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Diagnosis and management of covid-19 in pregnancy

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj-2021-069739 (Published 26 April 2022) Cite this as: BMJ 2022;377:e069739

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COVID-19 Diagnosis during Pregnancy: Looking beyond the Curtain

Dear Editor,

I have read with the greatest interest the review article by Nana et al. [1]. They have provided the scientific community with a reference guide for clinicians and allied healthcare professionals who treat women with Coronavirus Disease 2019 (COVID-19) during pregnancy.

COVID-19 is an infectious disease thus requires both medical history, pathognomonics as well as radiology and laboratory data, but, from a laboratory aspect, some crucial points should be added. Anti-HLA antibodies, which are produced even in the first semester for some pregnant women, are well-known for their serologic interferences, often resulting in lower diagnostic performances for both common rapid and laboratory antigen/antibody testing assays [2]. Whilst pregnancy deprives common Polymerase Chain Reaction (PCR) assay from a direct impact, maybe a poor assay could be inhibited by anti-HLA antibodies, if overproduced – generally, a case’s overall antibody titers can affect sensitivity (particularly referring to ‘sticky serum’) [2].

It is well-known that several blood diagnostic biomarkers are elevated during pregnancy. Nevertheless, pregnant COVID-19 cases could develop a pre-eclampsia like syndrome, that can be distinguished via angiogenic markers, and additionally, there is a significant overlap between COVID-19 and Hemolysis, Elevated Liver enzymes, and Low Platelets (HELLP) syndrome, with its complications possibly to affect even lung imaging [3]. Thus, it is required that physicians are able to differentiate between COVID-19 and pregnancy-related mimicking conditions, apart from an ostensible severe COVID-19 or a long-COVID syndrome. Undeniably, management and acute care is different in these conditions.

Despite the epidemiological data presentation, each patient is unique, thus prompt diagnosis is the golden desideratum, for better and on-the-spot management and further treatment.

References
1. Nana M, Hodson K, Lucas N, et al. Diagnosis and management of covid-19 in pregnancy. BMJ 2022;377:e069739. doi:10.1136/bmj-2021-069739
2. Mouliou DS, Gourgoulianis KI. False-positive and false-negative COVID-19 cases: respiratory prevention and management strategies, vaccination, and further perspectives. Expert Review of Respiratory Medicine 2021;15:993–1002. doi:10.1080/17476348.2021.1917389
3. Futterman I, Toaff M, Navi L, et al. COVID-19 and HELLP: Overlapping Clinical Pictures in Two Gravid Patients. AJP Rep 2020;10:e179–82. doi:10.1055/s-0040-1712978

Competing interests: No competing interests

05 May 2022
Dimitra S. Mouliou
Biochemist-Biotechnologist
University of Thessaly, Faculty of Medicine, BIOPOLIS, Larissa, Greece. email: demymoole@gmail.com
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