COVID-19 infection and hypertension disorders during pregnancy

Abstract

The objective: to determine the impact of COVID-19, which occurred before or during pregnancy, on the frequency of development and features of the course of gestational hypertension and preeclampsia.Materials and methods. An observational retrospective study with parallel control one was conducted. The pregnancy course and its outcomes in 178 women during the period of the COVID-19 pandemic – from March 2020 to January 2022 – who were observed in the women’s consultation of a private medical center, were analyzed. It is important to note that the medical documentation was taken one after the other, without being specially selected according to any principle, that is, the analysis carried out had the character of continuous screening.Out of 178 pregnant women, 125 (70.2%) persons were sick with COVID-19, they were included in the main group; 53 (29.8%) women who were part of the comparison group did not get sick. The groups are comparable by age and body mass index. The age of the women was 19–51 years; in the main group – 30.5±4.9 years, in the comparison group – 30.9±5.6 years. Body mass index (kg/m2) at the beginning of pregnancy in women of the main group was 21.6±4.3; comparison group – 22.9±4.8. There were 104 (58.4%) primigravida, 74 (41.6%) – multigravida. 117 (65.7%) women were primipara, 61 (34.3%) – multipara.All pregnant women were performed with a standard examination in accordance with the Order No. 417 of the Ministry of Health of Ukraine dated 15.07.2011. Clinical and anamnestic risk factors for the development of preeclampsia were assessed in all women without exception, on the basis of which 3 women were assigned to the risk group. In addition, 158 (88.8%) pregnant women as part of the first combined screening had an additional examination to determine the risk of developing preeclampsia, as a result of which additional 23 women were included in the risk group. As a result, 26 (14.6%) pregnant women from 12 weeks of gestation were prescribed prophylaxis using acetylsalicylic acid.Results. In women who have had COVID-19, hypertensive disorders of pregnancy develop statistically significantly less often than in those who have not had the disease. After mildly symptomatic COVID-19 the risks of hypertensive disorders in pregnant women are statistically significantly reduced: gestational hypertension – RR=1.15, 95% CI: 1.0–1.3; preeclampsia – RR=1.1, 95% CI: 1.0–1.2, all hypertensive disorders – BP=1.3, 95% CI: 1.1–1.6.The groups did not differ among themselves in the prevalence of generally accepted risk factors. The frequency of hypertensive disorders depending on the vaccination was analyzed. The risk of gestational hypertension in vaccinees who did not suffer from COVID-19 is reduced by 1.4 times (RR=1.4, 95% CI: 1.0–1.9), the risk of all hypertensive disorders in pregnant women in this same group is reduced 2 times (RR=2.0, 95% CI: 1.2–3.5).The development of preeclampsia also probably depends on the vaccination status (χ2=4.0; p=0.04; φ=-0.17). In non-vaccinated persons it increases by 1.1 times (RR=1.1, 95%CI: 1.2–1.8). The risk of all hypertensive disorders is also higher in the group with a negative vaccine status (RR=1.3, 95%CI: 1.0–1.7) only at the level of significance p=0.06, that is, it appears as a certain tendency.Conclusions. Hypertensive disorders associated with pregnancy are less likely to develop in women who have experienced COVID-19 in the preconception period or during pregnancy. Vaccination against COVID-19 reduces the frequency of hypertensive disorders in pregnant women, regardless of the disease presence.Since immune mechanisms, along with placental-vascular mechanisms play a significant role in the pathogenesis of preeclampsia, let’s assume that the experienced coronavirus infection or vaccination against it disrupts certain links of immunity, which results in a decrease in the frequency of hypertensive disorders in pregnant women.