COVID-19 in pregnant and non-pregnant women of early reproductive age

Aim. To identify confounding factors, features of the clinical course and outcomes of COVID-19 in pregnant and non-pregnant patients of early reproductive age who have no known risk factors and premorbid background.

Materials and methods. The study included 163 pregnant women in the third trimester of gestation, 100 non-pregnant women with laboratory-confirmed SARS-CoV-2 infection and 100 pregnant women who did not get sick. Patients of all groups were comparable in age (18–35 years), social status, parity, body mass index, had no known risk factors for COVID-19; those who got sick were treated simultaneously.

Results. Statistically significant associations were revealed between COVID-19 infection in the pregnant and iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat ethnicity, and smoking. Pregnant women with COVID-19 were more likely to have no symptoms (23.3% vs 5%; p<0.001) or had a mild course of the disease (58.9% vs 24%; p<0.001). In non-pregnant patients, the course of infection was more often moderate (61% vs 14.7%; p<0.001) or severe (10% vs 3.1%; p=0.038). Clinical manifestations of new coronavirus infection (NCV) in pregnant women were dominated by anosmia (87.7% vs 40%; p<0.001), drowsiness (68.7% vs 17%; p<0.001), dyspnea, even with a mild lung lesion (68.1% vs 19%; p<0.001), headache (41.7% vs 24%; p=0.006), arthralgia (29.4% vs 16%; p=0.021), while fever above 38 °C (7.4% vs 28%; p<0.001) and cough (38.7% vs 61%; p<0.001) were much less common. With computed tomography, pneumonia in pregnant women was diagnosed several times less often (21.4% vs 87.4%; p<0.001). In the non-pregnant group, there was one death (1% vs 0%; p=0.201) associated with late hospitalization for severe NCI with grade 4 pulmonary involvement as shown on computed tomography.

Conclusion. Confounders of COVID-19 in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat subpopulation, and smoking. In pregnant women, the main clinical symptoms of SARS-CoV-2 infection, with the exception of loss of smell, were nonspecific and characteristic of the physiological course of late gestation: drowsiness, dyspnea, joint pain. The predominance of mild or asymptomatic forms of infection, the lower incidence of pneumonia, and the absence of deaths in pregnant women suggests a more favorable course of COVID-19 NCI.