Perinatal outcomes in pregnant women with COVID-19 at different gestational ages and disease severities

BACKGROUND: Investigation of the impact of gestational age and the severity of Coronavirus Disease 2019 (COVID-19) on pregnancy outcomes is of particular importance in the context of the continuing relevance of this issue, as well as for the development of preventive strategies and therapeutic approaches aimed at reducing adverse maternal and fetal outcomes.

AIM: To evaluate perinatal outcomes in pregnant women who developed COVID-19 at different gestational ages and with varying degrees of disease severity.

METHODS: Perinatal outcomes were analyzed in pregnant women from three clinical groups: group 1, patients who developed COVID-19 during the first trimester (n = 119); group 2, patients infected during the second trimester (n = 121); group 3, patients infected during the third trimester of pregnancy (n = 120). Each clinical group was further divided into three subgroups according to the severity of COVID-19 (mild, moderate, and severe). Statistical analysis of the clinical data was performed using StatSoft software (Russia). Differences were considered statistically significant at p < 0.05.

RESULTS: The analysis showed that severe SARS-CoV-2 infection occurring in the first trimester of gestation contributes to pregnancy termination in more than 50% of clinical cases. At the same time, patients who had mild COVID-19 in early gestation significantly more frequently delivered infants with normal birth weight and favorable early neonatal adaptation compared with those born to mothers with moderate or severe COVID-19. SARS-CoV-2 infection during the second trimester identified pregnant women as a high-risk group for adverse perinatal outcomes, including fetal growth restriction, and increased the likelihood of complicated early neonatal adaptation. In pregnant women who developed COVID-19 during the third trimester, a high risk of acute fetal hypoxia and abdominal delivery was observed, not only for obstetric indications but also due to a more severe COVID-19 course. The higher rate of preterm birth among infants born to mothers with severe COVID-19 during the second and third trimesters was associated with earlier medically indicated delivery and with pathological maternal changes caused by infection-related hypoxia.

CONCLUSION: The study demonstrated that the distribution and frequency of perinatal complications depend on both the gestational age and the severity of COVID-19.