Clinical course of Coronavirus Disease‐2019 (COVID‐19) in pregnancy

Pereira, Augusto; Cruz‐Melguizo, Sara; Adrien, Maria; Fuentes, Lucia; Marin, Eugenia; Perez‐Medina, Tirso

INTRODUCTION: The aim of this study is to report our clinical experience in the management of pregnant women infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) during the first thirty days of the Coronavirus disease (COVID‐19) pandemic. MATERIAL AND METHODS: We reviewed clinical data from the first 60 pregnant women with COVID‐19 whose care was managed at Puerta de Hierro University Hospital, Madrid, Spain from March 14(th) to April 14(th), 2020. Demographic data, clinical findings, laboratory test results, imaging findings, treatment received, and outcomes were collected. An analysis of variance (Kruskal‐Wallis test) was performed to compare the medians of laboratory parameters. Fisher's exact test was used to evaluate categorical variables. A correspondence analysis was used to explore associations between variables. RESULTS: A total of 60 pregnant women were diagnosed with COVID‐19. The most common symptoms were fever and cough (75.5%, each) followed by dyspnea (37.8%). Forty‐one patients (68.6%) required hospital admission (18 due to disease worsening and 23 for delivery) of whom 21 patients (35%) underwent pharmacological treatment, including hydroxychloroquine, antivirals, antibiotics and tocilizumab. No renal or cardiac failures or maternal deaths were reported. Lymphopenia (50%), thrombocytopenia (25%), and elevated C‐reactive protein (CRP) (59%) were observed in the early stages of the disease. Median CRP, D‐dimer and the neutrophil/lymphocyte ratio were elevated. High CRP and D‐dimer levels were the parameters most frequently associated with severe pneumonia. The Neutrophil/lymphocyte ratio was found to be the most sensitive marker for disease improvement (relative risk: 6.65; 95% CI: 4.1‐5.9). During the study period, 18 of the women (78%) delivered vaginally. All newborns tested negative for SARS‐CoV‐2 and none of them were infected during breastfeeding. No SARS‐CoV‐2 was detected in placental tissue. CONCLUSIONS: Most of the pregnant COVID‐19 positive patients had a favorable clinical course. However, one‐third of them developed pneumonia, of whom 5% presented a critical clinical status. CRP and D‐dimer levels positively correlated with severe pneumonia and the neutrophil/lymphocyte ratio decreased as the patients improved clinically. Seventy‐eight percent of patients had a vaginal delivery. No vertical or horizontal transmissions were diagnosed in the neonates during labor or breastfeeding.