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COVID-19 у беременных и небеременных пациенток раннего репродуктивного возраста
COVID-19 у беременных и небеременных пациенток раннего репродуктивного возраста
Белокриницкая Т.Е., Фролова Н.И., Шаповалов К.Г., Колмакова К.А., Анохова Л.И., Авраченкова А.В., Преймак С.В., Григорьев А.В., Филёва Т.Ю., Горбунова А.Н., Дунаев Д.А., Сербина К.С. COVID-19 у беременных и небеременных пациенток раннего репродуктивного возраста. Гинекология. 2021; 23 (3): 255–259. DOI: 10.26442/20795696.2021.3.200882
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Аннотация
Цель. Выявить конфаундинг-факторы, особенности клинического течения и исходов COVID-19 у беременных и небеременных пациенток раннего репродуктивного возраста, не имеющих известных факторов риска и преморбидного фона.
Материалы и методы. В исследование вошли 163 беременные в III триместре гестации, 100 небеременных женщин с лабораторно подтвержденной SARS-CoV-2-инфекцией и 100 беременных, не заболевших. Пациентки всех групп были сопоставимы по возрасту (18–35 лет), социальному статусу, паритету, индексу массы тела, не имели известных факторов риска COVID-19; заболевшие находились на лечении одновременно.
Результаты. Выявлена статистически значимая ассоциативная связь инфекции COVID-19 у беременных с наличием железодефицитной анемии, вегетососудистой дистонии, принадлежностью к бурятской этнической группе, курением. У беременных симптомы COVID-19 чаще отсутствовали (23,3% vs 5%; р<0,001) или заболевание протекало в легкой форме (58,9% vs 24%; р<0,001). У небеременных пациенток течение инфекции чаще было среднетяжелое (61% vs 14,7%; р<0,001) и тяжелое (10% vs 3,1%; р=0,038). Из клинических проявлений новой коронавирусной инфекции (НКИ) у беременных преобладали аносмия (87,7% vs 40%; р<0,001), сонливость (68,7% vs 17%; р<0,001), одышка даже при легкой степени поражения легких (68,1% vs 19%; р<0,001), головная боль (41,7% vs 24%; р=0,006), артралгии (29,4% vs 16%; р=0,021), значительно реже отмечались лихорадка выше 38°С (7,4% vs 28%; р<0,001) и кашель (38,7% vs 61%; р<0,001). Пневмонии при компьютерной томографии у беременных диагностированы кратно реже (21,4% vs 87,4%; р<0,001). Один летальный исход отмечен в группе небеременных (1% vs 0%; р=0,201) и был связан с поздней госпитализацией при тяжелой форме НКИ с изменениями в легких 4-й степени при компьютерной томографии.
Заключение. Конфаундерами COVID-19 у беременных, не имеющих известных факторов риска в III триместре гестации, являются железодефицитная анемия, вегетососудистая дистония, принадлежность к бурятской субпопуляции, курение. У беременных основные клинические симптомы SARS-CoV-2-инфекции, за исключением потери обоняния, были неспецифичны и характерны для физиологического течения поздних сроков гестации: сонливость, одышка, боли в суставах. Преобладание у беременных легких и бессимптомных форм инфекционного процесса, меньшая частота развития пневмонии, отсутствие летальных исходов позволяет сделать вывод о более благоприятном течении НКИ COVID-19.
Ключевые слова: беременность, репродуктивный период, коронавирусная инфекция, COVID-19, клиника, пневмония, факторы риска
Materials and methods. The study included 163 pregnant women in the third trimester of gestation, 100 non-pregnant women with laboratory-confirmed SARS-CoV-2 infection and 100 pregnant women who did not get sick. Patients of all groups were comparable in age (18–35 years), social status, parity, body mass index, had no known risk factors for COVID-19; those who got sick were treated simultaneously.
Results. Statistically significant associations were revealed between COVID-19 infection in the pregnant and iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat ethnicity, and smoking. Pregnant women with COVID-19 were more likely to have no symptoms (23.3% vs 5%; p<0.001) or had a mild course of the disease (58.9% vs 24%; p<0.001). In non-pregnant patients, the course of infection was more often moderate (61% vs 14.7%; p<0.001) or severe (10% vs 3.1%; p=0.038). Clinical manifestations of new coronavirus infection (NCV) in pregnant women were dominated by anosmia (87.7% vs 40%; p<0.001), drowsiness (68.7% vs 17%; p<0.001), dyspnea, even with a mild lung lesion (68.1% vs 19%; p<0.001), headache (41.7% vs 24%; p=0.006), arthralgia (29.4% vs 16%; p=0.021), while fever above 38 °C (7.4% vs 28%; p<0.001) and cough (38.7% vs 61%; p<0.001) were much less common. With computed tomography, pneumonia in pregnant women was diagnosed several times less often (21.4% vs 87.4%; p<0.001). In the non-pregnant group, there was one death (1% vs 0%; p=0.201) associated with late hospitalization for severe NCI with grade 4 pulmonary involvement as shown on computed tomography.
Conclusion. Confounders of COVID-19 in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat subpopulation, and smoking. In pregnant women, the main clinical symptoms of SARS-CoV-2 infection, with the exception of loss of smell, were nonspecific and characteristic of the physiological course of late gestation: drowsiness, dyspnea, joint pain. The predominance of mild or asymptomatic forms of infection, the lower incidence of pneumonia, and the absence of deaths in pregnant women suggests a more favorable course of COVID-19 NCI.
Keywords: pregnancy, reproductive period, coronavirus infection, COVID-19, clinic, pneumonia, risk factors
Материалы и методы. В исследование вошли 163 беременные в III триместре гестации, 100 небеременных женщин с лабораторно подтвержденной SARS-CoV-2-инфекцией и 100 беременных, не заболевших. Пациентки всех групп были сопоставимы по возрасту (18–35 лет), социальному статусу, паритету, индексу массы тела, не имели известных факторов риска COVID-19; заболевшие находились на лечении одновременно.
Результаты. Выявлена статистически значимая ассоциативная связь инфекции COVID-19 у беременных с наличием железодефицитной анемии, вегетососудистой дистонии, принадлежностью к бурятской этнической группе, курением. У беременных симптомы COVID-19 чаще отсутствовали (23,3% vs 5%; р<0,001) или заболевание протекало в легкой форме (58,9% vs 24%; р<0,001). У небеременных пациенток течение инфекции чаще было среднетяжелое (61% vs 14,7%; р<0,001) и тяжелое (10% vs 3,1%; р=0,038). Из клинических проявлений новой коронавирусной инфекции (НКИ) у беременных преобладали аносмия (87,7% vs 40%; р<0,001), сонливость (68,7% vs 17%; р<0,001), одышка даже при легкой степени поражения легких (68,1% vs 19%; р<0,001), головная боль (41,7% vs 24%; р=0,006), артралгии (29,4% vs 16%; р=0,021), значительно реже отмечались лихорадка выше 38°С (7,4% vs 28%; р<0,001) и кашель (38,7% vs 61%; р<0,001). Пневмонии при компьютерной томографии у беременных диагностированы кратно реже (21,4% vs 87,4%; р<0,001). Один летальный исход отмечен в группе небеременных (1% vs 0%; р=0,201) и был связан с поздней госпитализацией при тяжелой форме НКИ с изменениями в легких 4-й степени при компьютерной томографии.
Заключение. Конфаундерами COVID-19 у беременных, не имеющих известных факторов риска в III триместре гестации, являются железодефицитная анемия, вегетососудистая дистония, принадлежность к бурятской субпопуляции, курение. У беременных основные клинические симптомы SARS-CoV-2-инфекции, за исключением потери обоняния, были неспецифичны и характерны для физиологического течения поздних сроков гестации: сонливость, одышка, боли в суставах. Преобладание у беременных легких и бессимптомных форм инфекционного процесса, меньшая частота развития пневмонии, отсутствие летальных исходов позволяет сделать вывод о более благоприятном течении НКИ COVID-19.
Ключевые слова: беременность, репродуктивный период, коронавирусная инфекция, COVID-19, клиника, пневмония, факторы риска
________________________________________________
Materials and methods. The study included 163 pregnant women in the third trimester of gestation, 100 non-pregnant women with laboratory-confirmed SARS-CoV-2 infection and 100 pregnant women who did not get sick. Patients of all groups were comparable in age (18–35 years), social status, parity, body mass index, had no known risk factors for COVID-19; those who got sick were treated simultaneously.
Results. Statistically significant associations were revealed between COVID-19 infection in the pregnant and iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat ethnicity, and smoking. Pregnant women with COVID-19 were more likely to have no symptoms (23.3% vs 5%; p<0.001) or had a mild course of the disease (58.9% vs 24%; p<0.001). In non-pregnant patients, the course of infection was more often moderate (61% vs 14.7%; p<0.001) or severe (10% vs 3.1%; p=0.038). Clinical manifestations of new coronavirus infection (NCV) in pregnant women were dominated by anosmia (87.7% vs 40%; p<0.001), drowsiness (68.7% vs 17%; p<0.001), dyspnea, even with a mild lung lesion (68.1% vs 19%; p<0.001), headache (41.7% vs 24%; p=0.006), arthralgia (29.4% vs 16%; p=0.021), while fever above 38 °C (7.4% vs 28%; p<0.001) and cough (38.7% vs 61%; p<0.001) were much less common. With computed tomography, pneumonia in pregnant women was diagnosed several times less often (21.4% vs 87.4%; p<0.001). In the non-pregnant group, there was one death (1% vs 0%; p=0.201) associated with late hospitalization for severe NCI with grade 4 pulmonary involvement as shown on computed tomography.
Conclusion. Confounders of COVID-19 in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat subpopulation, and smoking. In pregnant women, the main clinical symptoms of SARS-CoV-2 infection, with the exception of loss of smell, were nonspecific and characteristic of the physiological course of late gestation: drowsiness, dyspnea, joint pain. The predominance of mild or asymptomatic forms of infection, the lower incidence of pneumonia, and the absence of deaths in pregnant women suggests a more favorable course of COVID-19 NCI.
Keywords: pregnancy, reproductive period, coronavirus infection, COVID-19, clinic, pneumonia, risk factors
Полный текст
Список литературы
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J Perinat Med. 2020;48(9):950-8. DOI:10.1515/jpm-2020-0355
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DOI:10.18565/aig.2021.2.48-54
7. Organization of medical care for pregnant women, women in labor, women in labor and newborns with a new coronavirus infection COVID-19. Methodological recommendations. Version 3 (25.01.2021). Ministry of Health of Russia. Available at:
https://covid19.rosminzdrav.ru/wp-content/uploads/2021/01/25012021_b_covid-19_3.pdf. Accessed: 15.03.2021 (in Russian)
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10. Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. DOI:10.1136/bmj.m2107
11. Belokrinitskaya TE, Frolova NI, Anohova LI. Molecular genetic predictors of pregnancy complications. Novosibirsk: Nauka, 2019 (in Russian)
12. Strambovskaya NN. Clinical and some pathogenetic aspects of the carrier of genetic polymorphism in patients with acute and chronic brain ischemia. Dis. D. Sci. (Med.). Tomsk, 2019 (in Russian)
13. Belokrinitskaya TE, Shapovalov KG. Influenza and Pregnancy. Moscow: GEOTAR-Media, 2015 (in Russian)
14. Abramovici A, Gandley RE, Clifton RG, et al. Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. BJOG. 2015;122(13):1740-7. DOI:10.1111/1471-0528.13201
15. Gryzunova EM, Sovershaeva SL, Soloviev AG, et al. Hemodynamics state in “mother-placenta-fetus” system of pregnant smokers. Ekologiya cheloveka. 2016;9:15-20 (in Russian) DOI:10.33396/1728-0869-2016-9-15-20
16. Kohlhammer Y, Schwartz M, Raspe H, Schäfer T. Risk factors for community acquired pneumonia (CAP). A systematic review. Dtsch Med Wochenschr. 2005;130(8):381-6. DOI:10.1055/s-2005-863061
17. Tang YM, Chen XZ, Li GR, et al. Effects of iron deficiency anemia on immunity and infectious disease in pregnant women. Wei Sheng Yan Jiu. 2006;35(1):79-81.
18. Garzon S, Cacciato PM, Certelli C, et al. Iron Deficiency Anemia in Pregnancy: Novel Approaches for an Old Problem. Oman Med J. 2020;35(5):e166. DOI:10.5001/omj.2020.108
19. Poverennova IE, Zakharov AV. Vegetative dysfunction – an actual problem of our time. Modern therapy and prevention of vegetative-vascular dystonia. Remedium. 2014;8(128):17-21 (in Russian)
20. Galinova IV. Neurocirculatory or vegetative dystonia and pregnancy. Ural Medical Journal. 2019;2(170):42-6 (in Russian)
21. Gazdag G, Szabo Z, Szlavik J. Psychiatric aspects of infectious diseases –
a literature review. Neuropsychopharmacol Hung. 2014;16(4):181-7.
22. Sethi R, Gómez-Coronado N, Walker AJ, et al. Neurobiology and Therapeutic Potential of Cyclooxygenase-2 (COX-2) Inhibitors for Inflammation in Neuropsychiatric Disorders. Front Psychiatry. 2019;10:605. DOI:10.3389/fpsyt.2019.00605
23. WHO. Policy brief. Preconception care: maximizing the gains for maternal and child health. Geneva: World Health Organization, 2013. Available at: https://www.who.int/maternal_child_adolescent/documents/preconception_care_policy_brief.pdf. Accessed: 15.03.2021.
24. Antenatal care for uncomplicated pregnancies. NICE guideline. NICE, 2019. Available at: https://www.nice.org.uk/guidance/cg62/chapter/1-Guidance25. Accessed: 15.03.2021.
25. Dolgushina NV, Artymuk NV, Belokrinitskaya TE, et al. Normal pregnancy. Clinical recommendations. Moscow, 2020. Available at: https://minzdravao.ru/sites/default/files/2020/1/normalnaya_beremennost.pdf. Accessed: 15.03.2021 (in Russian)
2. COVID-19 Coronavirus pandemic. Available at: https://www.worldometers.info/coronavirus/. Accessed: 15.03.2021.
3. Di Mascio D, Sen C, Saccone G, et al. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.
J Perinat Med. 2020;48(9):950-8. DOI:10.1515/jpm-2020-0355
4. Jafari M, Pormohammad A, Neshin SSA, et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis. Rev Med Virol. 2021:e2208. DOI:10.1002/rmv.2208
5. Zambrano LD, Ellington S, Strid P, et al. 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(44):1641-7. DOI:10.15585/mmwr.mm6944e3
6. Белокриницкая Т.Е., Артымук Н.В., Филиппов О.С., Фролова Н.И. Клиническое течение, материнские и перинатальные исходы новой коронавирусной инфекции COVID-19 у беременных Сибири и Дальнего Востока. Акушерство и гинекология. 2021;2:48-54 [Belokrinitskaya TE, Artymuk NV, Filippov OS, Frolova NI. Clinical course, maternal and perinatal outcomes of 2019 novel coronavirus infectious disease (COVID-19) in pregnant women in Siberia and Far East. Akusherstvo i Ginekologiya. 2021;2:48-54 (in Russian)]. DOI:10.18565/aig.2021.2.48-54
7. Организация оказания медицинской помощи беременным, роженицам, родильницам и новорожденным при новой коронавирусной инфекции COVID-19. Методические рекомендации. Версия 3 (25.01.2021). Минздрав России. Режим доступа: https://covid19.rosminzdrav.ru/wp-content/uploads/2021/01/25012021_b_covid-19_3.pdf. Ссылка активна на 15.03.2021 [Organization of medical care for pregnant women, women in labor, women in labor and newborns with a new coronavirus infection COVID-19. Methodological recommendations. Version 3 (25.01.2021). Ministry of Health of Russia. Available at:
https://covid19.rosminzdrav.ru/wp-content/uploads/2021/01/25012021_b_covid-19_3.pdf. Accessed: 15.03.2021 (in Russian)].
8. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Временные методические рекомендации. Версия 10 (08.02.2021). Минздрав России. Режим доступа: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/054/588/original/%D0%92%D1%80%D0%B5.... Ссылка активна на 15.03.2021 [Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). The provisional guidelines. Version 10 (08.02.2021). Ministry of Health of Russia. Available at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/054/588/original/%D0%92%D1%80%D0%B5.... Accessed: 15.03.2021 (in Russian)].
9. Coronavirus (COVID-19) Infection in Pregnancy. Information for healthcare professionals. Version 12 (14.10.2020). RCOG. Available at: https://www.rcm.org.uk/media/4383/2020-10-14-coronavirus-covid-19-infection-in-pregnancy-v12.pdf. Accessed: 15.03.2021.
10. Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. DOI:10.1136/bmj.m2107
11. Белокриницкая Т.Е., Фролова Н.И., Анохова Л.И. Молекулярно-генетические предикторы осложнений беременности. Новосибирск: Наука, 2019 [Belokrinitskaya TE, Frolova NI, Anohova LI. Molecular genetic predictors of pregnancy complications. Novosibirsk: Nauka, 2019 (in Russian)].
12. Страмбовская Н.Н. Клинические и некоторые патогенетические аспекты носительства генетического полиморфизма у больных острой и хронической ишемией мозга. Дис. … д-ра мед. наук. Томск, 2019 [Strambovskaya NN. Clinical and some pathogenetic aspects of the carrier of genetic polymorphism in patients with acute and chronic brain ischemia. Dis. D. Sci. (Med.). Tomsk, 2019 (in Russian)].
13. Белокриницкая Т.Е., Шаповалов К.Г. Грипп и беременность. М.: ГЭОТАР-Медиа, 2015 [Belokrinitskaya TE, Shapovalov KG. Influenza and Pregnancy. Moscow: GEOTAR-Media, 2015 (in Russian)].
14. Abramovici A, Gandley RE, Clifton RG, et al. Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. BJOG. 2015;122(13):1740-7. DOI:10.1111/1471-0528.13201
15. Грызунова Е.М., Совершаева С.Л., Соловьев А.Г., и др. Состояние гемодинамики в системе «мать-плацента-плод» у курящих беременных. Экология человека. 2016;9:15-20 [Gryzunova EM, Sovershaeva SL, Soloviev AG, et al. Hemodynamics state in “mother-placenta-fetus” system of pregnant smokers. Ekologiya cheloveka. 2016;9:15-20 (in Russian)]. DOI:10.33396/1728-0869-2016-9-15-20
16. Kohlhammer Y, Schwartz M, Raspe H, Schäfer T. Risk factors for community acquired pneumonia (CAP). A systematic review. Dtsch Med Wochenschr. 2005;130(8):381-6. DOI:10.1055/s-2005-863061
17. Tang YM, Chen XZ, Li GR, et al. Effects of iron deficiency anemia on immunity and infectious disease in pregnant women. Wei Sheng Yan Jiu. 2006;35(1):79-81.
18. Garzon S, Cacciato PM, Certelli C, et al. Iron Deficiency Anemia in Pregnancy: Novel Approaches for an Old Problem. Oman Med J. 2020;35(5):e166. DOI:10.5001/omj.2020.108
19. Повереннова И.Е., Захаров А.В. Вегетативная дисфункция – актуальная проблема современности. Современная терапия и профилактика вегетососудистой дистонии. Ремедиум. 2014;8(128):17-21
[Poverennova IE, Zakharov AV. Vegetative dysfunction – an actual problem of our time. Modern therapy and prevention of vegetative-vascular dystonia. Remedium. 2014;8(128):17-21 (in Russian)].
20. Галинова И.В. Нейроциркуляторная или вегетососудистая дистония и беременность. Уральский медицинский журнал. 2019;2(170):42-6 [Galinova IV. Neurocirculatory or vegetative dystonia and pregnancy. Ural Medical Journal. 2019;2(170):42-6 (in Russian)].
21. Gazdag G, Szabo Z, Szlavik J. Psychiatric aspects of infectious diseases –
a literature review. Neuropsychopharmacol Hung. 2014;16(4):181-7.
22. Sethi R, Gómez-Coronado N, Walker AJ, et al. Neurobiology and Therapeutic Potential of Cyclooxygenase-2 (COX-2) Inhibitors for Inflammation in Neuropsychiatric Disorders. Front Psychiatry. 2019;10:605. DOI:10.3389/fpsyt.2019.00605
23. WHO. Policy brief. Preconception care: maximizing the gains for maternal and child health. Geneva: World Health Organization, 2013. Available at: https://www.who.int/maternal_child_adolescent/documents/preconception_care_policy_brief.pdf. Accessed: 15.03.2021.
24. Antenatal care for uncomplicated pregnancies. NICE guideline. NICE, 2019. Available at: https://www.nice.org.uk/guidance/cg62/chapter/1-Guidance25. Accessed: 15.03.2021.
25. Долгушина Н.В., Артымук Н.В., Белокриницкая Т.Е., и др. Нормальная беременность. Клинические рекомендации. М., 2020. Режим доступа: https://minzdravao.ru/sites/default/files/2020/1/normalnaya_beremennost.pdf. Ссылка активна на 15.03.2021 [Dolgushina NV, Artymuk NV, Belokrinitskaya TE, et al. Normal pregnancy. Clinical recommendations. Moscow, 2020. Available at: https://minzdravao.ru/sites/default/files/2020/1/normalnaya_beremennost.pdf. Accessed: 15.03.2021 (in Russian)].
________________________________________________
2. COVID-19 Coronavirus pandemic. Available at: https://www.worldometers.info/coronavirus/. Accessed: 15.03.2021.
3. Di Mascio D, Sen C, Saccone G, et al. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.
J Perinat Med. 2020;48(9):950-8. DOI:10.1515/jpm-2020-0355
4. Jafari M, Pormohammad A, Neshin SSA, et al. Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis. Rev Med Virol. 2021:e2208. DOI:10.1002/rmv.2208
5. Zambrano LD, Ellington S, Strid P, et al. 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(44):1641-7. DOI:10.15585/mmwr.mm6944e3
6. Belokrinitskaya TE, Artymuk NV, Filippov OS, Frolova NI. Clinical course, maternal and perinatal outcomes of 2019 novel coronavirus infectious disease (COVID-19) in pregnant women in Siberia and Far East. Akusherstvo i Ginekologiya. 2021;2:48-54 (in Russian)
DOI:10.18565/aig.2021.2.48-54
7. Organization of medical care for pregnant women, women in labor, women in labor and newborns with a new coronavirus infection COVID-19. Methodological recommendations. Version 3 (25.01.2021). Ministry of Health of Russia. Available at:
https://covid19.rosminzdrav.ru/wp-content/uploads/2021/01/25012021_b_covid-19_3.pdf. Accessed: 15.03.2021 (in Russian)
8. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). The provisional guidelines. Version 10 (08.02.2021). Ministry of Health of Russia. Available at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/054/588/original/%D0%92%D1%80%D0%B5.... Accessed: 15.03.2021 (in Russian)
9. Coronavirus (COVID-19) Infection in Pregnancy. Information for healthcare professionals. Version 12 (14.10.2020). RCOG. Available at: https://www.rcm.org.uk/media/4383/2020-10-14-coronavirus-covid-19-infection-in-pregnancy-v12.pdf. Accessed: 15.03.2021.
10. Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. DOI:10.1136/bmj.m2107
11. Belokrinitskaya TE, Frolova NI, Anohova LI. Molecular genetic predictors of pregnancy complications. Novosibirsk: Nauka, 2019 (in Russian)
12. Strambovskaya NN. Clinical and some pathogenetic aspects of the carrier of genetic polymorphism in patients with acute and chronic brain ischemia. Dis. D. Sci. (Med.). Tomsk, 2019 (in Russian)
13. Belokrinitskaya TE, Shapovalov KG. Influenza and Pregnancy. Moscow: GEOTAR-Media, 2015 (in Russian)
14. Abramovici A, Gandley RE, Clifton RG, et al. Prenatal vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. BJOG. 2015;122(13):1740-7. DOI:10.1111/1471-0528.13201
15. Gryzunova EM, Sovershaeva SL, Soloviev AG, et al. Hemodynamics state in “mother-placenta-fetus” system of pregnant smokers. Ekologiya cheloveka. 2016;9:15-20 (in Russian) DOI:10.33396/1728-0869-2016-9-15-20
16. Kohlhammer Y, Schwartz M, Raspe H, Schäfer T. Risk factors for community acquired pneumonia (CAP). A systematic review. Dtsch Med Wochenschr. 2005;130(8):381-6. DOI:10.1055/s-2005-863061
17. Tang YM, Chen XZ, Li GR, et al. Effects of iron deficiency anemia on immunity and infectious disease in pregnant women. Wei Sheng Yan Jiu. 2006;35(1):79-81.
18. Garzon S, Cacciato PM, Certelli C, et al. Iron Deficiency Anemia in Pregnancy: Novel Approaches for an Old Problem. Oman Med J. 2020;35(5):e166. DOI:10.5001/omj.2020.108
19. Poverennova IE, Zakharov AV. Vegetative dysfunction – an actual problem of our time. Modern therapy and prevention of vegetative-vascular dystonia. Remedium. 2014;8(128):17-21 (in Russian)
20. Galinova IV. Neurocirculatory or vegetative dystonia and pregnancy. Ural Medical Journal. 2019;2(170):42-6 (in Russian)
21. Gazdag G, Szabo Z, Szlavik J. Psychiatric aspects of infectious diseases –
a literature review. Neuropsychopharmacol Hung. 2014;16(4):181-7.
22. Sethi R, Gómez-Coronado N, Walker AJ, et al. Neurobiology and Therapeutic Potential of Cyclooxygenase-2 (COX-2) Inhibitors for Inflammation in Neuropsychiatric Disorders. Front Psychiatry. 2019;10:605. DOI:10.3389/fpsyt.2019.00605
23. WHO. Policy brief. Preconception care: maximizing the gains for maternal and child health. Geneva: World Health Organization, 2013. Available at: https://www.who.int/maternal_child_adolescent/documents/preconception_care_policy_brief.pdf. Accessed: 15.03.2021.
24. Antenatal care for uncomplicated pregnancies. NICE guideline. NICE, 2019. Available at: https://www.nice.org.uk/guidance/cg62/chapter/1-Guidance25. Accessed: 15.03.2021.
25. Dolgushina NV, Artymuk NV, Belokrinitskaya TE, et al. Normal pregnancy. Clinical recommendations. Moscow, 2020. Available at: https://minzdravao.ru/sites/default/files/2020/1/normalnaya_beremennost.pdf. Accessed: 15.03.2021 (in Russian)
Авторы
Т.Е. Белокриницкая*, Н.И. Фролова, К.Г. Шаповалов, К.А. Колмакова, Л.И. Анохова,
А.В. Авраченкова, С.В. Преймак, А.В. Григорьев, Т.Ю. Филёва, А.Н. Горбунова, Д.А. Дунаев, К.С. Сербина
ФГБОУ ВО «Читинская государственная медицинская академия» Минздрава России, Чита, Россия
* tanbell24@mail.ru
Chita State Medical Academy, Chita, Russia
* tanbell24@mail.ru
А.В. Авраченкова, С.В. Преймак, А.В. Григорьев, Т.Ю. Филёва, А.Н. Горбунова, Д.А. Дунаев, К.С. Сербина
ФГБОУ ВО «Читинская государственная медицинская академия» Минздрава России, Чита, Россия
* tanbell24@mail.ru
________________________________________________
Chita State Medical Academy, Chita, Russia
* tanbell24@mail.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.