LIVER DISEASE AND CORONAVIRUS DISEASE IN PREGNANT WOMEN

The novel coronavirus (SARS-CoV-2) poses significant risks to maternal health during pregnancy, a physiological state characterized by immune modulation that increases susceptibility to infectious diseases. The aim of our study was to evaluate the impact of maternal hepatic function on COVID-19 severity in pregnant women. Methods and materials. We prospectively analyzed 85 pregnant women categorized into three groups: Group I comprised 30 women with placental dysfunction; Group II included 30 women with both placental dysfunction and COVID-19 infection during pregnancy; the control group consisted of 25 healthy pregnant women without obstetric complications. Comprehensive evaluation included medical history review, symptom assessment, laboratory analyses (complete blood count, biochemical profile, urinalysis), cardiotocography, and ultrasonographic examination of fetal status and maternal lungs when pneumonia was suspected. Statistical analysis was performed using Microsoft Excel and Statistica 10. Results of the studies and their discussion. Coronavirus infection was moderate or severe in 18 patients (59.4%), necessitating hospitalization, while 12 pregnant women (39.6%) exhibited clinical signs of acute respiratory disease, including sore throat, general weakness, cough, and fever. Most patients were diagnosed with unilateral or bilateral polysegmental viral pneumonia, with varying degrees of lung tissue involvement (5% to 30%). Within the spectrum of extragenital pathology, anemia was diagnosed in half of the women, and one-quarter had various hepatobiliary conditions. Specifically, in Group II, every second woman was diagnosed with anemia, compared to only 20.0% in Group I (OR=2.8; 95% CI: 19.8-56.1; p < 0.05). Diseases of the hepatobiliary system included the following: non-calculous cholecystitis in 2 (6.6%) patients, biliary dyskinesia in 3 (9.9%), chronic viral hepatitis in 3 (9.9%), and obstetric cholestasis in 2 (6.6%). A comparison showed that the risk of developing coronavirus infection was five times higher in pregnant women with liver pathology (OR=5.0; 95% CI: 6.6-33.3; p < 0.05). Arterial hypertension was confirmed in 17 (56.1%) patients in Group II. Elevated transaminase levels were observed in almost 70.0% of cases, while elevated alkaline phosphatase was characteristic of 89.0% of cases. These data indicate that the liver is rapidly involved in SARS-CoV-2 infection, manifesting as coagulopathy, including elevated fibrinogen levels. The C-reactive protein level in pregnant women with coronavirus disease increased fivefold on average (OR=2.8; 95% CI: 9.5-27.5; p < 0.05). Regarding pregnancy complications associated with COVID-19, fetal growth restriction was observed in 12 pregnant women (39.6%) (OR=7.4; 95% CI: 6.7-49.5; p < 0.01), and fetal distress was noted in 4 (13.2%) (OR=5.9; 95% CI: 6.7-39.6, p < 0.01). Conclusions. Pregnant women with anemia, liver diseases, and arterial hypertension constitute a high-risk group for SARS-CoV-2 infection. The infection in this cohort was associated with a complicated course of pregnancy. The most common obstetric complications included fetal growth restriction, fetal distress secondary to fetoplacental insufficiency, and preterm birth.