The features of preeclampsia and the fetal condition during pregnancy complicated by COVID-19

BACKGROUND: COVID-19 continues to be relevant for such a vulnerable population as pregnant women. An increased risk of adverse perinatal outcomes such as hypertensive disorders of pregnancy, fetal distress, and intrauterine fetal death has been reported, but the published data remain contradictory and confusing. Of particular interest is the association between COVID-19 and preeclampsia due to the proposed common pathogenetic mechanisms.

AIM: The aim of this study was to assess the clinical manifestations of preeclampsia in patients with previous coronavirus disease and the impact of COVID-19 on the fetal condition.

MATERIALS AND METHODS: The main group consisted of 48 patients with previous COVID-19 and preeclampsia. The comparison group was a simple random sample of 70 patients with preeclampsia who gave birth before the pandemic. The study groups were comparable in age, parity, and somatic diseases. We carried out a retrospective analysis of the pregnancy course and gestational complications and assessed instrumental methods for the fetal condition.

RESULTS: The course of preeclampsia in patients with COVID-19 is characterized by a higher prevalence of severity of the disease and a more frequent need to use reserve antihypertensive drugs. Placental malperfusion is significantly more common in the COVID-19 group and is noted from the initial clinical manifestations of preeclampsia. We found an increased frequency of amniotic fluid pathology, in particular, oligohydramnios, in patients from the COVID-19 group. No significant differences were shown between the study groups in the incidence of fetal growth restriction, fetal distress, gestational diabetes mellitus, premature detachment of the normally situated placenta, and premature birth. The main indications for premature delivery in patients of the main group were the lack of the therapy effect and fetal distress. The impact of the severity of preeclampsia on the newborn weight-for-stature value and the Apgar score was more pronounced in the COVID-19 group.

CONCLUSIONS: In pregnancy complicated by COVID-19, severe preeclampsia develops more often than in patients without a history of COVID-19, and antihypertensive therapy is characterized by the complexity and the need to use reserve drugs. Given the data obtained on a more active course of preeclampsia, a higher incidence of its severe form, placental malperfusion, and the amniotic fluid pathology, further domestic research is needed to create recommendations for the management of high-risk patients after coronavirus disease with more frequent dynamic fetal monitoring.