Short-term outcomes of COVID-19 in pregnant women unvaccinated for SARS-CoV-2 in the first, second, and third trimesters: a retrospective study

ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) may be asymptomatic or symptomatic in pregnant women. Compared to non-pregnant reproductive-aged women, symptomatic individuals appear to have a higher risk of acquiring severe illness sequelae. OBJECTIVES: We assessed the clinical and laboratory characteristics and outcomes of pregnant COVID-19 patients unvaccinated for severe acute respiratory syndrome coronavirus 2 according to the trimester of pregnancy. DESIGN AND SETTING: This was a retrospective observational study conducted in a tertiary-level hospital in Turkey. METHODS: This retrospective study reviewed the clinical and laboratory characteristics and outcomes of 445 pregnant COVID-19 patients hospitalized during the first, second, and third trimesters of pregnancy and 149 other pregnant women as controls in a tertiary center from April 2020 to December 2021. All participants were unvaccinated. RESULTS: Overall, the study groups were comparable in terms of baseline clinical pregnancy characteristics. There was no clear difference among the study participants with COVID-19 in the first, second, and third trimesters of pregnancy. However, a considerably high number of clinical and laboratory findings revealed differences that were consistent with the inflammatory nature of the disease. CONCLUSIONS: The study results reveal the importance of careful follow-up of hospitalized cases as a necessary step by means of regular clinical and laboratory examinations in pregnant COVID-19 patients. With further studies, after implementing vaccination programs for COVID-19 in pregnant women, these data may help determine the impact of vaccination on the outcomes of pregnant COVID-19 patients.

Hipertensión en el embarazo: clasificación y fisiopatología / Hypertension in pregnancy: classification and pathophysiology

Existen cuatro trastornos hipertensivos principales que complican aproximadamente el 10% de todos los embarazos. La preeclampsia, que se clasifica en leve o grave, se manifiesta como hipertensión y proteinuria de reciente comienzo, después de la semana 20 de gestación, en una mujer previamente normotensa. La eclampsia, una variante de la preeclampsia grave, se manifiesta por la presentación de convulsiones generalizadas que no se atribuyen a otra causa. El síndrome HELLP (hemólisis, incremento de las enzimas hepáticas y disminución del recuento de las plaquetas), también es una forma grave de preeclampsia. La hipertensión crónica se define por el registro de valores de presión sistólica> 140 mm Hg, o de presión diastólica > 90 mm Hg, o de ambas, que precede al embarazo, o está presente antes de la semana 20 de la gestación o persiste más allá de la semana 12 posparto. La preeclampsia superpuesta se diagnostica cuando en una mujer con hipertensión preexistente surge proteinuria de reciente comienzo después de la semana 20 del embarazo. La hipertensión gestacional es la hipertensión (usualmente leve) sin proteinuria (u otros signos de preeclampsia) que aparece en el último tramo del embarazo. Debe normalizarse antes de la semana 12 posparto. La preeclampsia es un síndrome caracterizado por la disfunción endotelial materna. Tanto el estrés oxidativo, como la inflamación y la falta de adaptación circulatoria, junto con diversas anomalías humorales, minerales o metabólicas, tienen una función en la patogénesis de la preeclampsia. Las últimas investigaciones sugieren que la placenta libera factores circulantes cuyo papel es interferir la acción del factor de crecimiento endotelial vascular y del factor de crecimiento placentario, que tendrían una misión central en la presentación de la enfermedad. En esta revisión, se analiza la clasificación y la fisiopatología de la preeclampsia junto con sus formas graves, la eclampsia y el síndrome HELLP.

There are four major hypertensive disorders complicatingapproximately 10% of all pregnancies. Preeclampsia classified as mild or severe refers to the new onset of hypertension and proteinuria after 20 weeks of gestationin a previously normotensive woman. Eclampsia, a variantof severe preeclampsia, refers to the development ofgrand mal seizures that should not be attributable toanother cause. HELLP syndrome (hemolysis, elevated liverenzymes, and low platelets) is also a severe form of preeclampsia. Chronic hypertension is defined as systolicpressure = 140 mm Hg, diastolic pressure = 90 mm Hg,or both, that antedates pregnancy, is present before the20 weeks of pregnancy, or persists longer than 12 weeks postpartum. Superimposed preeclampsia is diagnosedwhen a woman with preexisting hypertension develops new onset proteinuria after 20 weeks of gestation. Gestational hypertension refers to hypertension (usuallymild) without proteinuria (or other signs of preeclampsia)developing in the latter part of pregnancy. It shouldresolve by 12 weeks postpartum. Preeclampsia is asyndrome characterized by maternal endothelial celldysfunction. Oxidative stress, inflammation, circulatory maladaptation, as well as humoral, mineral, or metabolic abnormalities all appear to play a role in the pathogenesis of preeclampsia. Newer studies suggest that placental release of circulating factors that interfere with the action of vascular endothelial growth factor and placental growth factor plays a central role in its presentation. Inthis review, classification and pathophysiology of preeclampsia with its severe forms, eclampsia and HELLPsyndrome, are discussed.