The role of eosinophil as a diagnostic, differential, and prognostic marker for Covid-19 during pregnancy: Case-control study from tertiary center.

PURPOSE: To evaluate the level of eosinophil count in Covid-19 pregnant patients as a cost-effective tool for aiding in diagnosis, differential diagnosis, and prognosis and, to assess whether eosinopenia could be similar or superior to lymphopenia in pregnancy with Covid-19. METHODS: Retrospective case-control study was conducted including pregnant women tested simultaneously for SARS-CoV-2 by RT-PCR and complete blood count (CBC). Eosinophil counts (EOS), lymphocytes (LYM), neutrophils (NEU) with calculation of EOS/LYM ratio, EOS/NEU ratio, NEU/LYM ratio, LYM/NEU ratio (LNR), eosinopenia, and lymphopenia were compared between the groups. ROC analysis was performed for determination of optimal cut-off values and comparative analysis between AUC were performed using the paired sample design. Logistic regression was used to determine the factors affecting the categorical variables. RESULTS: Four thousand two hundred sixteen pregnant women were included in the final analysis of which (n = 845) as healthy control group, (n = 1482) as non Covid-19 patient group and (n = 1889) as Covid-19 group. Covid-19 group was divided into three subgroups based on severity. To diagnose and distinguish Covid-19 from other infectious conditions, EOS had better performance with higher area under curve (AUC) (0.769 and 0.757 AUC, respectively, p < 0.001). Categorically, eosinopenia had better diagnostic (Covid-19 vs. healthy), prognostic (severe-critical vs. mild-moderate), and differential diagnostic (Covid-19 vs. non Covid-19) performance than lymphopenia (OR = 5.5 vs. 3.4, OR = 3.4 vs. 1.8, OR = 5.4 vs. 2.7 p = 0.000). CONCLUSION: Eosinopenia is a low-cost, reliable, and convenient marker for Covid-19 not only in diagnosis, but also in prognosis by acting as an early marker for predicting severe-critical cases.

Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience.

OBJECTIVES: This study aimed to present perinatal outcomes, clinical challenges, and basic ICU management in pregnant women with severe-critical COVID-19 at our tertiary referral center. METHODS: In this prospective cohort study, patients were divided into two groups, whether they survived or not. Clinical characteristics, obstetric and neonatal outcomes, initial laboratory test results and radiologic imaging findings, arterial blood gas parameters at ICU admission, and ICU complications and interventions were compared between groups. RESULTS: 157 of the patients survived, and 34 of the patients died. Asthma was the leading health problem among the non-survivors. Fifty-eight patients were intubated, and 24 of them were weaned off and discharged healthfully. Of the 10 patients who underwent ECMO, only 1 survived (p<0.001). Preterm labor was the most common pregnancy complication. Maternal deterioration was the most common indication for a cesarean section. Higher neutrophil-to-lymphocyte-ratio (NLR) values, the need for prone positioning, and the occurrence of an ICU complication were important parameters that influenced maternal mortality (p<0.05). CONCLUSIONS: Overweight pregnant women and pregnant women with comorbidities, especially asthma, may have a higher risk of mortality related to COVID-19. A worsening maternal health condition can lead to increased rates of cesarean delivery and iatrogenic prematurity.

Fetal neurosonography in pregnant women recovering from COVID-19 disease.

OBJECTIVE: To investigate the effect of severe acute respiratory virus 2 (SARS-CoV-2) on fetal neurodevelopment in pregnant women. METHODS: This prospective cohort study included 54 pregnant women at least 4 weeks after the SARS-CoV-2 infection and 58 controls. In the third trimester, the depths of the fetal insula, Sylvian, parieto-occipital, and calcarine fissures, the length of cavum septum pellucidum (CSP), and the thickness of the corpus callosum (CC) were measured. Sylvian fissure operculization and cortical development were graded. The correlation analysis between fetal cortical development and Sylvian fissure operculization was performed with the Pearson test. RESULTS: The calcarine fissure depth and CC thickness were reduced in the study group (P < 0.001, P = 0.004). The fetal CSP length and ratio were increased in the study group (P = 0.016, P = 0.039). Approximately half of the study group fetuses had grade 4 or less Sylvian fissure operculization. The study group had a significantly higher rate of fetuses with grade 2 (31.5% vs. 13.8%) and significantly lower rate of fetuses with grade 4 cortical development (14.8% vs. 31.0%), compared with the controls. There was a moderate negative significant correlation between pregnant women recovering from COVID-19 and fetal cortical development and Sylvian fissure operculization (P = 0.001). CONCLUSION: This is the first study to investigate fetal cortical development in pregnant women recovering from COVID-19. The results indicate that COVID-19 disease may affect fetal neurodevelopment.

The impact of covid-19 on thyroid function tests in pregnancy.

PURPOSE: To investigate the effects of laboratory-confirmed SARS-CoV-2 infection on thyroid function tests (TFTs) in pregnant women and to evaluate whether TFT changes are related to the severity and prognosis. METHODS: Consecutive pregnant women tested for SARS-CoV-2 by RT-PCR at Ankara City Hospital were recruited between January 2021 and September 2021. Thyroid-stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3), thyroid peroxidase antibody (anti-TPO), and thyroglobulin antibody (anti-TG) were measured on admission. RESULTS: Among 747 eligible pregnant women with the same baseline characteristics, 369 RT-PCR-positive women in the patient group and 378 RT-PCR-negative women in the control group were included in the analyses. Pregnant women in the patient group had significantly lower TSH, FT4, FT3, Anti TPO, and Anti TG concentrations compared with those in the control group (p < 0.001). The proportion of patient groups with mild, moderate, severe, and critical diseases were 297 (80.4%), 40 (10.8%), 17 (4.6%), and 15 (4.2%), respectively, among which with the moderate, severe, and critical disease had significantly lower FT3 values (2.5 vs 2.19 pg/mL, p < 0.001) and higher nonthyroidal illness syndrome (NTIS) (29.2 vs. 8.4%, p < 0.001) than those with mild disease. Lower FT3 values increased the risk of ICU admission, NICU admission, and severe disease (p < 0.001). FT3 and TSH correlated positively with lymphocytes (p < 0.001) and negatively correlated with C-reactive protein (CRP) (p < 0.001, p = 0.005). CONCLUSION: The SARS-CoV-2 infection seems to have an impact on the TFTs of pregnant women, and particularly FT3 level seems to be correlated with disease severity.

Comparison of cord blood pro-BNP levels in newborns of SARS-COV-2-positive and -negative women, and its association with adverse perinatal outcomes.

OBJECTIVE: To compare umbilical cord blood pro-B-type natriuretic peptide (BNP) levels in newborns of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) positive pregnancies to those of SARS-COV-2 negative pregnancies. METHODS: Prospectively cord blood samples from newborns of 42 SARS-COV-2 positive women, and 42 negative pregnant were collected at birth and analyzed for pro-BNP levels. RESULTS: The mean cord blood pro-BNP level was significantly higher in newborns of SARS-COV-2 positive women than in controls. Furthermore, the pro-BNP level was an independent predictor of NICU admission in both SARS-COV-2 positive and control patients. CONCLUSION: Cord blood pro-BNP level may be a parameter that can predict the under-stress fetus and adverse perinatal outcomes especially, in cases where placental involvement is present as in SARS-COV-2 infection.

Effect of COVID-19 pandemic process on prenatal diagnostic procedures.

OBJECTIVE: To evaluate the accessibility of pregnant women to prenatal screening and diagnostic tests during the COVID-19 pandemic process and analyze the effect of the pandemic process on acceptance-rejection rates of fetal diagnostic procedures for high risk pregnancies. MATERIALS AND METHODS: As part of this cross-sectional study, during the pandemic, between the dates of 11 March 2020-30 June 2020 at Karadeniz Technical University Faculty of Medicine Perinatology Clinic, fetal structural anomaly detected by ultrasonography or with increased risk in screening test in the first and second trimester of high risk pregnancies, who were therefore recommended a prenatal diagnosis test, were defined as the control group and retrospectively compared with high risk pregnancies of the same periods (11 March 2019-30 June 2019) in the previous year. RESULTS: A total of 267 cases were evaluated within the scope of the study. The rate of pregnant women undergoing the first and second trimester screening tests was 83% in the control group and 56% for pregnant women in the study group. When the total number of prenatal diagnostic procedures and the year each of the procedures performed are compared, a statistically significant difference was found between the study and control groups (p: .041 and p < .001, respectively). When evaluating the rates of performed prenatal diagnostic procedures during the first patient visit in comparison to years, a statistically significant difference was observed in the A/S group and in the total number of cases (p = .023, p < .001, respectively). Similarly, the rate of performed prenatal diagnostic procedure during the first patient visit and the patient's city of residence was similarly statistically significant from year to year (p < .05). CONCLUSIONS: The decrease in number of prenatal diagnosis and screening tests during the COVID-19 pandemic draws attention. Prenatal care services are a serious issue that cannot be overcome by any deficiencies in both maternal and fetal care.