Features of COVID-19 of Varying Severity in Pregnant Women

Aim. To determine the clinical and laboratory features of COVID-19 of varying severity during pregnancy. Design. Prospective cohort study. Materials and methods. The study included 1476 pregnant women. The main group included 1,386 patients with COVID-19 at various stages of gestation, admitted to the maternity hospital of the Regional Clinical Hospital No. 2 in Chelyabinsk, repurposed into a COVID hospital to provide medical care to pregnant women, women in labor and postpartum women with COVID-19 , as well as their newborns, in the territory of Chelyabinsk and the Chelyabinsk region, during the 1st–4th waves of the COVID-19 pandemic. Depending on the severity of COVID-19, patients of the main group were divided into 4 subgroups: Subgroup 1 — pregnant women with mild COVID-19 (n = 482), Subgroup 2 — women with moderate COVID-19 (n = 718), Subgroup 3 — patients with severe COVID-19 (n = 147), Subgroup 4 — pregnant women with extremely severe COVID-19 (n = 21). The comparison group consisted of 90 women admitted to the maternity hospital of the Regional Clinical Hospital No. 3 in Chelyabinsk from July 2020 to February 2021 in the third trimester of gestation. The comparison group consisted of 90 pregnant women admitted to the maternity hospital of the Regional Clinical Hospital No. 3 in Chelyabinsk from July 2020 to February 2021 in the third trimester of gestation. Results. The leading symptoms of infection in pregnant women with COVID-19 were fever, general weakness, dry cough with difficult-toseparate phlegm, and shortness of breath. Statistically significantly more often in severe and extremely severe COVID-19 at the time of hospitalization, chest congestion and pain, and rapid heartbeat were noted. Against the background of severe and extremely severe infection, and in comparison with the group of patients without COVID-19, lymphocytopenia, hypoproteinemia, high levels of band neutrophils, alanine aminotransferase, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), C-reactive protein, ferritin, procalcitonin, soluble fibrin monomer complexes, and D-dimer were statistically significantly more often recorded. Conclusion. Clinical signs of severe and extremely severe COVID-19 in pregnant women include general weakness, dry cough with difficult-toseparate phlegm, shortness of breath, chest congestion and pain, and rapid heartbeat. Laboratory factors statistically significantly associated with the progression of COVID-19 to extremely severe cases during pregnancy are the highest levels of AST, LDH, and hypoproteinemia with the lowest level of total protein in the blood serum determined at the time of hospitalization. The information obtained will help optimize the prediction of the most unfavorable form of COVID-19 for pregnant women — extremely severe infection. Keywords: pregnancy, new coronavirus infection, COVID-19, severity, clinical symptoms, laboratory parameters.