Decreased fetal cardiac output in pregnant women with severe SARS-Cov-2 infection

Abstract

Aim: We aimed to examine fetal cardiac output (CO) in patients who recovered from severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection.

Materials: This prospective study included 48 pregnant women recovered from SARS-CoV-2 infection and 50 control cases. SARS-CoV-2 infection was diagnosed by polymerase chain reaction (PCR) test in patients. Fetal echocardiographic evaluations were performed at 24-37 weeks of gestation in pregnant women who recovered from the infection and control group.

Results: The median value of ultrasound evaluation was 34 (2.6) weeks of gestation in the recovery from the SARS-CoV-2 infection (RSI) group, and 32 (7.6) weeks in the control group (p = .565). Left cardiac output (LCO) z score was significantly lower in the RSI group than the control group (p = .041). LCO and combine cardiac output (CCO) z score were significantly lower in the severe disease group than mild, moderate disease groups, and controls (p = .019 and p = .013). CCO (ml/min/kg) was decreased in the severe disease group when compared with control and mild disease groups (p = .044).

Conclusion: In the present study, fetal cardiac output in pregnant women who recovered from SARS-CoV-2 infection was found to be significantly reduced in those with severe disease, while there was no significant difference in mild and moderate cases. Placental dysfunction and inflammatory cytokines might cause fetal cardiac changes. Further studies could be clarified on the impact of SARS-CoV-2 infection on fetal cardiac function.

Keywords: fetal cardiac output; fetal echocardiography; severe acute respiratory syndrome coronavirus.

FIGURE 1

Aortic valve annulus diameter. L, left; R, right; AV annulus, aortic valve annulus; LA, left atrium; LV, left ventricle; RV, right ventricle; Zs‐GA, Z score for gestational age.

FIGURE 2

Pulmonary valve annulus diameter. Ao, aorta; LPA, left pulmonary artery; PV annulus, pulmonary valve annulus; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; Zs‐GA, Z score for gestational age.

FIGURE 3

The aortic valves flow velocity waveforms and velocity time integral (VTI) were obtained from the left ventricular outflow tract (LVOT) views. Cardiac outputs was calculated as VTI × π (Aortic valve diameter/2)2 × heart rate. LV, left ventricle; RV, right ventricle.