Novel coronavirus infection in the third trimester of pregnancy: perinatal and maternal outcomes
- Авторлар: Malgina G.1, Dyakova M.1, Bychkova S.1, Grishkina A.1, Melkozerova O.1, Bashmakova N.1, Pepelyaeva N.1, Olkov S.1
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Мекемелер:
- Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
- Шығарылым: № 4 (2023)
- Беттер: 58-66
- Бөлім: Original Articles
- URL: https://journals.rcsi.science/0300-9092/article/view/258554
- DOI: https://doi.org/10.18565/aig.2023.58
- ID: 258554
Дәйексөз келтіру
Аннотация
Objective: To investigate the characteristic features of the course of pregnancy, labor, and perinatal outcomes in women who had novel coronavirus disease 2019 (COVID-19) in the third trimester of pregnancy and gave birth after COVID-19.
Materials and methods: The study group included 313 patients divided into subgroups 1 (n=90), 2 (n=154), and 3 (n=69) who had COVID-19 at 28–32, 32.1–36.6 and ≥37 weeks of gestation, respectively. The comparison group included 216 women who gave birth before the COVID-19 pandemic (2019). Histological examination of the placenta was performed in the study (n=87) and comparison (n=20) groups.
Results: COVID-19 at 28–32 weeks increases the risk of fetal growth restriction (relative risk (RR)=5.6; 95% CI 2.4; 13.0; p<0.001), preterm birth (RR=2.7; 95% CI 1.2; 5.8; p=0.01), placental abruption (RR=5.2; 95% CI 1.6; 16.4; p=0.002), fetal distress (RR=4.9; 95% CI 1.7; 13.6; p=0.001), and emergency caesarean section (RR=4.0; 95% CI 1.8; 9.1; p=0.001). The newborns had significantly smaller chest circumferences and lower Apgar scores. The placentas showed marked signs of maternal and fetal vascular malperfusion. COVID-19 at 32.1–36.6 weeks gestation increased the risk of uteroplacental circulation disorders (UPCD) (RR=4.3; 95% CI 1.1; 16.1; p=0.02), preterm birth (RR=2.8; 95% CI 1.4; 5.6; p<0.001), fetal distress (RR=3.9; 95% CI 1.5; 10.3; p=0.003), and emergency caesarean section (RR=3.4; 95% CI 1.6; 7.3, p=0.001). Newborns had a significantly smaller chest circumference and lower Apgar scores. COVID-19 after 37 weeks increased the risk of UPCD (RR=8.0; 95% CI 2.0; 31.9, p=0.001). Vascular abnormalities were most pronounced in the placentas of patients in group 1.
Conclusion: COVID-19 in the early and middle third trimesters is associated with the most adverse perinatal outcomes.
Негізгі сөздер
Толық мәтін
##article.viewOnOriginalSite##Авторлар туралы
Galina Malgina
Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
Email: galinamalgina@mail.ru
ORCID iD: 0000-0002-5500-6296
Dr. Med. Sci., Director
Ресей, YekaterinburgMaria Dyakova
Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
Хат алмасуға жауапты Автор.
Email: mariadakova40@mail.ru
ORCID iD: 0000-0001-7911-6783
Junior Researcher
Ресей, YekaterinburgSvetlana Bychkova
Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
Email: simomm@mail.ru
ORCID iD: 0000-0002-8892-7585
PhD, Leading Researcher
Ресей, YekaterinburgAnastasia Grishkina
Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
Email: xumukyc.ru@mail.ru
ORCID iD: 0000-0001-7433-2217
PhD, Pathologist, Department of Immunology, Clinical Microbiology, Pathomorphology and Cytodiagnosis
Ресей, YekaterinburgOksana Melkozerova
Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
Email: abolmed@mail.ru
ORCID iD: 0000-0002-4090-0578
Dr. Med. Sci., Deputy Director for Science
Ресей, YekaterinburgNadezhda Bashmakova
Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
Email: bashmakovanv@niiomm.ru
ORCID iD: 0000-0001-5746-316X
Dr. Med. Sci., Professor, Chief Researcher
Ресей, YekaterinburgNatalia Pepelyaeva
Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
Email: pepelyaevana@niiomm.ru
ORCID iD: 0000-0003-3278-2249
PhD, Chief Physician
Ресей, YekaterinburgSergey Olkov
Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation
Email: olkovss@niiomm.ru
ORCID iD: 0000-0002-6142-3707
PhD, Deputy Head of the Pediatrics Clinic
Ресей, YekaterinburgӘдебиет тізімі
- Radzinsky V.E., Milovanov A.P. Extraembryonic and amniotic structures in normal and complicated pregnancy. Moscow: MIA; 2004. 393p. (in Russian).
- Sidorova I.S., Makarov I.O. The course and management of pregnancy by trimester. Moscow: MIA; 2009. 304 p. (in Russian).
- Malgina G.B., Dyakova M.M., Bychkova S.V., Grishkina A.A., Pepelyaeva N.A., Olkov S.S., Melkozerova O.A., Bashmakova N.V., Davydenko N.B. Novel coronavirus infection in the first trimester of pregnancy: perinatal and maternal outcomes. Obstetrics and Gynecology. 2022; (12): 90-9. (in Russian). https://dx.doi.org/10.18565/aig.2022.212.
- la Cour Freiesleben N., Egerup P., Hviid K.V.R., Severinsen E.R., Kolte A.M., Westergaard D. et al. SARS-CoV-2 in first trimester pregnancy: a cohort study. Hum. Reprod. 2021; 36(1): 40-7. https://dx.doi.org/10.1093/humrep/deaa311.
- Baud D., Greub G., Favre G., Gengler C., Jaton K., Dubruc E., Pomar L. Second-trimester miscarriage in a pregnant woman with SARS-CoV-2infection. JAMA. 2020; 23(21): 2198-200. https://dx.doi.org/10.1001/jama.2020.7233.
- Turgut E., Sakcak B., Uyan Hendem D., Oluklu D., Goncu Ayhan S., Sahin D. Decreased fetal cardiac output in pregnant women with severe SARS-Cov-2 infection. Echocardiography. 2022; 39(6): 803-10. https://dx.doi.org/10.1111/echo.15367.
- Zhang L., Dong L., Ming L., Wei M., Li J., Hu R., Yang J. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during late pregnancy: a report of 18 patients from Wuhan, China. Pregnancy Childbirth. 2020; 20(1): 394. https://dx.doi.org/10.1186/s12884-020-03026-3.
- Piekos S.N., Roper R.T., Hwang Y.M., Sorensen T., Price N.D., Hood L., Hadlock J.J. The effect of maternal SARS-CoV-2 infection timing on birth outcomes: a retrospective multicentre cohort study. Lancet Digit. Health. 2022; 4(2): e95-e104. https://dx.doi.org/10.1016/S2589-7500(21)00250-8.
- Li N., Han L., Peng M., Lv Y., Ouyang Y., Liu K. et al. Maternal and neonatal outcomes of pregnant women with coronavirus disease 2019 (COVID-19) pneumonia: a case-control study. Clin. Infect. Dis. 2020; 71(16): 2035-41. https://dx.doi.org/10.1093/cid/ciaa352.
- Cosma S., Carosso A.R., Cusato J., Borella F., Carosso M., Gervasoni F. et al. Preterm birth is not associated with asymptomatic/mild SARS-CoV-2 infection per se: Pre-pregnancy state is what matters. PLoS One. 2021; 16(8): e0254875. https://dx.doi.org/10.1371/journal.pone.0254875.
- von Elm E., Altman D.G., Egger M., Pocock S.J., Gøtzsche P.C., Vandenbroucke J.P.; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J. Clin. Epidemiol. 2008; 61(4): 344-9. https://dx.doi.org/10.1016/ j.jclinepi.2007.11.008.
- Ministry of Health of the Russian Federation. Organization of medical care for pregnant women, women in labor, women in labor and newborns with a new coronavirus infection COVID-19. Methodological guidelines. Version 2, 28.05.2020. Version 3, 25.01.2021, Version 4, 05.07.2021 (in Russian).
- Statistical methods. Random sampling and randomization procedures. Standart ISO 24153-2012. Group T59. OKS 03.120.30. (in Russian).
- Sealed Envelope Ltd. 2012. Power calculator for binary outcome superiority trial. Available at: https://www.sealedenvelope.com/power/binary-superiority
- Khong T.Y., Mooney E.E., Gordijn S.J., Morgan T.K., Nikkels P.G.J. et al. Pathology of the placenta: Practical guide. Springer: Nature; 2019. https://dx.doi.org/10.1007/978-3-319-97214-5.
- Adamyan L.V., Vechorko V.I., Konysheva O.V., Kharchenko E.I. Pregnancy and COVID-19: current issues (literature review). Russian Journal of Human Reproduction. 2021; 27(3): 70-7. (in Russian). https://dx.doi.org/10.17116/repro20212703170.
- Eskenazi B., Rauch S., Iurlaro E., Gunier R.B., Rego A., Gravett M.G. et al. Diabetes mellitus, maternal adiposity, and insulin-dependent gestational diabetes are associated with COVID-19 in pregnancy: the INTERCOVID study. Am. J. Obstet. Gynecol. 2022; 227(1): 74.e1-74. https://dx.doi.org/10.1016/ j.ajog.2021.12.032.
- Malgina G.B. Stress and pregnancy: perinatal aspects. Yekaterinburg; 2002. 188p. (in Russian).
- Gulkevich Yu.V., Makkaveeva M.Yu., Nikiforov B.I. Pathology of the human afterbirth and its effect on the fetus. Minsk; 1968. 232p. (in Russian).
- Yusenko S.R., Nagorneva S.V., Kogan I.Yu. Patterns of development and formation of the fetal central nervous system integrative function in the antenatal period. Journal of obstetrics and woman diseases. 2022; 71(5): 97-110. (in Russian). https:/dx./doi.org/10.17816/ JOWD107183.
- Hosier H., Farhadian S.F., Morotti R.A., Deshmukh U., Lu-Culligan A., Campbell K.H. et al. SARS-CoV-2 infection of the placenta. J. Clin. Invest. 2020; 130(9): 4947-53. https://dx.doi.org/10.1172/JCI139569.
- Wong S.F., Chow K.M., Leung T.N., Ng W.F., Ng T.K., Shek C.C. et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am. J. Obstet. Gynecol. 2004; 191(1): 292-7. https://dx.doi.org/10.1016/ j.ajog.2003.11.019.
- Jafari M., Pormohammad A., Neshin S.A.S., Ghorbani S., Bose D. et al. et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: Aasystematic review and meta-analysis. Rev. Med. Virol. 2021; 31(5): 1-16. https://dx.doi.org/10.1002/ rmv.2208.
- Martinez-Perez O., Prats Rodriguez P., Muner Hernandez M., Encinas Pardilla M.B., Perez Perez N., Vila Hernandez M.R. et al. The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis. BMC Pregnancy Childbirth. 2021; 21(1): 273. https://dx.doi.org/10.1186/s12884-021-03742-4.
- Filippov O.S., Guseva E.V. Key performance indicators of the obstetric and gynecological service in the Russian Federation in 2019. Moscow; 2020. 30p. (in Russian).
- Vivanti A.J., Vauloup-Fellous C., Prevot S., Zupan V., Suffee C., Do Cao J. et al. Transplacental transmission of SARS-CoV-2 infection. Nat. Commun. 2020; 11(1): 3572. https://dx.doi.org/10.1038/s41467-020-17436-6.
- Korebrits C., Ramirez M.M., Watson L., Brinkman E,. Bocking A.D., Challis J.R. Maternal corticotropin-releasing hormone is increased with impending preterm birth. J. Clin. Endocrinol. Metab. 1998; 83(5): 1585-91. https://dx.doi.org/10.1210/jcem.83.5.4804.
- Shchegolev A.I., Tumanova U.N., Serov V.N. Placental lesions in pregnant women with SARS-¬CoV-¬2 infection. Obstetrics and Gynecology. 2020; (12: 44-52. (in Russian). https://dx.doi.org/10.18565/ aig.2020.12.44-52.