Pregnancy during a pandemic: perinatal effects of prolonged stress and ways of correction

Literature review

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.60.8-14

Keywords:

pregnancy, COVID-19, postcovid syndrome, stress, perinatal outcome, prevention, drug correction, magnesium, psychotherapy

Abstract

This article presents current data about the perinatal effects of prolonged stress on pregnant women during the COVID-19 pandemic. The peculiarities of the postcovid syndrome in general and in the female population in particular are determined. Peculiarities of pregnancy and perinatal consequences after coronavirus infection, as well as manifestations of postcovid syndrome in this group of women are considered. There is an increase in the frequency of anxiety and depressive disorders in pregnant women and women in labor during the pandemic and their impact on the fetal brain and its subsequent mental state.
The specific effects of long-term stress have been identified: it has become known that pregnant women during the pandemic are exposed to prolonged stress, which affects the course of gestation. Among the most common conditions under the stressors impact (illness of the woman or her close environment, loss of relatives and acquaintances, existence in limited physical
and communication space, deterioration of financial condition, etc.) should be noted the increasing risk of abortion up to 17–28%; exacerbation during pregnancy of chronic somatic diseases
(hypertension, diabetes, metabolic syndrome, chronic pancreatitis, neurological and mental illness, etc.); increase in body mass index on the eve of pregnancy and pathological weight gain; strengthening of nutritional deficiencies (folate, iron, magnesium, vitamin D, iodine, etc.).
The timely detection and possible ways to correct these conditions are considered, given the transition to remote methods of monitoring pregnant women in quarantine. Organizational , treatment and prevention measures with inclusion of micronized progesterone, magnesium citrate, folate (metafolin) and vitamin D, as well as methods of psychoprophylaxis and psychotherapy are also proposed. Magnesium is of particular importance in pregnant women, it has neuroprotective and metabolic properties, in particular when used as a citrate in soluble form. The main directions of rehabilitation measures for pregnant women and women in labor after COVID-19 have been formulated.

Author Biographies

Y.G. Antypkin, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Kyiv

MD, professor, academician of the NAMS of Ukraine, director;
President of the Association of Pediatricians of Ukraine

I.A. Zhabchenko, SI “Academician O.M. Lukyanova IPOG of the NAMS of Ukraine”, Kyiv

MD, professor, сhief of the Department of pathology of pregnancy and childbirth

T.M. Kovalenko, SI “Academician O.M. Lukyanova IPOG of the NAMS of Ukraine”, Kyiv

PhD in physical education and sport, senior researcher at the Department of Pregnancy and Childbirth Pathology

I.S. Lishchenko, SI “Academician O.M. Lukyanova IPOG of the NAMS of Ukraine”, Kyiv

PhD, researcher, Department of pathology of pregnancy and childbirth

References

Babak, S.I., Krotyuk, T.F., Galushko, O.A. “Violation of water-electrolyte balance and their correction. Part 3. Correction of disorders of magnesium and phosphorus metabolism.” Acute and urgent conditions in the doctor's practice 5–6.68–69 (2017): 21–4.

Boris, O.M. “The problem of magnesium deficiency during pregnancy and the possibility of its correction.” Collection of scientific works of the Association of Obstetricians and Gynecologists of Ukraine 1.35 (2015): 65–71.

Gordienko, N.N. “Postcovid syndrome: main symptoms and rehabilitation.” Health of the nation. Internet-resource. Available from: [https://zn48.ru/articles/postkovidnyy-sindrom-osnovnye-priznaki-i-reabilitatsiya], last accessed June 29, 2021.

Gromova, O.V., Torshin, I.Y., Rudakov, K.V., et al. “Systematic analysis of magnesium-dependent mitochondrial proteins.” Cardiology 9 (2014): 86–92.

Zhabchenko, I.A. “Magnesium in obstetric practice: known facts and new opportunities.” Medical aspects of women's health. 1–2. 122–123 (2019): 32–8.

Ministry of Health of Russian Federation. Clinical protocol of diagnosis and treatment. Coronavirus infection COVID-19 in pregnant women and in the postpartum period. Moscow (2020): 60 p.

Kravchenko, O.V. “Peculiarities of the formation of the vascular component of the chorion in the dynamics of the first trimester of physiological pregnancy.” Bukovynian Medical Bulletin 3.75 Vol. 19 (2015): 15–7.

Lisitsyna, O.I., Khilkevich, E.G. “The use of magnesium preparations during pregnancy.” Human and Medicine – Kazakhstan 7.102 (2018): 28–32.

Ministry of Health of Russian Federation. Organization of medical care for pregnant women, parturients, parturients and newborns with a new coronavirus infection COVID-19. Methodical recommendations. Version 3 (25.01.2021). Ministry of Health of the Russian Federation. Moscow (2021): 119 p.

Radzinskiy, V.E. “On definiteness and uncertainty in obstetrics in coronavirus pandemic.” StatusPraesens 3.68 (2020): 22–3.

Raevskaya, O.A., Lishchuk, O.V. “We are what we eat.” StatusPraesens 10 (2018): 103–8.

Runikhina, N.K., Orekhov, A.B. “Migraine and pregnancy: a private example of the disease.” Effective pharmacotherapy 12 (2014): 44–8.

Spasov, А.A., Bugaeva, L.I., Lebedeva, S.I., et al. “Influence of alimentary magnesium deficiency on the processes of embryo- and fetogenesis registered in the antenatal period of rat fetal development.” Bulletin of Orenburg State University 198 (2016): 82–6.

Tsymbaliuk, V.I. Obstetric and gynecological care and preservation of reproductive health of women in armed conflict (monograph). Lviv (2020): 160 p.

Butterworth, M., McClellan, B., Allansmith, M. “Influence of sex in immunoglobulin levels.” Nature 214.5094 (1967): 1224–5.

Carrel, L., Brown, C.J. “When the Lyon (ized chromosome) roars: ongoing expression from an inactive X chromosome.” Philos Trans R Soc Lond B Biol Sci 372.1733 (2017): 20160355.

Chen, G., Wu, D., Guo, W., et al. “Clinical and immunological features of severe and moderate coronavirus disease.” J Clin Invest 130.5 (2020): 2620–9.

Chen, L., Li, Q., Zheng, D., et al. “Clinical characteristics of pregnant women with Covid-19 in Wuhan, China.” N Engl J Med 382.25 (2020): 100.

Claxton, A.J., et al. “A Systematic Review of the Associations Between Dose Regimens and Medication Compliance.” Clinical therapeutics 23.8 (2001): 1296–310.

Royal College of Obstetricians and Gynecologists. Coronavirus (COVID-19) Infection in Pregnancy. Information for healthcare professionals. RCOG Clinical Guidelines, 14.10.2020. Version 12 (2020). Available from: [https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy].

Crowther, C.A., Middleton, P.F., Voysey, M., et al. “Assessing the neuroprotective benefits for babies of antenatal magnesium sulfate: An individual participant data meta-analysis.” PLos Med 14.10 (2017): 11–24.

World Health Organization. Daily iron supplementation in adult women and adolescent girls: Guideline. Geneva. WHO (2016).

Dolinsky, B.M., Ippolito, D.L., Tinnemore, D., et al. “The effect of magnesium sulfate on the activity of matrix metalloproteinase-9 in fetal cord plasma and human umbilical vein endothelial cells.” Am J Obstet Gynecol 203.4 (2010): 371.е1–371.е5.

Doria, A., Iaccarino, L., Arienti, S., et al. “Th2 immune deviation induced by pregnancy: the two faces of autoimmune rheumatic diseases.” Reprod Toxicol 22.2 (2006): 234–41.

Durankuş, F., Erson, A. “Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study.” The Journal of Maternal-Fetal & Neonatal Medicine (2020). DOI: 10.1080/14767058.2020.1763946

Guan, W.J., Ni, Z.Y., Hu, Y., et al. “Clinical characteristics of coronavirus disease 2019 in China.” N Engl J Med 382 (2020): 1708–20.

Kane, J.M., Kishimoto, T., Correll, C.U. “Non-adherence to treatment in patients with psychotic disorders: epidemiology, predisposing factors and tactics.” World Psychiatry 12.216 (2013): 26.

Larsen, B. “Progesterone Interactions with the Cervix: Translational Implication for Term and Preterm Birth.” Infectious Diseases in Obstetrics and Gynecology (2011): 353297, 13 pages.

Li, X., Han, X., Yang, J., et al. “Magnesium sulfate provides neuroprotection in eclampsia-like seizure model by ameliorating neuroinflammation and brain edema.” Mol Neurobiol 54.10 (2017): 7938–48.

Mortazavi, F., Mehrabadi, M., Tabar, R.K. “Pregnant women’s well-being and worry during the COVID-19 pandemic: a cross-sectional study.” BMC Pregnancy Childbirth 21.59 (2021). DOI: 10.1186/s12884-021-03548-4

Motrico, E., Bina, R., Domínguez-Salas, S., et al. “Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study.” BMC Public Health 21.368 (2021). DOI: 10.1186/s12889-021-10330-w

Move-Jarvis, F., Klein, S., Levin, E. “Estradiol, progesterone, immunomodulation and outcomes COVID-19.” Endocrinology 161.9 (2020). DOI: 10.1210/endocr/bqaa127

Reeder, S.B., Hu, H.H., Sirlin, C.B., et al. “Antenatal exposure to magnesium sulfate is associated with reduced cerebellar hemorrhage in preterm newborns.” J Pediatr 178 (2016): 68–74.

Rosner, J.Y., Gupta, M., McGill, M., et al. “Magnesium deficiency during pregnancy in mice impairs placental size and function.” Placenta 39 (2016): 87–93.

Saccone, G., Florio, A., Aiello, F., et al. “Psychological impact of coronavirus disease 2019 in pregnant women.” Am J Obstet Gynecol 223.2 (2020): 293–5. DOI: 10.1016/j.ajog.2020.05.003

Sarris, J., et al. “Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses.” Am J Psychiatry 173.6 (2016): 575.

Shlegel, R.N., Cuffe, J.S.M., Moritz, K.M., Paravichini, T.M. “Maternal hypomagnesiemia causes placental abnormalities and fetal and postnatal mortality.” Placenta 36.7 (2015): 750–8.

Shlegel, R.N., Spiers, J.G., Moritz, K.M., et al. “Maternal hypomagnesiemia alters hypocampal NMDAR subunit expression and programs anxiety-like behavior in adult offspring.” Behav Brain Res 328 (2017): 39–47.

Smith, V., Seo, D., Warty, R., et al. “Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review.” PLoS One (2020). DOI: 10.1371/journal.pone.0234187

Straub, R.H. “The complex role of estrogens in inflammation.” Endocr Rev 28.5 (2007): 521–74.

Tarighat, E.A., Mahdavi, R., Talebi, M., et al. “The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis.” Biol Traсe Elem Res 150.1–3 (2012): 42–8.

Thapa, S.B., Mainali, A., Schwank, S.E., Acharya, G. “Maternal mental health in the time of the COVID-19 pandemic.” Acta Obstet Gynecol Scand 99 (2020): 817–8. DOI: 10.1111/aogs.13894

World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva. WHO (2017).

Zarate, C., Duman, R.S., Liu, G., et al. “New paradigms for treatment-resistant depression.” Ann NY Acad Sci 1292.1 (2013): 21–31.

Al-Aly Z., Xie, Y., Bowe, B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature 594 (2021): 259–64. DOI: 10.1038/s41586-021-03553-9

Published

2021-09-24

Issue

Section

Pregnancy and childbirth