = 22) showed no significant differences in complications or prognosis. The median symptom-to-discharge duration was 23 days in the continued pregnancy group and 24 days in the terminated pregnancy group. Laboratory indicators, such as lymphocyte percentage, neutrophil percentage, and high-sensitivity C-reactive protein levels, showed mild changes after pregnancy termination, suggesting that the physiological and immune status of pregnancy is reversible.
Discussion
The study highlights that pregnant and non-pregnant women with COVID-19 share similar epidemiological characteristics, but pregnant patients tend to have milder clinical manifestations, shorter symptom-to-discharge durations, and specific laboratory characteristics. The findings suggest that pregnancy does not exacerbate the severity of COVID-19, and terminating a pregnancy does not significantly impact the prognosis of the disease.
The distinct laboratory findings in pregnant women, such as higher leukocyte counts and neutrophil percentages, may be attributed to the physiological and immunological changes during pregnancy rather than bacterial co-infection. The study also underscores the importance of tailored clinical management for pregnant women with COVID-19, considering their unique physiological state.
Conclusion
In summary, this retrospective study provides valuable insights into the clinical characteristics and outcomes of pregnant and non-pregnant women with COVID-19. Pregnant patients exhibited milder clinical manifestations, shorter hospital stays, and specific laboratory features, suggesting that pregnancy does not worsen the prognosis of COVID-19. Further research is needed to elucidate the underlying mechanisms and to develop targeted interventions for pregnant women with COVID-19.
doi.org/10.1097/CM9.0000000000001396
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