The Association of Serum Electrolytes with Disease Severity and Obstetric Complications in Pregnant Women with COVID-19: a Prospective Cohort Study from a Tertiary Reference Center

 

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Abstract

Introduction To evaluate the association of serum electrolytes with disease severity and obstetric complications in pregnant women with Coronavirus disease 2019 (COVID-19).

Materials and Methods This prospective cohort study was conducted on pregnant women with confirmed COVID-19. Study population was divided into two groups: 1) Mild COVID-19 group (n = 811) and 2) Moderate/severe COVID-19 group (n = 52). Demographic features, clinical characteristics, obstetric complications, and serum electrolytes were compared between the groups. Afterward, a correlation analysis was performed to investigate the association between serum electrolyte disturbances with COVID-19 severity and obstetric complications.

Results Highest serum sodium, hypernatremia, potassium replacement, hypopotassemia, hyperchloremia, initial serum magnesium, hypermagnesemia, and hypocalcemia were significantly higher in the moderate/severe COVID-19 group. The lowest serum sodium, lowest serum potassium, and initial serum calcium were significantly higher in the mild COVID-19 group (p < 0.05). Statistically significant positive weak correlations were found between hypernatremia, hypopotassemia, hyperchloremia, hypermagnesemia, hypocalcemia and COVID-19 severity (r values were 0.27, 0.20, 0.12, 0.18 and 0.12, p values were < 0.001, < 0.001, 0.02, 0.03 and 0.03, respectively). Furthermore, statistically significant positive weak correlations were found between hypopotassemia, hypochloremia, hypermagnesemia, and obstetric complications (r values were 0.10, 0.10, and 0.28, p values were 0.004, 0.03, and 0.001, respectively). A statistically significant negative weak correlation was found between hypomagnesemia and obstetric complications (r = − 0.23 and p = 0.01, respectively).

Conclusion Electrolyte disturbances in pregnant women with COVID-19 seem to be associated with disease severity and obstetric complications.

Zusammenfassung

Einleitung Ziel der Studie war es, die Verbindung zwischen dem Schweregrad der Erkrankung und den geburtshilflichen Komplikationen bei schwangeren Frauen, die nach Infektion mit SARS-CoV-2 an COVID-19 erkrankt sind, zu evaluieren.

Material und Methoden Diese prospektive Kohortenstudie wurde in einer Gruppe von schwangeren Frauen mit bestätigter COVID-19-Erkrankung durchgeführt. Die Studienpopulation wurde in 2 Gruppen unterteilt: 1) eine Gruppe bestand aus Frauen mit milder COVID-19-Erkrankung (n = 811) und 2) eine Gruppe bestand aus Frauen mit mittelschwerer/schwerer COVID-19-Erkrankung (n = 52). Die demografischen Merkmale, klinischen Charakteristika, geburtshilflichen Komplikationen und der Elektrolytspiegel beider Gruppen wurden verglichen. Danach wurde eine Korrelationsanalyse durchgeführt, um einen möglichen Zusammenhang zwischen Störungen des Elektrolytspiegels und dem COVID-19-Schweregrad bzw. den geburtshilflichen Komplikationen zu untersuchen.

Ergebnisse Die höchsten Natriumkonzentrationen im Blut, Hypernatriämie, Kaliumsubstitution, Kaliummangel, Hyperchlorämie, die anfänglichen Magnesiumkonzentrationen im Blut, Hypermagnesiämie und Hypokalzämie waren alle signifikant höher in der Gruppe mit mittelschwerer/schwerer COVID-19-Erkrankung. Die tiefsten Natriumkonzentrationen im Blut, tiefsten Kaliumkonzentrationen im Blut und die anfänglichen Kalziumkonzentrationen im Blut waren signifikant höher in der Gruppe mit milder COVID-19-Erkrankung (p < 0,05). Es gab statistisch signifikante schwache positive Korrelationen zwischen Hypernatriämie, Hypokaliämie, Hyperchlorämie, Hypermagnesiämie, Hypokalzämie und dem COVID-19-Schweregrad (der r-Wert betrug jeweils 0,27, 0,20, 0,12, 0,18 und 0,12; der p-Wert betrug jeweils < 0,001, < 0,001, 0,02, 0,03 und 0,03). Es gab auch statistisch signifikante schwache positive Korrelationen zwischen Hypokaliämie, Hyperchlorämie, Hypermagnesiämie und den geburtshilflichen Komplikationen (der r-Wert betrug jeweils 0,10, 0,10 und 0,28; der p-Wert betrug 0,004, 0,03 und 0,001). Eine statistisch signifikante schwache negative Korrelation gab es auch zwischen Hypermagnesiämie und geburtshilflichen Komplikationen (r = − 0,23 und p = 0,01).

Schlussfolgerung Es scheint eine Verbindung zwischen Störungen des Elektrolytspiegels bei schwangeren Frauen, die an COVID-19 erkrankt sind, und dem Schweregrad der Erkrankung bzw. den geburtshilflichen Komplikationen zu geben.

Publication History

Received: 08 June 2021

Accepted after revision: 01 August 2021

Article published online:
03 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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• References

• 1 Fenwick M, McCahery JA, Vermeulen EPM. Will the World Ever Be the Same After COVID-19? Two Lessons from the First Global Crisis of a Digital Age. Eur Bus Org Law Rev 2021; 22: 125-145
  CrossrefPubMedGoogle Scholar
• 2 Zambrano LD, Ellington S, Strid P. et al. CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status – United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 1641-1647
  CrossrefPubMedGoogle Scholar
• 3 Allotey J, Stallings E, Bonet M. et al. for PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370: m3320
  CrossrefPubMedGoogle Scholar
• 4 Bein B, Bachmann M, Huggett S. et al. SARS-CoV-2/COVID-19: Evidence-Based Recommendations on Diagnosis and Therapy. Geburtshilfe Frauenheilkd 2020; 80: 491-498
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Singh S, Nair VG, Singh VV. et al. Pregnancy-Specific Concerns and Psychological Impact of COVID-19 on Antenatal Women. GORM 2021; 1-6 [online ahead of print]
  CrossrefPubMedGoogle Scholar
• 6 Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ 2020; 368: m1198
  CrossrefPubMedGoogle Scholar
• 7 Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G. board of the OEGGG. COVID-19 During Pregnancy and Puerperium – A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd 2020; 80: 813-819
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Stumpfe FM, Titzmann A, Schneider MO. et al. SARS-CoV-2 Infection in Pregnancy – a Review of the Current Literature and Possible Impact on Maternal and Neonatal Outcome. Geburtshilfe Frauenheilkd 2020; 80: 380-390
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem 2020; 57: 262-265
  CrossrefPubMedGoogle Scholar
• 10 Tezcan ME, Dogan Gokce G, Sen N. et al. Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients. New Microbes New Infect 2020; 37: 100753
  CrossrefPubMedGoogle Scholar
• 11 Sarvazad H, Cahngaripour SH, Eskandari Roozbahani N. et al. Evaluation of electrolyte status of sodium, potassium and magnesium, and fasting blood sugar at the initial admission of individuals with COVID-19 without underlying disease in Golestan Hospital, Kermanshah. New Microbes New Infect 2020; 38: 100807
  CrossrefPubMedGoogle Scholar
• 12 Taheri M, Bahrami A, Habibi P. et al. A Review on the Serum Electrolytes and Trace Elements Role in the Pathophysiology of COVID-19. Biol Trace Elem Res 2021; 199: 2475-2481
  CrossrefPubMedGoogle Scholar
• 13 Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol 2009; 114: 1326-1331
  CrossrefPubMedGoogle Scholar
• 14 Turğal M, Yazıcıoğlu A, Beksaç K. et al. Pregnancy Outcome of Renal Transplant Recipients: Analysis of Nine Patients. GORM 2016; 19: 162-164
  PubMedGoogle Scholar
• 15 Sahin D, Tanacan A, Erol SA. et al. Updated experience of a tertiary pandemic center on 533 pregnant women with COVID-19 infection: A prospective cohort study from Turkey. Int J Gynaecol Obstet 2021; 152: 328-334
  CrossrefPubMedGoogle Scholar
• 16 Tanacan A, Erol SA, Turgay B. et al. The rate of SARS-CoV-2 positivity in asymptomatic pregnant women admitted to hospital for delivery: Experience of a pandemic center in Turkey. Eur J Obstet Gynecol Reprod Biol 2020; 253: 31-34
  CrossrefPubMedGoogle Scholar
• 17 Turkish Ministry of Health, General Directorate of Public Health. COVİD-19 (SARS-CoV-2 infection) Guideline, Scientific Committee Report. Accessed May 01, 2021 at: https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi.pdf?type=file
  PubMedGoogle Scholar
• 18 Rasmussen SA, Smulian JC, Lednicky JA. et al. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020; 222: 415-426
  CrossrefPubMedGoogle Scholar
• 19 Recker F, Weber E, Strizek B. et al. Lung Sonography in Obstetrics during COVID-19. Geburtshilfe Frauenheilkd 2020; 80: 1026-1032
  Article in Thieme ConnectPubMedGoogle Scholar
• 20 Yurtcu E, Mutlu S, Ozkaya E. The Effects of Pre-Pregnancy Body Mass Index and Weight Gain During Pregnancy on Perinatal Outcomes: A Retrospective Cohort Study. GORM 2021; DOI: 10.21613/GORM.2021.1149.
  CrossrefPubMedGoogle Scholar
• 21 Wiersinga WJ, Rhodes A, Cheng AC. et al. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA 2020; 324: 782-793
  CrossrefPubMedGoogle Scholar
• 22 Cavalcante MB, Cavalcante CTMB, Braga ACS. et al. COVID-19 Treatment: Drug Safety Prior to Conception and During Pregnancy and Breastfeeding. Geburtshilfe Frauenheilkd 2021; 81: 46-60
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Karasu Y, Dilbaz B, Ülker K. Renal Failure in Pregnancy: Case Reports and Review of the Literature. GORM 2016; 21: 161-166
  PubMedGoogle Scholar
• 24 Kohlhepp LM, Hollerich G, Vo L. et al. [Physiological changes during pregnancy]. Anaesthesist 2018; 67: 383-396
  CrossrefPubMedGoogle Scholar
• 25 Anuk AT, Polat N, Akdas S. et al. The Relation Between Trace Element Status (Zinc, Copper, Magnesium) and Clinical Outcomes in COVID-19 Infection During Pregnancy. Biol Trace Elem Res 2020; DOI: 10.1007/s12011-020-02496-y.
  CrossrefPubMedGoogle Scholar