Vitamin D status is not associated with clinical severity of COVID-19 in pregnant women

Purpose

To investigate the association between vitamin D status and the clinical severity of COVID-19 in pregnant women.

Methods

This prospective case–control study included 147 pregnant women with COVID-19 and 300 matched controls. Serum 25-hydroxyvitamin (25(OH)D) concentrations were measured on admission. Patients with mild-to-moderate disease (n = 114, 77.6%) and severe-to-critical disease (n = 33, 22.4%) were classified as symptomatic patients who did not require oxygen support and those who received oxygen support, respectively. SARS-CoV-2 positivity rates, clinical severity of COVID-19, and pulmonary involvement were compared according to vitamin D status.

Results

Serum 25(OH)D concentrations were found to be 36.6 ± 26.8 and 31.3 ± 20.7 nmol/L in pregnant women infected with SARS-CoV-2 and healthy controls, respectively (p = 0.001). The clinical severity of pregnant women with COVID-19 did not differ concerning vitamin D deficiency (RR = 0.568, 95% CI [0.311–1.036]; p = 0.065), even after excluding patients on vitamin supplementation (RR = 0.625, 95% CI [0.275–1.419]; p = 0.261). Testing positive for SARS-CoV-2 was not related to vitamin D status in the overall cohort of pregnant women (RR = 0.767, 95% CI [0.570–1.030]; p = 0.078). Pulmonary involvement of COVID-19 was found to be similar between patients with vitamin D deficiency and adequate vitamin D levels (RR = 0.954; 95% CI [0.863–1.055]; p = 0.357).

Conclusion

The clinical severity and pulmonary involvement of COVID-19 may not be associated with vitamin D status in pregnant women. Vitamin D deficiency/adequacy rates were comparable in pregnant women infected with SARS-CoV-2 and healthy pregnant women.

Anxiety levels and obsessive compulsion symptoms of pregnant women during the COVID-19 pandemic

Objective

Reliable data regarding maternal mental well-being during the Severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic are scarce. This study aimed to assess the state/trait anxiety and obsessive-compulsive symptoms of pregnant women and compare those with the non-pregnant population using patient-reported validated outcome measures.

Materials and Methods

This prospective case-control study was conducted at a tertiary 'Coronavirus Pandemic Hospital' in İstanbul, Turkey in April, 2020. Pregnant and non-pregnant women were consecutively allocated to two groups regardless of gestational age. The primary outcome was to identify the anxiety levels and obsessive-compulsive symptoms of pregnant women during the SARS-CoV-2 pandemic using the State-Trait Anxiety inventory (STAI) and Maudsley Obsessive-Compulsive inventory (MOCI), respectively.

Results

Two hundred three pregnant women and 101 non-pregnant women were included. The mean STAI-S questionnaire score of pregnant and nonpregnant women was 41.96±9.15 and 46.62±12, respectively (p=0.001). The overall incidence of STAI >40 in pregnant and non-pregnant women was 62.6% and 73.3%, respectively. The mean total score of MOCI was 17.9±6.7 and 15±6.6 in pregnant and non-pregnant women, respectively. The overall incidence of 30-item-MOCI ≥13.1 in pregnant and non-pregnant women was 61.6% (125/203) and 30.7% (31/103), respectively (p<0.001).

Conclusion

State anxiety and obsessive-compulsive symptoms in pregnant women were found increased during the current SARS-CoV-2 pandemic. Pregnant women showed more favourable anxiety levels compared with non-pregnant women. These findings can be used to improve the coping skills of pregnant women during the pandemic, to prepare for the post-pandemic period, and to deal with the long-term mental health impact of COVID-19.

How to perform and interpret the lung ultrasound by the obstetricians in pregnant women during the SARS-CoV-2 pandemic

Objective:

Evidence for the use of lung ultrasound scan (LUS) examinations in coronavirus 2019 pneumonia is rapidly growing. The safe and non-ionizing nature of LUS drew attention, particularly for pregnant women. This study aimed to contribute to the interpretation of LUS findings in pregnant women for the obstetricians.

Materials and Methods:

LUS was performed to pregnant women suspected of or diagnosed as having Severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2) in the first 24 hours of admission. Fourteen areas (3 posterior, 2 lateral, and 2 anterior) were scanned per patient for at least 10 seconds along the indicated anatomical landmarks. The scan was performed in supine, right-sided and left-sided positions, respectively. Each area was given a score between 0 and 3 according to the specific pattern.

Results:

In this study, 21 still images and 21 videoclips that enabled dynamic and real-time evaluation were provided. Pleural line assessment, physiologic A-lines, pathologic B-lines, light beam pattern, white lung pattern, and specific patterns for quick recognition and evaluation are described.

Conclusion:

The potential advantages and limitations of LUS and its areas of use for obstetricians are discussed. LUS is a promising supplementary imaging tool during the SARS-CoV-2 pandemic. It is easy to perform and may be feasible in the hands of obstetricians after a brief didactic course. It may be a firstline imaging modality for pregnant women.

Pregnancy worsens the morbidity of COVID-19 and this effect becomes more prominent as pregnancy advances

Objective

To investigate pregnancy outcomes and compare the clinical characteristics of coronavirus 2019 (COVID-19) disease in pregnant and agematched non-pregnant women.

Materials and Methods

Hospital records of four tertiary care centers were reviewed retrospectively. The subjects comprised 188 pregnant patients and 799 non-pregnant women who were admitted to these hospitals.

Results

Pregnancy significantly affected the clinical severity of COVID-19 and this effect was more prominent in pregnant women at >20 weeks gestation (p<0.001). Rates of oxygen support (10.1% vs 4.8%; p≤0.001), intensive care unit admission (3.2% vs 0.6%; p=0.009), presence of fever (12.8% vs 4.4%; p<0.001), tachypnea (7.0% vs 2.4%; p=0.003) and tachycardia (16.0% vs 1.9%; p<0.001) were significantly more frequent in pregnant women compared with non-pregnant women. Pregnancy was strongly associated with the need for oxygen support [relative risk (RR), 2.125; 95% confidence interval (CI): 1.25-3.60] and admission to the intensive care unit (RR, 5.1; 95% CI: 1.57-16.53) compared with non-pregnant women. Some 14.4% of the pregnant women had co-morbidities. Sixty of the 188 pregnant women (31.9%) delivered during the Severe Acute Respiratory syndrome coronavirus-2 infection, 11 (18.3%) had vaginal deliveries and 49 (81.7%) were by cesarean section. Of these 60 deliveries, 40 (66.7%) were <37 weeks gestation.

Conclusion

Pregnancy worsens the morbidity of COVID-19 and this effect seems to increase as the pregnancy advances, but not the mortality rate.