This article presents current data about the perinatal effects of prolonged stress on pregnant women during the COVID-19 pandemic. The peculiarities of the postcovid syndrome in general and in the female population in particular are determined. Peculiarities of pregnancy and perinatal consequences after coronavirus infection, as well as manifestations of postcovid syndrome in this group of women are considered. There is an increase in the frequency of anxiety and depressive disorders in pregnant women and women in labor during the pandemic and their impact on the fetal brain and its subsequent mental state.The specific effects of long-term stress have been identified: it has become known that pregnant women during the pandemic are exposed to prolonged stress, which affects the course of gestation. Among the most common conditions under the stressors impact (illness of the woman or her close environment, loss of relatives and acquaintances, existence in limited physical and communication space, deterioration of financial condition, etc.) should be noted the increasing risk of abortion up to 17–28%; exacerbation during pregnancy of chronic somatic diseases (hypertension, diabetes, metabolic syndrome, chronic pancreatitis, neurological and mental illness, etc.); increase in body mass index on the eve of pregnancy and pathological weight gain; strengthening of nutritional deficiencies (folate, iron, magnesium, vitamin D, iodine, etc.).The timely detection and possible ways to correct these conditions are considered, given the transition to remote methods of monitoring pregnant women in quarantine. Organizational , treatment and prevention measures with inclusion of micronized progesterone, magnesium citrate, folate (metafolin) and vitamin D, as well as methods of psychoprophylaxis and psychotherapy are also proposed. Magnesium is of particular importance in pregnant women, it has neuroprotective and metabolic properties, in particular when used as a citrate in soluble form. The main directions of rehabilitation measures for pregnant women and women in labor after COVID-19 have been formulated.

The objective: to determine the peculiarities of hormonal support, liver enzymatic function and the state of the fetal-placental complex (FPC) in unvaccinated women with fetal growth retardation (FGR) and placental dysfunction (PD) who was ill with the coronavirus disease during the current pregnancy, on the background of the proposed correction scheme of the disorders and evaluation of its effectiveness.Materials and methods. The study included 22 pregnant women with FGR and PD who were being treated and delivered in the Department of Pregnancy and Childbirth Pathology of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova National Academy of Sciences of Ukraine» in 2021–2022 and suffered a coronavirus disease during the current pregnancy. All pregnant women had a general clinical examination and the following parameters were additionally determined: the level of placental lactogen (PL) in blood serum, indicators of liver enzyme activity (alanine aminotransferase – ALT, aspartate aminotransferase – AST, gamma-glutamyl transpeptidase – GHTP), the level of estriol in urine (after the 22d week of pregnancy). The examination was carried out before the start of treatment and preventive measures and 12–14 days after a 10-day course of therapy with simultaneous ultrasound (US) monitoring of the condition of the FPC. In the case of diagnosis of FGR and PD, a course of therapy was carried out, which included daily consecutive intravenous infusions of a balanced crystalloid infusion preparation with lactate and sorbitol in the amount of 200 ml and a solution of levocarnitine and arginine hydrochloride in the amount of 100 ml for 10 days, followed by ultrasound control of the condition of the fetus and FPC. The evaluation of the effectiveness of the treatment was carried out based on a combination of clinical, laboratory and instrumental indicators after 10 days of therapy. Results. All pregnant women had a moderate or mild course of the coronavirus disease at different terms of the current pregnancy. There were 9 (40.9 %) women who were infected with SARS-CoV-2 in the early terms of pregnancy (up to 12 weeks), and they were diagnosed the 2nd and 2nd-3rd degrees of FGR.The majority of pregnant women had gestational complications. Before treatment, 10 (45.5 %) women had oligohydramnios. FGR was diagnosed in 14 (63.6 %) pregnant women, among them: in 3 (13.6 %) persons – fetal growth retardation of the 2nd-3rd degree, in 6 (27.3 %) – of the 2nd degree, in 5 (22.7 %) – 1st degree. The analysis of laboratory indicators demonstrated the increase in the levels of ALT, AST and GHTP, and a decrease in the levels of estriol in urine. After the proposed course of treatment, oligohydramnios was found only in 2 (9.1 %) women. The average amniotic index before treatment was 10.1, after treatment – 15.3. 4 (18.2 %) women were diagnosed FGR after the treatment. As a result of the treatment, the improvement of all determined laboratory parameters and perinatal consequences were determined. Conclusions. The proposed scheme for correcting the identified disorders with the inclusion of balanced crystalloid infusion preparation with lactate and sorbitol and balanced crystalloid infusion preparation with lactate and sorbitol drugs made possible to improve microcirculation, metabolic processes, and to normalize the consequences of postcovid endotheliitis in the vascular system of pregnant women in general and in the FPC, in particular. This was manifested in the improvement of clinical, laboratory and instrumental indicators of conducted studies and had a positive effect on perinatal results.

This article presents current data on the impact of COVID-19 (SARS-CoV-2) on pregnancy and perinatal consequences. The working theories of the pathogenesis of obstetric and fetal complications due to infection during pregnancy, already proven to date, are considered.Symptoms of COVID-19 disease, the risk of their development, and frequency of severe disease in non-pregnant and pregnant women of reproductive age do not differ significantly. However, there are powerful studies that have shown that this infection in pregnant women leads to a high probability of a dramatically severe and fulminant course. Pregnant women with SARS-CoV-2 infection have an increased risk of preeclampsia, incl. severe, hemolysis, thrombocytopenia and increased levels of liver enzymes compared with pregnant women without infection. Women who have COVID-19 are twice as likely to have preterm rupture of the membranes and three times as likely to have a preterm birth compared to the not infected pregnant women.Vertical transmission of the virus from mother to fetus is likely, but data are insufficient to be certain. There is also insufficient evidence of an increased miscarriage rate and teratogenic effects of the COVID-19 virus. However, antenatal fetal death is statistically significantly more common in infected pregnant women than in uninfected pregnant women. Morphological and functional disorders in the chorion/placenta are the main pathogenetic factor in the development of preeclampsia, intrauterine growth retardation, antenatal fetal death and impaired state of the fetus and children born by women with COVID-19.Many studies report that mothers with confirmed COVID-19 infection has asymptomatic babies. At the same time, some studies indicate adverse complications in newborns from infected mothers. The most common neonatal disorders in babies from pregnant women with COVID-19 are tachypnea, hyperthermia, and gastrointestinal disorders, in particular vomiting and flatulence.

The risk of fetal intrauterine growth retardation (IUGR) is increased in women who have experienced acute infections, as well as in pregnant women with gynecological pathology and endocrine diseases. A woman’s lack of nutrition also makes a negative contribution to the development of IUGR. The frequency of IUGR in the population is very variable and depends on a number of reasons. In practically healthy pregnant women, IUGR is registered in 3–5% of cases, in case of complicated obstetric and gynecological diagnosis and complicated pregnancy – in 10–25%. Morphofunctional disorders in the chorion/placenta in pregnant women with COVID-19 on the background of post-covid endotheliitis are the main pathogenetic factor in the development of preeclampsia, ectopic pregnancy, antenatal fetal death, and impaired condition of the fetus and newborns. Sufficient saturation of the pregnant woman’s body with the nitric oxide donor L-arginine and L-carnitine (main cofactor of fatty acid metabolism in cells) with the improvement of microcirculation and the correction of hypovolemic disorders in the fetoplacental complex can be considered one of the real ways to prevent IUGR in women in the post-covid period.A review of the scientific literature on pathogenesis, diagnosis, impact on the life and health of a newborn with IUGR in women after COVID-19, as well as the possibilities of medical correction of placental dysfunction during pregnancy was performed.This analysis and our own clinical experience allow us to state the fact that after a coronavirus infection during pregnancy, one of the frequent and threatening for the further development of the child is the formation of placental dysfunction and IUGR. One of the ways to prevent these conditions is to saturate the woman’s body with the nitric oxide donor L-arginine from the stage of pre-gravid preparation, which will provide the opportunity for adequate angiogenesis and development of the embryo/fetus. In the case of additional risk factors, such as coronavirus disease, complex therapy blood (Rheosorbilact), in combination with a nitric oxide donor and L-carnitine as an endothelium-protective agent (Tivor-L).