Interpretation
In this study, we have tried to address some issues including: the
severity of Covid-19 virus infection in pregnancy, the risk of virus
infection with pregnancy progress, the virus impact on pregnancy
outcomes, delivery type, the possibility of vertical transmission and
neonatal consequences.
Studies to date have shown that Covid-19 virus infection is not more
severe in pregnant women.(9-12). We also did not have any severe case of
corona virus during our study.However, it should be noted that our study
was performed only during 50 days and therefore, the absence of a
critically ill patient during this period cannot be generally attributed
to all pregnancies. In late February 2020, a very ill 22-year-old
pregnant woman with no underlying disease who had been infected by
Covid-19 virus was referred to our hospital at 37 gestational weeks due
of fever and severe shortness of breathing that had started ten days
earlier. She developed lymphopenia, thrombocytopenia and low O2
saturation (60%) and unfortunately passed away within 7 hours of
admission. Since this happened before beginning of our cohort study, we
did not include her in this study.Recently, Hantoushzadeet al. has
reported nine pregnant women with severe Covid-19 disease which 7 of
them died(13). Their study is a multidisciplinary study that has
selected highly ill patients from different centers across Iran,
alongside non-random selection bias. However, since no cases of Covid-19
death have been reported in pregnancy so far, their study could make an
important change in available evidence about the manifestation of the
virus in pregnancy.
Most of the Covid-19 infected pregnant women that have been reported so
far were in the third and late second trimesters.(10, 14, 15).In our
study,88.3% of those surveyed were in the third trimester of pregnancy.
Really, the possibility of picking up infected women based on careful
examination and history at earlier ages of pregnancy is lower because of
the less routine prenatal visits in first and second trimesters. On the
other hand, given the general policies around the world regarding home
quarantine during a virus pandemic, pregnant women may not go to medical
centers even if there are mild symptoms. So we believe that previous
reports including our study might be influenced by these factors and the
higher average gestational age in our patients should be interpreted
with caution.
In our study, there was no increase in adverse pregnancy outcomes
including PTL,GDM, preeclampsia, IUGR, PROM, stillbirth, postpartum
haemorrhage and postpartum infection. Most previous studies including a
review article(16)also had the same results. Since in most previous
studies no comparison has been made between infected and non-infected
individuals duo to their methodology, it is not possible to give a
definite opinion about the effect of this virus on pregnancy outcomes
based on the available data and it demands more prospective studies.
Our results showed that CS rate was not different in the studied groups,
but in the majority of previous studies, it was rather higher in
infected people(10, 14, 16-18). In a review study, fetal distress was
reported to be the most common cause of CS in infected
women(17).However, In our study, the most common cause of CS was a
history of previous CS.
In our study, only one infant had a positive Covid-19 PCR test after
birth that it cannot be definitively related to vertical transmission.
Although no decisive vertical transmission of the virus has been
reported so far,there area few reports of covid-19 viral pneumonia in 3
infants(19),elevated SARS-Cov-2 IgM and IgG levels in 2 hours after
birth in a newborn(20)and a newborn whose nasopharyngeal culture was
positive for covid-19 virus 16 hours after birth(21).
Since several factors may play some
roles in the vertical transmission, we recommend culture of amniotic
fluid, umbilical cord blood and neonatal nasopharyngeal swab at the time
of delivery in order to accurately determine the vertical transmission.
Several studies have reported neonatal complications in some of their
neonates(10, 19, 22), whereas in some other studies, no neonatal
complication has been observed (14, 23).The prevalence of neonatal
complications was not different between groups in our study.
Nevertheless, we have the impression that maternal condition during peak
of the disease may lead to severe transient placental insufficiency. We
suggest evaluating uterine and umbilical vessels doppler at the onset
and peak of the disease and also after the mother’s recovery and
comparing them with neonatal outcomes in futures studies.