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Thomas E, Ganesan N, Gunaseelan L, Tadury Madhukar S. The effect of COVID-19 infection on the hematological parameters in pregnant women. mljgoums 2025; 19 (3) :1-3
URL: http://mlj.goums.ac.ir/article-1-1712-en.html
URL: http://mlj.goums.ac.ir/article-1-1712-en.html
1- Department of Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India , elshaddai4eliz@gmail.com
2- Department of Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
2- Department of Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Discussion
The findings of our study are similar to those in several previous reports about patients with COVID-19 who suffered from fever and cough as the most common symptoms at admission (12-15). In addition, a common laboratory finding was lymphopenia.
The iron deficiency anemia seen in 4 of the patients was attributed to nutritional deficiency, which is common in the Indian subcontinent. It had no correlation with the COVID-19 infection.
Mohr-Sasson A et al. (6), in a retrospective study, examined 11 pregnant women with SARS-CoV-2 and compared them with 25 non-pregnant controls for clinical and laboratory characteristics. They concluded that a trend of lymphopenia was seen in the pregnant women, but no other laboratory differences were observed between pregnant and non-pregnant women. They also stated that the physiological changes in laboratory parameters during pregnancy, including relatively elevated WBC count, neutrophilia, and lower thrombocyte count, could mask the hematological abnormalities related to SARS-CoV-2 infection and cause delays in early detection of the disease during pregnancy.
Liu et al. (8) studied 16 COVID-19-infected pregnant women and found that leukocytosis and an elevated neutrophil-to-lymphocyte ratio were the most characteristic hematologic findings.
In a study by Chen et al. (9) published in The Lancet, the laboratory data of 9 pregnant women were retrospectively analyzed. They observed that five out of the nine patients had lymphopenia. As all the patients developed COVID-19 pneumonia subsequently, caesarean section was done for them at term to avoid any risk of transmission, as limited data were available regarding vertical transmission. We saw a similar trend in the laboratory parameters in our study, along with lymphopenia, although this did not translate into poorer outcomes.
Although thrombocytopenia was reported in many studies, in our study population, the platelet count was within the normal range.
With respect to maternal outcomes, there were no recorded cases of maternal mortality.
At 1 and 5 minutes, APGAR scores of all neonates were greater than 7, and only one of the neonates was found to have fetal anemia.
Our findings were concordant with some studies (16-18) that presented no notable clinical symptoms suggestive of COVID-19 infection in the neonates born to positive mothers, and also reported that samples were negative for SARS-CoV-2. A recent study showed that some pregnant women who developed severe COVID-19 disease underwent emergency caesarean section (19).
A study done in Iran showed that pregnant women with COVID-19 had an increased risk of pre-eclampsia, preterm labor, and caesarean delivery (20).
This study is among the very few conducted in the Asian subcontinent among COVID-infected pregnant women. However, since all the enrolled women were in the third trimester, laboratory changes in the first and second trimesters of pregnancy are not reflected in our study, which is one of its limitations.
List of abbreviations: COVID-19: Corona Virus Disease 2019; SARS-CoV-2: Severe Acute Respiratory Syndrome Corona Virus 2; MERS: Middle East Respiratory Syndrome; APGAR: Appearance, Pulse, Grimace, Activity, and Respiration.
Conclusion
In our present study, we found that the characteristics of SARS-CoV-2 infection in pregnant women, as reflected in hematological parameters, are very similar to those seen in COVID-negative pregnant women, although a trend for lymphopenia is quite predominant. This could be of value to the treating physician. We also did not find any evidence of intrauterine or peripartum transmission of COVID-19 from mother to baby. Although our conclusions are limited by the small sample size, we believe that the findings reported here are important for understanding the clinical and hematological characteristics of COVID-19 infection in pregnant women. Further investigations are necessary to assess any long-term outcomes or adverse effects in these neonates.
Acknowledgement
Not applicable.
Funding sources
This study did not receive any external funding.
Ethical statement
The study was approved by the Institutional Ethics Committee (IHEC 20/168) and conducted in accordance with the Helsinki Declaration.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Author contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by ET and NG. The first draft of the manuscript was written by ET, and all authors reviewed and commented on the manuscript. All authors read and approved the final manuscript.
Data availability statement
All data are available upon request from the corresponding author.
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Introduction
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), brought about a wave of unprecedented anxiety and fear. Amidst this, pregnancy would have been an overwhelming experience for many. Alterations in cell-mediated immunity take place in pregnancy, and this could increase the susceptibility of pregnant women to infectious diseases (1). Given the maternal physiologic changes, particularly in the immune system, pregnant women are vulnerable to respiratory viruses and need special attention regarding prevention, diagnosis, and management of SARS-CoV-2 (2). This concern is based on the experience of SARS and Middle East respiratory syndrome (MERS), caused by related coronaviruses, which were found to be associated with worse outcomes during pregnancy (3-5). Basic hematological parameters can provide significant information on the health of a person. Many physicians and obstetricians rely on hematological investigations for the prognosis and management of pregnant women with underlying illnesses. Laboratory abnormalities, which characterize SARS-CoV-2 infection, have been identified; however, data related to the hematological characteristics of pregnant women with SARS-CoV-2 are limited (6-11).
Methods
The study was approved by the Institutional Ethics Committee (IHEC 20/168) and conducted in accordance with the Helsinki Declaration. In the current retrospective cohort study, 64 COVID-19 positive patients who were admitted to our hospital, under the obstetrics department, during the 6-month study period were included. The hematological parameters such as hemoglobin, MCV, MCH, RDW, total and differential leukocyte count, and platelet counts of these women during the last trimester were assessed, and the outcome of the pregnancy was recorded to evaluate if any of the hematological changes were reflected in the outcome of the pregnancy.
Results
The study group included 64 pregnant women in their third trimester who were diagnosed with SARS-CoV-2 infection by RT-PCR testing. Table 1 displays the clinical characteristics of these pregnant women. The majority of the women were asymptomatic and were found to be COVID-positive only as part of routine testing. The most common symptomatic presentation was fever. Only one woman complained of increased breathlessness, which was attributed to the infection. Hospitalization was not needed for any of them until at term.
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), brought about a wave of unprecedented anxiety and fear. Amidst this, pregnancy would have been an overwhelming experience for many. Alterations in cell-mediated immunity take place in pregnancy, and this could increase the susceptibility of pregnant women to infectious diseases (1). Given the maternal physiologic changes, particularly in the immune system, pregnant women are vulnerable to respiratory viruses and need special attention regarding prevention, diagnosis, and management of SARS-CoV-2 (2). This concern is based on the experience of SARS and Middle East respiratory syndrome (MERS), caused by related coronaviruses, which were found to be associated with worse outcomes during pregnancy (3-5). Basic hematological parameters can provide significant information on the health of a person. Many physicians and obstetricians rely on hematological investigations for the prognosis and management of pregnant women with underlying illnesses. Laboratory abnormalities, which characterize SARS-CoV-2 infection, have been identified; however, data related to the hematological characteristics of pregnant women with SARS-CoV-2 are limited (6-11).
Methods
The study was approved by the Institutional Ethics Committee (IHEC 20/168) and conducted in accordance with the Helsinki Declaration. In the current retrospective cohort study, 64 COVID-19 positive patients who were admitted to our hospital, under the obstetrics department, during the 6-month study period were included. The hematological parameters such as hemoglobin, MCV, MCH, RDW, total and differential leukocyte count, and platelet counts of these women during the last trimester were assessed, and the outcome of the pregnancy was recorded to evaluate if any of the hematological changes were reflected in the outcome of the pregnancy.
Results
The study group included 64 pregnant women in their third trimester who were diagnosed with SARS-CoV-2 infection by RT-PCR testing. Table 1 displays the clinical characteristics of these pregnant women. The majority of the women were asymptomatic and were found to be COVID-positive only as part of routine testing. The most common symptomatic presentation was fever. Only one woman complained of increased breathlessness, which was attributed to the infection. Hospitalization was not needed for any of them until at term.
|
Table 1. Clinical characteristics of COVID-19 pregnant women
.PNG) |
|
Table 2. Laboratory parameters of the study population
.PNG) Data are presented as median and interquartile range. |
Discussion
The findings of our study are similar to those in several previous reports about patients with COVID-19 who suffered from fever and cough as the most common symptoms at admission (12-15). In addition, a common laboratory finding was lymphopenia.
The iron deficiency anemia seen in 4 of the patients was attributed to nutritional deficiency, which is common in the Indian subcontinent. It had no correlation with the COVID-19 infection.
Mohr-Sasson A et al. (6), in a retrospective study, examined 11 pregnant women with SARS-CoV-2 and compared them with 25 non-pregnant controls for clinical and laboratory characteristics. They concluded that a trend of lymphopenia was seen in the pregnant women, but no other laboratory differences were observed between pregnant and non-pregnant women. They also stated that the physiological changes in laboratory parameters during pregnancy, including relatively elevated WBC count, neutrophilia, and lower thrombocyte count, could mask the hematological abnormalities related to SARS-CoV-2 infection and cause delays in early detection of the disease during pregnancy.
Liu et al. (8) studied 16 COVID-19-infected pregnant women and found that leukocytosis and an elevated neutrophil-to-lymphocyte ratio were the most characteristic hematologic findings.
In a study by Chen et al. (9) published in The Lancet, the laboratory data of 9 pregnant women were retrospectively analyzed. They observed that five out of the nine patients had lymphopenia. As all the patients developed COVID-19 pneumonia subsequently, caesarean section was done for them at term to avoid any risk of transmission, as limited data were available regarding vertical transmission. We saw a similar trend in the laboratory parameters in our study, along with lymphopenia, although this did not translate into poorer outcomes.
Although thrombocytopenia was reported in many studies, in our study population, the platelet count was within the normal range.
With respect to maternal outcomes, there were no recorded cases of maternal mortality.
At 1 and 5 minutes, APGAR scores of all neonates were greater than 7, and only one of the neonates was found to have fetal anemia.
Our findings were concordant with some studies (16-18) that presented no notable clinical symptoms suggestive of COVID-19 infection in the neonates born to positive mothers, and also reported that samples were negative for SARS-CoV-2. A recent study showed that some pregnant women who developed severe COVID-19 disease underwent emergency caesarean section (19).
A study done in Iran showed that pregnant women with COVID-19 had an increased risk of pre-eclampsia, preterm labor, and caesarean delivery (20).
This study is among the very few conducted in the Asian subcontinent among COVID-infected pregnant women. However, since all the enrolled women were in the third trimester, laboratory changes in the first and second trimesters of pregnancy are not reflected in our study, which is one of its limitations.
List of abbreviations: COVID-19: Corona Virus Disease 2019; SARS-CoV-2: Severe Acute Respiratory Syndrome Corona Virus 2; MERS: Middle East Respiratory Syndrome; APGAR: Appearance, Pulse, Grimace, Activity, and Respiration.
Conclusion
In our present study, we found that the characteristics of SARS-CoV-2 infection in pregnant women, as reflected in hematological parameters, are very similar to those seen in COVID-negative pregnant women, although a trend for lymphopenia is quite predominant. This could be of value to the treating physician. We also did not find any evidence of intrauterine or peripartum transmission of COVID-19 from mother to baby. Although our conclusions are limited by the small sample size, we believe that the findings reported here are important for understanding the clinical and hematological characteristics of COVID-19 infection in pregnant women. Further investigations are necessary to assess any long-term outcomes or adverse effects in these neonates.
Acknowledgement
Not applicable.
Funding sources
This study did not receive any external funding.
Ethical statement
The study was approved by the Institutional Ethics Committee (IHEC 20/168) and conducted in accordance with the Helsinki Declaration.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Author contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by ET and NG. The first draft of the manuscript was written by ET, and all authors reviewed and commented on the manuscript. All authors read and approved the final manuscript.
Data availability statement
All data are available upon request from the corresponding author.
Research Article: Research Article |
Subject:
Laboratory hematology
Received: 2023/08/31 | Accepted: 2024/04/6 | Published: 2025/08/19 | ePublished: 2025/08/19
Received: 2023/08/31 | Accepted: 2024/04/6 | Published: 2025/08/19 | ePublished: 2025/08/19
References
1. Jamieson DJ,Theiler RN, Rasmussen SA. Emerging Infections and Pregnancy. Emerg Infect Dis. 2006;12(11):1638-1643. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-Cov-2 infection during pregnancy. J Infect. 2020:S0163-4453(20)30109-2 [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Alserehi H, Wali G, Alshukairi A, Alraddadi B. Impact of Middle East Respiratory Syndrome corona virus (MERS-CoV) on pregnancy and perinatal outcome. BMC Infect Dis. 2016;16:105. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Malik A, Medhat K, El Masry KM, Ravi M, Sayed F. Middle East Respiratory Syndrome Coronavirus during Pregnancy, Abu Dhabi, United Arab Emirates, 2013. Emerg Infect Dis. 2016;22(3):515-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Mohr-Sasson A, Chayo J, Bart Y, Meyer R, Sivan E, Mazaki-Tovi S, et al. Laboratory characteristics of pregnant compared to non-pregnant women infected with SARS-CoV-2. Arch Gynecol Obstet. 2020;302(3):629-34. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Vakili S, Savardashtaki A, Jamalnia S, Tabrizi R, Nematollahi MH, Jafarinia M, et al. Laboratory findings of COVID-19 infection are conflicting in different age groups and pregnant women: a literature review. Arch Med Res. 2020;51(7):603-7 [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and Ct imaging features of the COVID-19 pneumonia: focus on pregnant women and children. J Infect. 2020;80(5):7-13 [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395:809-15. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Liu W, Wang Q, Zhang Q, Chen L, Chen J, Zhang B, et al. Corona virus disease 2019 (COVID-19) during pregnancy: a case series. Preprints. 2020. [View at Publisher] [Google Scholar]
11. Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women with corona virus disease (COVID-19) pneumonia: a preliminary analysis. AJR Am J Roentgenol. 2020:1-6. [View at Publisher] [DOI] [Google Scholar]
12. Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS‐CoV‐2 infection in UK: national population-based cohort study. BMJ. 2020;369:m2107. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID‐19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020;99(7):823‐9. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Kim YK, Kim EH. Pregnancy and COVID-19: past, present and future. Obstet Gynecol Sci. 2023 May;66(3):149-160. [View at Publisher] [DOI] [Google Scholar]
15. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019‐nCoV pneumonia. TranslPediatr. 2020;9(1):51‐60. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Panahi L, Amiri M, Pouy S. Clinical characteristics of COVID-19 infection in newborns and pediatrics: a systematic review. Arch Acad Emerg Med. 2020;8(1):e50.eCollection 2020. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Xiao TT, Yan K, Wang LS, Zhou WH. What can we learn from neonates with COVID-19? World J Pediatr. 2020;16(3):280-3. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. Akbarian-Rad Z, Mojaveri MH, Bouzari Z, Sadeghi F, Yahyapour Y, Naeimi Rad M,et al. Neonatal Outcomes in Pregnant Women Infected with COVID-19 in Babol, North of Iran: A Retrospective Study with Short-Term Follow-Up. Infect Dis Obstet Gynecol. 2021;2021:9952701. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Arslan B, Bicer IG, Sahin T, Vay M, Dilek O, Destegul E. Clinical characteristics and hematological parameters associated with disease severity in COVID-19 positive pregnant women undergoing cesarean section: A single-center experience. J Obstet Gynaecol Res. 2022;48(2):402-10. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Abedzadeh-Kalahroudi M, Sehat M, Vahedpour Z, Talebian P. Maternal and neonatal outcomes of pregnant patients with COVID-19: A prospective cohort study. Int J Gynaecol Obstet. 2021;153(3):449-56. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009;114(6):1326-31. [View at Publisher] [DOI] [PMID] [Google Scholar]
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