ABSTRACT
Objectives: to determine the clinical and genetic determinants of the severe course of COVID-19 in pregnant women in order to identify a risk group and search for therapeutic targets. Materials and methods. 21 patients (group 1) with a severe course of COVID-19 who required intensive care in the Anesthesiology and Intensive Care Unit (AICU) and 126 pregnant women with moderate severity treated in the Infectious-Obstetrics Unit (IOCU) were examined (group 2). Genomic DNA for molecular genetic analysis of gene variants ACE (I/D, rs 4340), PGR (Alu insertion), ESR1 (A351G, rs 9340799), PON1 (C108T, rs 705379) was isolated from the peripheral blood of patients using a commercial Quick-DNA Miniprep Plus Kit (Zymo Research, USA). Variants of ACE and PGR genes were determined using allele-specific polymerase chain reaction;polymerase chain reaction followed by restriction analysis was used to determine ESR1 and PON1 gene variants. Results. Severe course of COVID-19 is observed in 18.2% of pregnant women, critical condition in 7.5%. A third of AICU patients are over 35 years old. Somatic anamnesis was complicated in 23.8% of patients;thyroid gland pathology (14.3%) and varicose disease (19.0%) prevailed. A significant factor in the severe course of COVID-19 is obesity of the III-IV degree in 28.5% cases. The severe course of the disease was associated with complications of pregnancy (oligohydramnios - 52.4%, ahydramnios - 14.3%, fetal growth retardation syndrome - 33.3%, circulatory disorders - 57.1%, fetal distress - 47.6%, preeclampsia - 14.3%), labor (caesarean section - 57.1%, premature birth - 28.6%), disorders of newborns state (asphyxia - 35.6%). These patients are characterized by anemia (58.7%), thrombocytopenia (23.8%), leukocytosis (33.3%), lymphopenia (90.5%), a shift of the leukocyte formula to the left (an increase of rod-nuclear leukocytes by 85.7%). There were significantly increased levels of transaminases: alanine aminotransferase in 47.6%, aspartate aminotransferase in 76.2%. Prothrombotic changes are indicated by a decrease in prothrombin time and activated partial thromboplastin time in 66.7%, which is confirmed by an increase in D-dimer in 85.7% of patients up to the maximum 15,000 ng/ml in 9.5% of women. An increase in inflammation markers (C-reactive protein and interleukin-6 in all AICU patients, procalcitonin in 66.7%) is a reflection of the destructive effect of inflammatory processes. The genetic determinants of the severe course of COVID-19 in pregnant women can be the ID genotype of the ACE I/D rs4340 polymorphism (81.0%), the T2/T2 PROGINS genotype (19.0%), the ESR1 A351G rs9340799 GG genotype (28.5%). Conclusions. The use of separate clinical, laboratory and genetic indicators in pregnant women with COVID-19 will contribute to the selection of the risk group of a coronavirus severe course and the determination of targets of therapeutic impact.Copyright © 2022 Trylyst. All rights reserved.
ABSTRACT
SARS-CoV-2 infection during pregnancy can potentially affect the health of the fetus and newborn through various mechanisms: increased rates of preterm birth, placental infection that can disrupt placental-fetal exchange, and through transmission of the virus in utero, during childbirth or after birth. Purpose - to determine the characteristics of the state of newborns and the neonatal period, depending on the severity of the mother's illness with COVID-19. Materials and methods. Under observation were 14 newborns (group 1), whose mothers were ill with severe COVID-19 and needed intensive care in the department of anesthesiology and intensive care, and 46 children from mothers with moderate COVID-19, who were treated in the infectious diseases and obstetrics department (group 2). Results. In mothers with COVID-19, especially when the disease is severe, the fetus is exposed to direct and indirect negative effects of a viral infection, which is confirmed by signs of placental insufficiency in the vast majority of pregnant women (71.4%) and its clinical manifestations in the form of distress and fetal growth retardation (50.0% and 35.7%, respectively), placental dysfunction was confirmed pathohistologically. Dangerous for the fetus are oligohydramnios in 50.0% of women up to ahydramnios (14.3%), preeclampsia (14.3%), caesarean section (57.1%), premature rupture of fruit membranes (14.3%) and preterm birth (28.0%). 42.9% of children are born in a state of asphyxia, with 14.3% having severe asphyxia, 35.7% of children were born weighing less than 2500 g. A positive test for COVID-19 was observed in 7.1% of newborns. 21.4% of children were diagnosed with pneumonia, 35.7% had respiratory distress syndrome. Children from mothers with COVID-19 have a high incidence of maladaptation syndromes (64.3%). In addition to RDS, there was a high incidence of neurological disorders (57.1%) in the form of a syndrome of depression, gastrointestinal syndrome (50.0%), thermoregulation disorders (42.9%), and 35.7% had hypoglycemic and hemorrhagic syndromes. Necrotizing enterocolitis was diagnosed in children with pneumonia on the 5-7th day of life. Conclusions. Disorders in children from mothers with COVID-19 at birth and a high incidence of maladjustment syndromes, the risk of health and cognitive impairment in the future necessitate further scientific research, active follow-up of this new cohort of children and the development of prevention and rehabilitation measures. © 2022 The authors.
ABSTRACT
Research objective: to study the clinical efficacy of the proposed treatment complex in pregnant women with coronavirus disease (COVID-19). Materials and methods. 60 pregnant women with a moderate COVID-19 who were treated at the Kyiv City Center for Reproductive and Perinatal Medicine were examined and selected to assess the effectiveness of the proposed treatment. Pregnant women were divided into 2 clinical groups: the main group (n = 30) were prescribed treatment complex with progestin, the comparison group consisted of 30 pregnant women with COVID-19, who did not differ in age, sex, body mass index and received only standard drug therapy. Given the immunomodulatory effect, micronized progesterone was administered orally 200 mg three times a day immediately after hospitalization for 2 weeks, regardless of gestational age. Clinical manifestations, laboratory and instrumental indicators, duration of oxygen therapy and respiratory support, duration of hospital stay and intensive care were analyzed to assess the treatment complex. Results. Therapeutic complex with progesterone helps to reduce the severity of respiratory disorders in pregnant women with COVID-19, the general condition of pregnant women improves faster and inflammatory changes in the lungs regress. The positive dynamics of pulse oximetry indicators was noted. The frequency of the additional methods of respiratory support and transfer to the intensive care unit were lower, and a more rapid normalization of laboratory parameters was noted. Incidence of gestational complications (threats of pregnancy termination, placental insufficiency, fetal growth retardation and distress, oligohydramnios, premature birth and premature rupture of membranes) was lower against the background of treatment with progesterone, children status was better at birth. The need for oxygen therapy, the length of stay in the intensive care unit and the total length of hospitalization are significantly reduced when progesterone was prescribed for pregnant women with COVID-19. Conclusions. The use of progesterone in pregnant women with coronavirus disease has a stabilizing effect, has no negative side effects which is significantly expands the scope of the proposed therapy in pregnant women at different stages of gestation. © 2021 Trylyst. All rights reserved.