Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience

Abstract

Objective The aim of this study was to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. Study Design This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. Results Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. Conclusion Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. Key Points

Complete Blood Count Peculiarities in Pregnant SARS-CoV-2-Infected Patients at Term: A Cohort Study

“…Lymphopenia may be associated with moderate or severe cases of SARS-CoV-2 infection, while our patients had only a mild form of infection and no respiratory complaints. This would be in accordance with Berry [ 34 ], who demonstrated that, in pregnant women who tested positive for SARS-CoV-2, significant laboratory findings associated with increasing disease severity included decreased hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers.…”

Comparison of the pregnancy outcomes of the patients with severe symptoms who received medical treatment for COVID-19 versus the patients with mild-moderate symptoms

“…Similar to our study, the COVID-19 disease was related to severe symptoms later in pregnancy compared to earlier weeks of gestation. [16] However, in another study it was reported that higher gestational age was protective against COVID-19 in pregnant women. [17] Fever, cough, lymphopenia and raised C-reactive protein levels are the most common characteristics of the severe COVID-19 disease.…”

Treatment of COVID-19 disease in pregnancy and breastfeeding

“…In two reports describing 18 pregnancies with COVID-19, all were infected in the third trimester [11]. Altered tests with leukopenia, anemia, C-protein reaction, procalcitonin, and ferritin were also related to the severity of the disease in pregnant women [10].…”

“…Those in the third trimester also have a higher risk of admission to intensive care units, as well as being mechanically ventilated [3]. According to a study by Berry M. et al [10], pregnant women with advanced pregnancies are at a greater risk. In two reports describing 18 pregnancies with COVID-19, all were infected in the third trimester [11].…”