Estudo caso-controle sobre o modo de nascimento de fetos de mulheres com e sem COVID-19 e os marcadores inflamatórios PCR e ferritina

Abstract

Introduction: SARS-CoV-2, the etiologic agent of coronavirus disease 2019 (COVID-19), affects the upper and lower respiratory tract with multiorgan involvement. Pregnant women are at high risk of morbidity and mortality and hospitalizations due to COVID-19 due to immunophysiological changes. Adverse perinatal outcomes and a higher number of cesarean deliveries suggest an association between coronavirus infection and pregnancy complications with worse prognosis. Ferritin and C-reactive protein are used as markers to monitor the treatment and prognosis of this disease, as they vary according to their severity. Hyperferritinemia in COVID-19 is associated with mortality in critically ill patients and negatively influences fetal development. The study aims to analyze the mode of birth and inflammatory biomarkers in pregnant women infected with the SARS-CoV-2 virus, in order to identify the most appropriate predictive marker for the gestational outcome. Methods: Paired case-control observational study. The case group included 76 pregnant women with positive diagnoses for COVID-19 and 76 age-matched control pregnant women. Sociodemographic and clinical data were collected from physical records and/or application systems at the Hospital Universitário Materno Infantil at the Federal University of Maranhão. Analyzes of serum ferritin and C-reactive protein markers were performed. Clinical and sociodemographic characteristics were analyzed in terms of frequency and percentage, categorical variables by Chi-square, G, Z and Odds Ratio tests, and numerical variables by Normality and Mann Whitney tests. Results: The participants had a mean age of 27.32 years. Data analysis showed an association between the presence of COVID-19 and the mode of birth (the probability of cesarean section among pregnant women with COVID-19 was 3 times higher than that of pregnant women without this disease - p=0.0008, and the greater probability of pregnant women with comorbidity having COVID-19: 63 times higher than those without infection - p<0.001). It was also verified that the serum ferritin biomarker is higher in the group of pregnant women with COVID-19 (p=0.0131), using the Z test for two different samples. As for the serum ferritin levels between the test and control groups with the variable mode of birth, it was found that there is a difference in ferritin levels between the two groups, both with the one who underwent vaginal delivery (p=0.0185) and the ones with cesarean section (p=0.0406). Conclusion: Pregnant women infected with the SARS-CoV-2 virus are more likely to undergo a cesarean delivery than non-infected ones, and it was observed that the inflammatory marker ferritin was significantly higher in these cases.