Jha Sangam, Singh Jafeesha B, Naaz Shagufta
Obstetrics and Gynecology, All India Institute of Medical Sciences, Patna, IND.
Anesthesiology, All India Institute of Medical Sciences, Patna, IND.
Cureus. 2023 May 26;15(5):e39514. doi: 10.7759/cureus.39514. eCollection 2023 May.
We aim to compare risk factors and clinical outcomes of acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19) in pregnant versus non-pregnant women of reproductive age.
This retrospective study included all women (18-45 years) with ARDS and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted during the study period from May 2020 to July 2021. Pregnant women were considered as case and non-pregnant women as control. Primary outcomes included ventilatory support, the need for high-flow nasal oxygenation (HFNO), severe ARDS, and death. Secondary outcomes included intensive care unit (ICU) admission, length of hospital stay, and requirement of oxygen at discharge.
We included 59 women diagnosed with ARDS and confirmed SARS-CoV-2 infection, of them 12 were pregnant and 47 were non-pregnant. The non-pregnant women were significantly older than pregnant women (28.7±5 versus 35.5±8.2, p=0.008). Presenting symptoms were comparable among the groups. Diabetes was significantly higher in the non-pregnant group (8.3% versus 31.9%, p<0.02). Pregnant women had a significantly higher range of D-dimer (5.8±7.2 versus 1.8±1.9, p<0.01) and interleukin-6 (IL-6) (212.0±300.8 versus 49.7±57.7, p<0.011) and lower platelet count (129.4±120.1 versus 197.6±92.9, p<0.05) compared to non-pregnant women. Pregnant women were more likely to experience primary outcomes including the need for HFNO (33% versus 8.5%, odds ratio (OR): 5.3, p<0.02) and death (50% versus 31.9%, OR: 2.1, p<0.04) compared to non-pregnant women.
Pregnant women with severe COVID-19 and ARDS were at an increased risk for experiencing ICU admission, intubation, and mechanical ventilation compared to age-matched non-pregnant women, although comorbidities such as diabetes were higher among the non-pregnant cohort. These findings suggest that pregnancy itself is a potential risk factor for complications and morbidities among women with severe COVID-19.
我们旨在比较2019冠状病毒病（COVID-19）相关的急性呼吸窘迫综合征（ARDS）在育龄孕妇与非孕妇中的风险因素和临床结局。
这项回顾性研究纳入了2020年5月至2021年7月研究期间收治的所有患有ARDS且确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的18至45岁女性。孕妇被视为病例组，非孕妇被视为对照组。主要结局包括通气支持、高流量鼻导管给氧（HFNO）需求、重度ARDS和死亡。次要结局包括入住重症监护病房（ICU）、住院时间和出院时的吸氧需求。
我们纳入了59例被诊断为ARDS且确诊SARS-CoV-2感染的女性，其中12例为孕妇，47例为非孕妇。非孕妇的年龄显著大于孕妇（28.7±5岁对35.5±8.2岁，p = 0.008）。两组的临床表现症状相似。非孕妇组的糖尿病患病率显著更高（8.3%对31.9%，p<0.02）。与非孕妇相比，孕妇的D-二聚体水平范围显著更高（5.8±7.2对1.8±1.9，p<0.01）、白细胞介素-6（IL-6）水平显著更高（212.0±300.8对49.7±57.7，p<0.011），而血小板计数更低（129.4±120.1对197.6±92.9，p<0.05）。与非孕妇相比，孕妇更有可能出现主要结局，包括HFNO需求（33%对8.5%，优势比（OR）：5.3，p<0.02）和死亡（50%对31.9%，OR：2.1，p<0.04）。
与年龄匹配的非孕妇相比，患有重度COVID-19和ARDS的孕妇入住ICU、插管和机械通气的风险增加，尽管非孕妇队列中的糖尿病等合并症患病率更高。这些发现表明，妊娠本身是重度COVID-19女性发生并发症和发病的潜在风险因素。
