Immunoinflammatory changes in the severe course of COVID-19 in pregnant women




coronavirus disease, pregnant women, cytokine storm, immune-inflammatory changes


Pregnant women are the most sensitive contingent to the effects of the virus and this is due to adaptive physiological changes in the woman’s bronchopulmonary system and features of the immune system. “Physiological tolerance” is formed during pregnancy and this is accompanied by a decrease in the level of T-helpers and natural killers in pregnant women and leads to a decrease in the resistance of the woman’s body to the action of altering viral and bacterial agents.

Purpose - to reveal the peculiarities and clarify the nature of clinical and instrumental changes in pregnant women with a severe course of COVID-19 under dynamic observation.

Materials and methods. The study included 40 pregnant women with coronavirus disease with a gestational age of 22 to 41 weeks, who formed the main group. The control group consisted of 40 women whose pregnancies were not complicated by coronavirus disease. The course of the disease and the influence of the coronavirus infection on the course of pregnancy were evaluated according to the results of: general - clinical examination, laboratory examination (general blood test, biochemical blood test, coagulogram, C-reactive protein, D-dimer, procalcitonin and interleukin 6), instrumental examination (cardiotocographic research, pulse oximetry).

Results. Peculiarities of changes in clinical and laboratory indicators in pregnant women were studied depending on the stage of development of the coronavirus disease. During the study, it was established: a significant increase in the level of indicators in accordance with the control group, namely an increase in leukocytes by 38.2% to 10.07±1.59×109/l (р<0.05), an increase in thrombocytes by 35% to 314.36±49.70 (р<0.05), an increase in monocytes by 22.5% to 7.08±1.12 and a decrease in lymphocytes to 13.46±2.13, which is 51.2% lower than the indicators of the control group. The level of C-reactive protein in pregnant women with COVID-19 is probably higher than in all groups of examined patients. The level of D-dimer exceeded the indicators of the control group in patients of all groups with the maximum values of indicators in patients at the time of admission to department of anaesthesiology and intense therapy (DAIT) and was 4867.42 ng FEU/ml, which was 6.3 times higher than the level of the control group (p<0.05). It should be noted that the amount of interleukin-6 in patients of all studied groups was statistically higher than that of the control group.

Conclusions. Immune-inflammatory blood changes in pregnant women occur in the case of a severe course of COVID-19 and are accompanied by an increase in the level of interleukin-6 at all stages of the severe course of the disease. СRP is a marker of the severe course of the coronavirus disease in pregnant women. The identified changes are accompanied by coagulopathy and hypercoagulation with increased D-dimer content in patients with a severe course of the disease.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Author Biographies

O.O. Karlova, Shupyk National Healthcare University of Ukraine, Kyiv

CNCE “Kyiv City Center of Reproductive and Perinatal Medicine”, Ukraine

A.V. Balan, Shupyk National Healthcare University of Ukraine, Kyiv

CNCE “Kyiv City Center of Reproductive and Perinatal Medicine”, Ukraine


Brodin P. (2020). Why is COVID-19 so mild in children? Acta Paediatr. 109 (6): 1082-1083.; PMid:32212348

Cao Q, Chen Y, Chen C, Chiu C. (2020). SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. J. Formos. Med. Assoc. 119 (3): 670-673.; PMid:32139299 PMCid:PMC7126646

Carlotti APCP, Carvalho WB, Johnston CJ et al. (2020). COVID-19 diagnostic and management protocol for pediatric patients. Clinics. 75: e1894.; PMid:32321116 PMCid:PMC7153362

Dong Y, Mo X, Hu Y et al. (2020). Epidemiology of COVID-19 among children in China. Pediatrics. 145 (6): e20200702.; PMid:32179660

Gudbjartsson DF, Helgason A, Jonsson H et al. (2020). Spread of SARS-CoV-2 in the Icelandic population. N. Engl. J. Med. 382: 2302-2315.; PMid:32289214 PMCid:PMC7175425

Hong H, Wang Y, Chung H, Chen C. (2020). Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborns, infants and children. Pediatr. Neonatol. 61 (2): 131-132.; PMid:32199864 PMCid:PMC7129773

Irfan O, Tang K, Arii M, Bhutta ZA. (2020). Epidemiology, spectrum, and impact of COVID-19 on children, adolescents, and pregnant women. Pediatric Pharmacology. 17 (4): 352-359.

Jackson DJ, Busse WW, Bacharier LB et al. (2020). Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2. J. Allergy Clin. Immunol. 146 (1): 203-206.e3.; PMid:32333915 PMCid:PMC7175851

Lu X, Zhang L, Du H et al. (2020). SARS-CoV-2 infection in children. N. Engl. J. Med. 382 (17): 1663-1665.; PMid:32187458 PMCid:PMC7121177

Ministerstvo Okhorony Zdorovia Ukrainy. (2020). Protokol «Nadannia medychnoi dopomohy dlia likuvannia koronavirusnoi khvoroby (COVID-19)». Kyiv: MOZ Ukrainy. URL:

MOZ Ukrainy. (2020). Standarty medychnoi dopomohy «Koronavirusna khvoroba (COVID-19). Nakaz MOZ Ukrainy vid 28.03.2020 No. 722.

MOZ Ukrainy. (2022). Pro vnesennia zmin do Standartiv medychnoi dopomohy «Koronavirusna khvoroba (COVID-19)». Nakaz MOZ Ukrainy vid 04.02.2022 No. 230.

Schelkanov MYu, Popova AYu, Dedkov VG i dr. (2020). Istoriya izucheniya i sovremennaya klassifikatsiya koronavirusov (Nidovirales: Coronaviridae). Infektsiya i immunitet. 10 (2): 221-246.

Starshinova AA, Kushnareva EA, Malkova AM i dr. (2020). Novaya koronavirusnaya infektsiya: osobennosti klinicheskogo techeniya, vozmozhnosti diagnostiki, lecheniya i profilaktiki infektsii u vzroslyih i detey. Voprosyi sovremennoy pediatrii. 2 (19): 123-131.

Tagarro A, Epalza C, Santos M et al. (2020). Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatr: e201346.; PMid:32267485 PMCid:PMC7142799

World Health Organization. (2020, May 27). Clinical management of COVID-19: interim guidance. URL:

Xu Y, Li X, Zhu B et al. (2020). Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat. Med. 26 (4): 502-505.; PMid:32284613 PMCid:PMC7095102

Zang R, Castro MFG, McCune BT et al. (2020). TMPRSS2 and TMPRSS4 promote SARS-CoV-2 infection of human small intestinal enterocytes. Sci. Immunol. 5 (47): eabc3582.; PMid:32404436 PMCid:PMC7285829

Zaplatnikov AL, Svintsitskaya VI. (2020). COVID-19 i deti. RMZh. 6: 20-22.

Zhang J, Wang S, Xue Y. (2020). Fecal specimen diagnosis 2019 novel coronavirus - infected pneumonia. J. Med. Virol. 92 (6): 680-682.; PMid:32124995 PMCid:PMC7228355