Laboratory changes and clinical correlates of disease severity in hospitalized pregnant women with COVID-19.

BACKGROUND

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, in December 2019 and rapidly spread globally. This study aimed to evaluate laboratory changes in pregnant women hospitalized with COVID-19 and their association with disease severity.

METHODS

This cross-sectional study, conducted from 21 to 30 February November 2020, included 59 pregnant women with reverse-transcriptase-polymerase chain reaction-confirmed COVID-19 at teaching hospitals of Shahid Beheshti University of Medical Sciences. Clinical signs and laboratory findings were extracted from medical records, categorized by disease severity (mild, moderate, and severe), and analyzed using GraphPad Prism (version 8).

RESULTS

Main reasons for admission included possible ICU need due to severe symptoms (n = 13), labor pain (n = 10), and premature rupture of membranes (n = 6). Common symptoms were dry cough (n = 58), fever (n = 40), fatigue (n = 40), shortness of breath (n = 39), and myalgia (n = 38). COVID-19 severity was significantly associated with fever, dyspnea, sore throat, vomiting, myalgia, headache, and fatigue. Laboratory findings linked to increased severity included lower initial, minimum, and average lymphocyte counts (P = 0.007, 0.006, 0.052, respectively), lymphopenia (P = 0.005), anemia (P = 0.01), elevated prothrombin time (P = 0.001), aspartate aminotransferase (P < 0.05), alkaline phosphatase (P < 0.05), lactate dehydrogenase (P < 0.05), direct bilirubin, hypoalbuminemia, and elevated 24-hour urine protein.

CONCLUSIONS

Severe COVID-19 in pregnant women is associated with lymphopenia, anemia, elevated liver enzymes, hypoalbuminemia, and proteinuria, which can mimic pregnancy complications like preeclampsia. These findings suggest that monitoring these laboratory parameters may aid in identifying severe cases and differentiating them from pregnancy-related conditions, guiding timely clinical management.