Clinical Manifestation and Laboratory Characteristics of SARS-CoV-2 Infection in Pregnant Women

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has become a major challenge to public health in China and other countries, considering its pathogenicity across all age groups. Pregnancy is a unique physiological condition, and is characterized by altered immunity and elevated hormone levels to actively tolerate the semi-allogeneic fetus, which undergoes a sudden and substantial fluctuation during the immediate postpartum period. Changes in clinical features, laboratory characteristics, and imaging features of pregnant women during the pre-partum and post-partum periods require further elucidation. Here, we retrospectively analyzed the clinical features, laboratory characteristics, and imaging features of eight pregnant cases of SARS-CoV-2 infection during the pre-partum and post-partum periods. Our results showed that four of the eight pregnant women were asymptomatic before delivery but became symptomatic post-partum. Correspondingly, white blood cell (WBC) counts increased and lymphocyte (LYMPH) counts decreased. C-reactive protein (CRP) levels in the serum also increased to a higher level than those in general pregnancy. Therefore, it is imperative to closely monitor laboratory parameters including the WBC count, LYMPH count, and CRP, along with other imaging features in chest CT scans, to promptly prevent, diagnose, and treat a SARS-CoV-2 infection during pregnancy.

Keywords: Clinical manifestation; Immunity; Laboratory characteristics; Pregnant women; SARS-CoV-2.

Fig. 1

Chest CT scans (transverse plane) of eight pregnant women with confirmed SARS-CoV-2 infection. Patients 1 and 2: no visible ground-glass opacities or small plaque; Patient 3–8: ground-glass opacities or/and small plaque are indicated by red arrow.

Fig. 2

Dynamic profile of white blood cells and lymphocyte count in pregnant women with or without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Considering pregnant women with SARS-CoV-2 infection, patients 1–6 are pregnant patients with laboratory-confirmed SARS-CoV-2 infection, and patients 7–8 are pregnant patients with highly suspected SARS-CoV-2 infection. The left y-axis shows the number of white blood cells (WBC). The right y-axis shows the number of lymphocytes (LYMPH). The dotted lines in blue show the upper normal limit of the WBC count, and the dotted line in grey shows the lower normal limit of LYMPH count. Pre, pre-partum; Post, post-partum.

Fig. 3

The levels of inflammatory factors and kinase in pregnant women at pre-partum and post-partum. The pregnant women with SARS-CoV-2 infection included six pregnant patients with laboratory-confirmed SARS-CoV-2 infection and two pregnant patients with highly suspected SARS-CoV-2 infection. The participants without the SARS-CoV-2 infection. The levels of C-reactive protein (CRP), D-dimer, creatine kinase (CK), and creatine kinase-MB (CK-MB) in the serum or plasma were detected.