Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : QC09 - QC13 Full Version

Comparison of the Haematological and Psychological Parameters between COVID-19 Positive Pregnant and Non Pregnant Female: A Case-control Study from Tertiary Care Centre, Puducherry, India


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52682.16139
Gaurang Narayan, P Sabita, Rimi Singh, A Sivaraman

1. Compulsory Rotatory Residential Internship (CRRI), Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India. (ORCID Id: 0000-0003-0546-1140) 2. Associate Professor and Head, Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India. (ORCID Id: 0000-0002-6869-8551) 3. Assistant Professor, Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India. (ORCID Id: 0000-0002-9750-7056) 4. Assistant Professor, Department of General Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India. (ORCID Id: 0000-0002-7278-3521)

Correspondence Address :
Dr. P Sabita,
Associate Professor and Head, Department of Obstetrics and Gynaecology,
Indira Gandhi Medical College and Research Institute, Vazhudavour Road,
Kathirkamam, Puducherry, India.
E-mail: sabita.kutty@gmail.com

Abstract

Introduction: Pregnancy is associated with lot of physiological and psychological changes, and it becomes important to study these changes in the background of COVID-19. A simple Complete Blood Count (CBC) can help to indicate the COVID-19 disease severity.

Aim: To understand the differences in the haematological and psychological parameters between COVID-19 infected pregnant females and age-matched non pregnant COVID-19 infected females.

Materials and Methods: This case-control study was conducted in Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India, from October 2020 to December 2020. Data collection was in an ambispective manner. Haematological values {Total Leukocyte Count, neutrophil, lymphocyte, Neutrophil-Lymphocyte ratio (NLR) and Red Cell Distribution Width (RDW)} were obtained from routine CBC and for the psychological component (scales- beliefs, practices for prevention of infection, fear, global) a pre-tested validated questionnaire was used. The questionnaire used the Likert scale and comprised of a total of 29 questions with a maximum score of 145. These scales analysed psychological apprehensions in general population and its impact on pregnancy and reproductive health of women. Categorical variables were expressed as mean±Standard Deviation (SD). Student t-test was used for comparison of means.

Results: The present study included 80 participants with 40 in each of the pregnant and non pregnant group. The total leukocyte count, neutrophil, lymphocyte, NLR and RDW were the haematological parameters with statistically significant difference between the two groups (p-value <0.001). While the mean total score of COVID-19 psychological impact in the COVID-19 pregnant women was 79.42±20.18 and higher in COVID-19 non pregnant women (88.92±20.77).

Conclusion: The significant difference in the haematological parameters of both the groups indicates the differential impact of COVID-19 in pregnant women. ‘Coronaphobia’ is on the rise and addressing this concern is important for holistic delivery of healthcare in patients.

Keywords

Behaviour-prevention practice, Caesarean section, Coronavirus disease-2019, Coronaphobia, Neutrophil-Lymphocyte ratio, Red cell distribution width

The entire globe is fighting against the novel Coronavirus pandemic-Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Ideally, for any infectious condition, to contain its transmission, it is important to know the target populations for active interventions. One such secluded group is the cohort of pregnant women (1). Pregnancy is known to have multitudes of physiological changes which make them to be disproportionately affected by respiratory infections there by increasing the morbidity and mortality profile. The previous pandemics by Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Symptoms (MERS) are a proof to this undoubted fact (2),(3),(4).

Coronavirus disease-2019 (COVID-19) infection has a congregation of symptoms reshaping all the blood parameters (5). The most crucial and easily accessible change is the change in the haematological parameters in blood (6),(7). The haematological indices have been studied constructively and have been successfully used as early indicators of severity of COVID-19 infection and as early biomarkers for cytokine/inflammatory storms in such patients which are the most important cause of morbidity in COVID-19 patients. Bearing the background physiological changes in mind, it becomes absolutely important to study the differences in such parameters to frame and form distinct cut-off for such parameters in pregnant females infected with COVID-19 infection. So, studying these parameters is of paramount importance.

With the ongoing pandemic, there is a constellation of fears present in all the patients. Fear of social distancing, ongoing lockdowns, economic depressions, stigmas from the society and info emic fear instilled by media have all added to the apprehensions and a new terminology called ‘Coronaphobia’ is on the rise (8). Studies have also suggested that these fears or the odds of developing such fears are more in the female gender than the male, making them a vulnerable population to mental stress and trauma (9). When all of these are added with pregnancy, they reach a new high level. It is also documented that these fears and apprehensions could lead on to mediate depression and they could also trigger future career anxiety (10). It is also a well-known fact that mental health during pregnancy affects foetal development and also hinders with physiological process of pregnancy including delivery and breast feeding. These apprehensions could be different between a pregnant and a non pregnant female. Thus, understanding those key raw areas and addressing those fears in the antenatal period is a crucial step in giving holistic approach to maternal and child health (11).

Studies have also shown that, minor surgical interventions can provoke severity in the course of COVID-19 infection (12). Though, caesarean section is reserved only for obstetric indications in COVID-19 infected mothers, these could trigger the severity of the illness. One of the early predictors of severity of the illness is the Neutrophil Lymphocyte Ratio (NLR) and Red Cell Distribution Width (RDW). So, it becomes important to study the salient effect of a surgical intervention on these parameters (13). Thus, the study aimed to understand the differences in the haematological and psychological parameters between antenatal COVID-19 infected pregnant female and age-matched non pregnant COVID-19 infected females.

Material and Methods

This case-control study was conducted in Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute (tertiary healthcare government hospital, designated as the state exclusive COVID-19 hospital), Puducherry, India, from October 2020 to December 2020. Institute Human Ethics Committee (IEC) clearance was obtained prior to start of the project (Reference No: 265/IEC No.-29/PP/2020). Convenience sampling was followed and a total of 80 participants, with 40 in each group (pregnant and non pregnant, respectively) were included in the study.

Inclusion and Exclusion criteria: All COVID-19 positive participants who gave the consent to participate in the study were included. Patients with known psychiatric illness and any co-morbidities which would affect the basic Complete Blood Count (CBC) parameters like patients with hypertensive disorders, chronic kidney disease and chronic liver disease were excluded from both the groups.

Parameters

The study tools included a participant record form to collect data on their socio-demographic details, menstrual history. For the non pregnant women only previous obstetric history (if applicable) and menstrual history were obtained.

Haematological parameters: Red Blood Cells, Total leukocyte count, Neutrophils, Lymphocytes, Neutrophil/Lymphocytes ratio, Basophils, Monocytes, Eosinophils, Haemoglobin, Mean corpuscular volume, Red cell distribution width, Mean corpuscular haemoglobin, Mean corpuscular haemoglobin concentration, Platelets, Packed Cell Volume.

Psychological evaluation: A pretested questionnaire was used after validating with a pilot test. The questionnaire comprised of a total of 30 questions with 29 on various components and one general question on feedback of participation:

a) Belief scales with regards to COVID-19 information-4 (3),
b) Behaviour scales for COVID-19 infection prevention control practices and information-8 (3),
c) Fear of COVID-19 scale or apprehension factor-10,
d) Global question relating to COVID-19 infection (14), pregnancy and women health-7,
e) Feedback question-1.

Each of the questions had five options in Likert scales with a maximum score of 5 and a minimum score of 1.

The study tools were prepared taking into view the previously published literatures on the topic of interest along with incorporating inputs from the subject experts (14). Face and content validity were ensured. The pilot study comprised of a total of 30 participants with 15 in each group. The results of the pilot study were not included in the present study.

Of the 80 participants, we had 40 previously treated patients and 40 new patients with 20 each in the pregnant and non pregnant groups of both the cohorts.

Procedure

For the previously treated patients, list of COVID-19 infected pregnant females and age matched COVID-19 positive non pregnant females were obtained from the hospital census/statistical department. The socio-demographic data, haematological parameters were obtained from their case files in the Medical Records Department (MRD). For the psychological analysis, the questionnaire was administered through the computerised electronic channel system. A proper electronic documented informed consent form and an e-questionnaire were prepared in both, local vernacular language and English, using the Google forms app/Forms Heart survey app. All these participants were contacted over phone and after explaining the procedure, a verbal consent was obtained to share the questionnaire evaluating the psychological component. Based on their convenience, the e-questionnaire and e-consent form was sent to them through e-mail/WhatsApp. The choice of language was given to the participants and each participant was given a total time of 45 minutes to fill the form. For participants who lacked technological support, a trained interviewer received their responses after due consent through voice calls (Table/Fig 1).

For the new patients, 20 each in both the pregnant and the non pregnant group, an informed written consent was obtained, and their basic data was obtained using the participant record form during the routine rounds. All the haematological parameters were procured from the routine CBC’s done for these patients. The vitals at the time of admission were documented. For the psychological component, a questionnaire in the pen and paper format was given to the participants to receive their response. Help from the trained interviewers were sort for participants finding difficulty.

Statistical Analysis

All the responses were entered and analysed in Microsoft Excel software version 2020 and were analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0. Continuous variables were expressed as Means±SD and categorical variables as percentages and proportions. Student t-test was used for comparison of means.

Results

In the present study, total 40 participants each from the pregnant and the non pregnant cohort was taken. The mean age of the pregnant group was 23.8±3.2 years and of the non pregnant group was 25±4.1 years (p-value 0.213, non significant). With regards to the presenting symptomatology, 40% (n=32) of the total population presented with cough and 40% (n=32) were asymptomatic (Table/Fig 2).

(Table/Fig 3) shows neutrophil, lymphocyte, NLR and total leucocyte count are the parameters with statistical significance (p-value ≤0.05).

Interestingly, the fear of COVID-19 seemed to predominate in the non pregnant group (29.05±12.89) in comparison to the pregnant group (24.72±13.33) (Table/Fig 4).

Discussion

The present study included 80 participants with 40 in each cohort. The most common disorder associated with pregnancy in the present population was identified as hypothyroidism (n=11, 27.5%). The other disorders noted in the pregnant women included malpresentations (n=3, 7.5%). Though Pregnancy Induced Hypertension (PIH) and Gestational Diabetes Mellitus (GDM) are commonly spoken off in the context of medical disorders complicating pregnancy, hypothyroidism is equally a medical disorder encountered in pregnancy. The present study agrees with the conclusion of the study by Yadav V et al., in recommending universal screening for thyroid dysfunctions among the antenatal population, considering maternal hypothyroidism is a preventable cause of mental retardation/sub normality in the offspring (15). In the present study the total leukocyte count, neutrophil, lymphocyte, NLR and RDW were the haematological parameters with statistical significance (p-value <0.005). The total of COVID-19 psychological impact scale is higher in non pregnant group.

The finding of the present study is on a cross with the report by Dashraath P et al., (4). Fever (84%) was the most common symptom reported among their study group while in the present study asymptomatic women topped the list alongside cough as a presenting symptom. Also, in his study, 38% of the population had leukocytosis and in the present study 40% of the pregnant women had leukocytosis (total leukocyte count >11,000 cells/mm3).
Similarly, 13% had thrombocytopenia in his study while its 15% in the current study (platelets <1,50,000 cells/ mm3). Despite a larger sample size in the present study, the percentages remain similar, which indicates that the presentation in a pregnant COVID-19 infected female with regards to haematological parameters is strikingly unique from a non pregnant female and despite geographic and racial changes in the study settings, the blood picture remains similar.

Further, majority of pregnant women in the present study were asymptomatic which is on a cross with the findings of Liu Y et al., study, where fever was the most common symptom (77%) (7).

In the study conducted by Shi S et al., NLR has been found to be an indicator for severity of infection (16). The values between severely infected patients and non severe group were statistically significant. Similarly, the mean value of NLR of severe group (9.95) was found to be higher than the non severe group (2.24). Even in the present study, the mean NLR of pregnant group (5.30) was found to be higher than the non pregnant group (2.70). It is interesting to note that, the non pregnant group and the non severe group of their study are on consensus. This indirectly reflects, pregnancy can be considered a group with plausible severity of infection. The present study seconds the finding of haematological changes appreciated in the study by Liu Y et al., and Ponti G et al., (7),(8). There is a statistical significance in the NLR. This means separate cut-offs for pregnant women is necessary and these finding mandates further evaluation in this regard.

Also, in the study taken up by Wang C et al., NLR and RDW have been found to be promising severity markers for COVID-19 infection. Both these markers are quintessential severity indicators in accordance to the present study (11).

In the study conducted by Broche-Pérez Y et al., about the fear of COVID-19 amongst the population in Cuba, the total score mean was found to be 17.9 (2). In the present study, the mean is proportionately higher. This difference could be because of change in the geographical setting, small sample size of the present study. Also, a small difference in the mean score between pregnant and non pregnant group is identified. The non pregnant group seems to have more fear of COVID-19 than the pregnant. This difference could be attributed to acceptance among pregnant women about COVID-19, as they knew somewhere down the line that they had to visit a hospital for their antenatal management and that they would come across COVID-19 during their visits to hospital. From the other corner, this could be because of the fact that pregnant women have a timely concern about their foetus, while non pregnant women have families which are of larger concern to them. So, timely priorities vary along with which the fear and apprehension keep changing.

In comparison to the study conducted by Chang KC et al., the individual means of the three scales in the present study are slightly different (3). The mean of the fear scales is lower in the present study, than 2.63±1.02 in their study. The mean of belief scales is slightly higher in the present study, than 3.31±0.74 in their study. The prevention of infective behaviour 3.54±0.92 is more in their study, than in the present study. All these could be because of the difference in the study setting. Also, huge difference in the sample size and geographic setting could be reasons for variations in the psychological perceptions.

One of the future plans is to compare the same parameters between pregnant COVID-19 positive females and age matched COVID-19 negative pregnant females. This would help get a vivid picture and help eliminate pregnancy as a confounder from the study.

Limitation(s)

The peak of first wave of COVID-19 in the union territory of Puducherry was observed in the months of August and September, 2020. With beginning of October 2020, the total number of inpatient admissions had reduced as the curve began to flatten. Owing to this logistic limitation, we had to recruit 20 previously treated patients and had to retrospectively collect the data. While the haematological records were from their time of admission, we were unable to fully comprehend the magnitude of psychological impact that the participants would have undergone as a result of being COVID-19 positive. Due to logistic and technical constraints other inflammatory markers and their coherence with pregnant state could not be ascertained. The present study setting was also a limitation. The study was conducted in an exclusively designated COVID-19 hospital with no access to non COVID-19 Patients.

Conclusion

Pregnancy per say is subject to plethora of constitutional and physiological changes. COVID-19 infection could add to the morbidity profile of pregnant women. In the study, the majority of positive pregnant women were asymptomatic, had a distinct change in their neutrophil, lymphocyte, NLR and RDW-SD values. With regards to the psychological parameters, apprehensions were noted, and predominantly non pregnant group is affected and is down with ‘Coronaphobia’. Thus, studying the haematological and psychological changes and setting up appropriate interventions could avert severity of COVID-19 infection.

Acknowledgement

Authors would like to thank the postgraduate students in the Department of Obstetrics and Gynaecology, Dr. Arularasan, Dr. Balanivedha, and Dr. Hemavathy. Authors also would like to extend their sincere gratitude to Ms. Daya Narayan and Mr. Arun for their support and assistance.

References

1.
Alfaraj SH, Al-Tawfiq JA, Memish ZA. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection during pregnancy: Report of two cases & review of the literature. J Microbiol Immunol Infect. 2019;52(3):501-03. Available from: http://dx.doi.org/10.1016/j.jmii.2018.04.005. [crossref] [PubMed]
2.
Broche-Pérez Y, Fernández-Fleites Z, Jiménez-Puig E, Fernández-Castillo E, Rodríguez-Martin BC. Correction to: Gender and fear of COVID-19 in a Cuban population sample. Int J Ment Health Addict. 2020;1. Available from: http://dx.doi.org/10.1007/s11469-020-00377-y. [crossref]
3.
Chang KC, Hou WL, Pakpour AH, Lin CY, Griffiths MD. Psychometric testing of three COVID-19-related scales among people with mental illness. Int J Ment Health Addict. 2022;20(1):324-36. Available from: http://dx.doi.org/10.1007/s11469-020-00361-6. [crossref] [PubMed]
4.
Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Obstet Anesth Dig. 2021;41(1):07-07. Available from: http://dx.doi.org/10.1097/01.aoa.0000732344.83244.30. [crossref]
5.
Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: A systematic review of reported cases. Am J Obstet Gynecol. 2020;223(1):36-41. Available from: http://dx.doi.org/10.1016/j.ajog.2020.04.013. [crossref] [PubMed]
6.
Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020;14(5):779-88. Available from: http://dx.doi.org/10.1016/j.dsx.2020.05.035. [crossref] [PubMed]
7.
Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-74. Available from: http://dx.doi.org/10.1007/s11427-020-1643-8. [crossref] [PubMed]
8.
Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci. 2020;57(6):389-99. Available from: http://dx.doi.org/10.1080/10408363.2020.1770685. [crossref] [PubMed]
9.
Rahman J, Muralidharan A, Quazi SJ, Saleem H, Khan S. Neurological and psychological effects of Coronavirus (COVID-19): An overview of the current era pandemic. Cureus. 2020;12(6):e8460. Available from: http://dx.doi.org/10.7759/cureus.8460. [crossref]
10.
Schuchat A. Reflections on pandemics, past and present. Am J Obstet Gynecol. 2011;204(6 Suppl 1):S04-06. Available from: http://dx.doi.org/10.1016/j.ajog.2011.02.039. [crossref] [PubMed]
11.
Wang C, Deng R, Gou L, Fu Z, Zhang X, Shao F, et al. Preliminary study to identify severe from moderate cases of COVID-19 using combined haematology parameters. Ann Transl Med. 2020;8(9):593. Available from: http://dx.doi.org/10.21037/atm-20-3391. [crossref] [PubMed]
12.
Doglietto F, Vezzoli M, Gheza F, Lussardi GL, Domenicucci M, Vecchiarelli L, et al. Factors associated with surgical mortality and complications among patients with and without Coronavirus disease 2019 (COVID-19) in Italy. JAMA Surg. 2020;155(8):691-702. Available from: http://dx.doi.org/10.1001/jamasurg.2020.2713. [crossref] [PubMed]
13.
Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-41. Available from: http://dx.doi.org/10.1111/all.14238. [crossref] [PubMed]
14.
Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. Fear of COVID-19 scale: Development and initial validation. Int J Ment Health Addict. 2020:01-09. Advance online publication: https://doi.org/10.1007/s11469-020-00270-8. [crossref]
15.
Yadav V, Dabar D, Goel AD, Bairwa M, Sood A, Prasad P, et al. Prevalence of hypothyroidism in pregnant women in India: A meta-analysis of observational studies. J Thyroid Res. 2021;2021:5515831. Available at: https://doi.org/10.1155/2021/5515831. [crossref] [PubMed]
16.
Shi S, Nie B, Chen X, Cai Q, Lin C, Zhao G, et al. Clinical and laboratory characteristics of severe and non severe patients with COVID-19: A retrospective cohort study in China. J Clin Lab Anal. 2021;35(1):e23692. Available at: http://dx.doi.org/10.1002/jcla.23692. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/52682.16139

Date of Submission: Oct 01, 2021
Date of Peer Review: Nov 15, 2021
Date of Acceptance: Feb 12, 2022
Date of Publishing: Mar 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 07, 2021
• Manual Googling: Jan 13, 2022
• iThenticate Software: Feb 17, 2022 (2%)

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