The eight pregnant women were in their third trimester, six underwent cesarean section, and two underwent eutocia (Table 1). Their ages ranged from 26 to 35 years, and the range of gestational weeks at admission was from 33 weeks (+ 6 days) to 40 weeks (+ 4 days).
Characteristic Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 Patient 8 Age (years) 28 31 30 30 30 26 29 35 Gestational age on admission 39 weeks 38 weeks, 1 day 39 weeks, 1 day 36 weeks, 4 days 37 weeks, 6 days 40 weeks, 3 days 40 weeks, 4 days 33 weeks, 6 days Onset to delivery (days) Post-partum 1 Post-partum 1 No No No No Post-partum 2 Pre-partum 1 Fever on admission No No No No No No No Yes Post-partum fever Yes Yes No No No No Yes No Cough No No No No No No No No Other symptoms No No No No No No No No CT evidence of pneumonia Pre-partum typical signs of viral infection No No No Yes Yes Yes No Yes Post-partum typical signs of viral infection No No Yes Yes Yes Yes Yes Yes SARS-CoV-2 RNA Yes Yes Yes Yes Yes Yes NA NA Delivery Method of Delivery C-section C-section C-section C-section Vaginal delivery C-section Vaginal delivery C-section Indication for C-section History of C-section PROM Pre-eclampsia PROM Fetal distress History of C-section Treatment Intensive unit care No No No No No No No No Mechanical ventilation No No No No No No No No NA, not available; C-section; cesarean section; PROM, premature rupture of membrane.
Table 1. Baseline characteristics of 8 pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Seven of the eight patients had no fever, cough, or other symptoms before delivery. Three of the seven patients developed fever at the 1 or 2 days postpartum, and one demonstrated the typical ground-glass opacities in the lungs on chest CT scans as described previously (Huang et al. 2020) (Table 1; Fig. 1). The remaining four patients did not present with symptoms after delivery. Among which, three had typical ground-glass opacities in the lungs in chest CT scans before delivery and one developed ground-glass opacities in chest CT scans after delivery (Table 1; Fig. 1). One of the eight patients had fever and typical ground-glass opacities on admission at 1-day pre-partum. None of the patients had a high fever (body temperature > 39 ℃) or developed a severe pneumonia, requiring intensive unit care or mechanical ventilation (Table 1).
Figure 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.
Laboratory test outcomes suggested that the white blood cell (WBC) counts of all eight patients were normal (patients 1–4 and 6–8) or slightly higher than the upper normal limit (patient 5) before delivery (Fig. 2A). However, the WBC counts of six patients drastically increased (patients 1–3, 5–6, and 8) after delivery, specifically for patients 1–2 and 5–6 (Fig. 2A). In contrast, a slight increase in WBC counts was observed in pregnant patients, excluding those with SARS-CoV-2 infection after delivery (Fig. 2B). The lymphocyte (LYMPH) counts were normal (patients 1–6 and 8) or slightly lower than the normal lower limit (patient 7) before delivery (Fig. 2A). However, the LYMPH counts of five patients drastically decreased (patients 1–3, 5–6) lower than the normal lower limit after delivery (Fig. 2A). In contrast, there were no obvious changes in the LYMPH counts of the pregnant patients without the SARS-CoV-2 infection between pre-partum and post-partum (Fig. 2B).
Figure 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.
Furthermore, we closely monitored the C-reactive protein (CRP) levels, since it is an important marker and gauge of inflammation in the body (Wu et al. 2015). Its levels were normal and comparable between pregnant women with SARS-CoV-2 infection and pregnant women without the SARS-CoV-2 infection before delivery (Fig. 3A). Patient CRP levels drastically increased postpartum. However, the mean serum CRP level was higher in patients with SARS-CoV-2 infection than in those without (Fig. 3A and Supplementary Table S1). D-dimer is one of the most important procoagulant markers, which may be elevated during viral infections (Subramaniam and Scharrer 2018). The plasma D-dimer levels during the prepartum period were normal and comparable between pregnant women with SARS-CoV-2 infection and those without (Fig. 3B). However, D-dimer levels of four patients with SARS-CoV-2 infection increased significantly postpartum, but did not change in the five patients without SARS-CoV-2 infection (Fig. 3B and Supplementary Table S1). Both creatine kinase (CK) and creatine kinase-MB (CK-MB) levels increased in four pregnant women with SARS-CoV-2 infection after delivery (Fig. 3C, 3D and Supplementary Table S1). In terms of other laboratory tests, all eight patients with confirmed or highly suspected SARS-CoV-2 infection had normal levels of liver enzymes.
Figure 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.
All patients received empirical antibiotic treatment and supportive care. None of the eight patients required intensive care or mechanical ventilation.