Pregnancy and COVID-19: Comparing ICU Outcomes for Pregnant and Nonpregnant Women

Overview

Journal Viruses

Publisher MDPI

Date 2025 Jan 25

PMID 39861839

Authors

Malgorzata Lipinska-Gediga

Waldemar Gozdzik

Jakub Smiechowicz

Barbara Adamik

Affiliations

Soon will be listed here.

Abstract

Background: This study compares organ dysfunction, treatment strategies, and unfavorable outcome rates between pregnant and nonpregnant women admitted to the ICU with severe COVID-19, highlighting the increased susceptibility of pregnant women to respiratory infections due to physiological changes.

Methods: A retrospective, age-matched study was conducted at a referral center specializing in critical care for pregnant women. Data from 14 pregnant/postpartum and 11 nonpregnant women were analyzed at ICU admission and on days 3, 5, and 7.

Results: Acute respiratory distress syndrome was diagnosed in 100% of the pregnant/postpartum group and 64% of the nonpregnant group ( = 0.026). Inflammatory parameters were similar between groups, except for lower ferritin levels in the pregnant/postpartum group compared to the nonpregnant (120 vs. 568 µg/L at admission and 90 vs. 616 µg/L on day 3). Creatinine, lactate, and lactate dehydrogenase levels were significantly lower in the pregnant/postpartum group. A reduction in the SOFA score was observed over time in the pregnant/postpartum group (from 7.0 to 4.0 points, = 0.009), while no change was noticed in the nonpregnant group (from 3.0 to 2.5 points, = 0.181). Unfavorable outcome rates were similar, with two patients from each group succumbing to the disease ( = 0.604).

Conclusions: The findings suggest that pregnancy does not increase the risk of unfavorable outcomes among women with severe COVID-19 receiving ICU treatment. However, additional studies with larger sample sizes are needed to validate these observations.

References

Horby P, Lim W, Emberson J, Mafham M, Bell J, Linsell L . Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2020; 384(8):693-704. PMC: 7383595. DOI: 10.1056/NEJMoa2021436. View

Ruscitti P, Berardicurti O, Di Benedetto P, Cipriani P, Iagnocco A, Shoenfeld Y . Severe COVID-19, Another Piece in the Puzzle of the Hyperferritinemic Syndrome. An Immunomodulatory Perspective to Alleviate the Storm. Front Immunol. 2020; 11:1130. PMC: 7270352. DOI: 10.3389/fimmu.2020.01130. View

Lin Z, Long F, Yang Y, Chen X, Xu L, Yang M . Serum ferritin as an independent risk factor for severity in COVID-19 patients. J Infect. 2020; 81(4):647-679. PMC: 7313486. DOI: 10.1016/j.jinf.2020.06.053. View

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

Leal D, Ferreira J, Mansilha A . Thromboembolic risk in pregnant women with SARS-CoV-2 infection - A systematic review. Taiwan J Obstet Gynecol. 2022; 61(6):941-950. PMC: 9500082. DOI: 10.1016/j.tjog.2022.06.012. View

Martinez-Varea A, Satorres E, Florez S, Domenech J, Desco-Blay J, Monfort-Pitarch S . Comparison of Maternal-Fetal Outcomes among Unvaccinated and Vaccinated Pregnant Women with COVID-19. J Pers Med. 2022; 12(12). PMC: 9787626. DOI: 10.3390/jpm12122008. View

Knaus W, Draper E, Wagner D, Zimmerman J . APACHE II: a severity of disease classification system. Crit Care Med. 1985; 13(10):818-29. View

Palella S, Muscara L, La Via L, Sanfilippo F . Veno-venous extracorporeal membrane oxygenation for rescue support in pregnant patients with COVID-19: a systematic review. Br J Anaesth. 2023; 131(4):e130-e132. DOI: 10.1016/j.bja.2023.07.008. View

Byrne J, Shamshirsaz A, Cahill A, Turrentine M, Seasely A, Eid J . Outcomes Following Extracorporeal Membrane Oxygenation for Severe COVID-19 in Pregnancy or Post Partum. JAMA Netw Open. 2023; 6(5):e2314678. PMC: 10203887. DOI: 10.1001/jamanetworkopen.2023.14678. View

10.

Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T . Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020; 370:m3320. PMC: 7459193. DOI: 10.1136/bmj.m3320. View

11.

Perkins G, Graesner J, Semeraro F, Olasveengen T, Soar J, Lott C . European Resuscitation Council Guidelines 2021: Executive summary. Resuscitation. 2021; 161:1-60. DOI: 10.1016/j.resuscitation.2021.02.003. View

12.

Kemp M, Newnham J, Challis J, Jobe A, Stock S . The clinical use of corticosteroids in pregnancy. Hum Reprod Update. 2015; 22(2):240-59. DOI: 10.1093/humupd/dmv047. View

13.

Ramanathan K, Tan C, Rycus P, Anders M, Lorusso R, Zhang J . Extracorporeal Membrane Oxygenation in Pregnancy: An Analysis of the Extracorporeal Life Support Organization Registry. Crit Care Med. 2020; 48(5):696-703. DOI: 10.1097/CCM.0000000000004269. View

14.

van Genderen M, van Uitert E, Duvekot J, Gommers D . Management and outcome of critically ill pregnant women with COVID-19. Intensive Care Med. 2022; 48(5):613-615. PMC: 8918598. DOI: 10.1007/s00134-022-06653-w. View

15.

Barrantes J, Ortoleva J, ONeil E, Suarez E, Beth Larson S, Rali A . Successful Treatment of Pregnant and Postpartum Women With Severe COVID-19 Associated Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation. ASAIO J. 2020; 67(2):132-136. PMC: 7846250. DOI: 10.1097/MAT.0000000000001357. View

16.

Zambrano L, Ellington S, Strid P, Galang R, Oduyebo T, Tong V . Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(44):1641-1647. PMC: 7643892. DOI: 10.15585/mmwr.mm6944e3. View

17.

Herminghaus A, Osuchowski M . How sepsis parallels and differs from COVID-19. EBioMedicine. 2022; 86:104355. PMC: 9718536. DOI: 10.1016/j.ebiom.2022.104355. View

18.

Combes A, Peek G, Hajage D, Hardy P, Abrams D, Schmidt M . ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive Care Med. 2020; 46(11):2048-2057. PMC: 7537368. DOI: 10.1007/s00134-020-06248-3. View

19.

Kellum J, Lameire N . Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17(1):204. PMC: 4057151. DOI: 10.1186/cc11454. View

20.

Camacho-Dominguez L, Rojas M, Herran M, Rodriguez Y, Beltran S, Galindo P . Predictors of mortality in hospitalised patients with COVID-19: a 1-year case-control study. BMJ Open. 2024; 14(2):e072784. PMC: 10868294. DOI: 10.1136/bmjopen-2023-072784. View