More than one year after the declaration of the Coronavirus Disease-19 (COVID-19) pandemic [1], the number of confirmed cases continues to increase, estimated worldwide at 161,513,458 as of May 15, 2021, according to the World Health Organization (WHO) [2], and affecting, in particular, the various populations at risk.

Concerning pregnant women, a recently published study did not show any significant difference, in the absence of comorbidity, on the clinical, biological and radiological aspects related to COVID-19 in pregnant women [3]. This differs from other epidemics, including the Middle East Respiratory Syndrome coronavirus (MERS-CoV) in 2012, where significant complications had been described in pregnant women, compared to the general population [4]. In general, pregnancy is a physiological state that leads to a decrease in immunity [5] and limits certain explorations, such as medical imaging modalities with ionizing radiation. The use of this type of examination must be justified, as the potential benefits must outweigh the risk of any harm [6].

However, if it is established that the diagnosis of COVID-19, is made using the Real Time Polymerase Chain Reaction test (RT-PCR), which is the reference test and usually obtained by nasal or pharyngeal swab [7]. The contribution of medical imaging, through the thoracic scanner, is very important in the detection of pneumonia [8], and also in the follow-up of the evolution of the parenchymal damage [9].

At a time when several countries, including our own, are stepping up their efforts, in particular through the intensification of vaccination [10], it seemed important to us to highlight and compare the different thoracic CT characteristics of pregnant and non-pregnant patients, especially since few studies have been carried out on the subject in our context [5], and thus to present the experience of our hospital structure.

In our environment, where several studies have been carried out on COVID-19, very few have highlighted an association with pregnant women, who constitute a fragile segment of the population. During the first wave of the epidemic, some pregnant women who tested positive for Covid-19, by RT-PCR test, were able to benefit from a thoracic scanner, which was requested, more often for an evaluation of the pulmonary involvement, than for diagnostic purposes. However, it is useful to specify that if radiating examinations are not recommended in pregnant women [12], their use is not formally forbidden and depends on the indications [6]. In our study, the scans were carried out in low dose, which remains without risk for the fetus, as stated by Liu et al. [13] [14]. Likewise, these examinations did not require any injection of iodinated contrast medium, which, if necessary, depending on the indications, does not constitute any teratogenic risk, as demonstrated by studies in animals [6] [15]. Therefore, in order to contribute to the improvement of patient management in general, and pregnant women in particular, we conducted the present study, which is one of the first in our context, and which allowed us to compare the CT characteristics of 9 pregnant women and 22 non-pregnant women of childbearing age, confirmed positive for COVID-19, by RT-PCR, at the Douala Gynaecological-Obstetric and Paediatric Hospital.

Our series established a median age of 26 years in pregnant women, relatively young, compared to 40 years in non-pregnant women, which diverges from the results of Liu et al., in China, where the median age of pregnant women was 30 years [16], while this is close to the data of Diouf et al., in Senegal, where the median age in 9 pregnant women testing positive for COVID was 28 years [17]. This discrete age difference between African and Asian populations may be due to our small sample sizes, but also to the relatively young age of pregnant women in sub-Saharan Africa [18].

Clinically, asthenia was the most frequent symptom in our two groups, sometimes associated with fever in pregnant women, and more often with headache in non-pregnant women, although this was not statistically significant. Ngalame et al. also found fever to be the predominant symptom in 18 pregnant women [19], as did Chawki Mrazguia in 11 other cases [20]. As a severity factor, usually encountered in the general population of our context [21], dyspnea was frequently encountered in our 2 groups (p: 0.024). Thus, this similarity of clinical data between pregnant and non-pregnant patients corroborates the results of the metanalysis of Yang et al., which also described no significant difference [22].

Regarding CT features, the combination of ground-glass opacity images and parenchymal condensation, was frequently encountered in the 2 groups (p: 0.024), going in the direction of Huanhuan findings [16]. This was in slight contrast to the results of Xiaoping, where they were also associated with fibrous bands [23]. This discrepancy in the results is probably related to the delay in performing the CT scan, which varies between individuals, depending on the onset of the symptomatology. It is worth noting that the natural history of COVID-19 pneumonia is usually characterized by regression of the initial ground glass images, followed later by the progressive development of alveolar condensation [24]. In our pregnant women, the involvement was mainly of a mixed axial distribution, mostly bilateral, which without being significantly specific, was however similar to the results of the meta-analysis in 427 pregnant women by Oshay et al. [12]. In our 2 groups, the middle and lower right lobes were the most frequently affected, which was also consistent with the analyses of Shi et al. in a general population of 81 patients [25]. These authors assumed that the anatomical characteristics of the right bronchus, in particular its shortness, might be a factor favoring this unilateral right predominance. The other abnormalities commonly found in COVID-19 and present in both groups, such as pleural effusion, were rather a sign of severity [3] [22], although it is common to find it in early post-partum [14]. Specifically, and after multivariate analysis, only the pseudo-nodular and linear band lesion types were significantly found in both groups, although the pseudo-nodular form is described in only about 10% of cases, according to the literature [3].

Limitations of this study include the poor maintenance of many medical records, which hindered the collection of laboratory data, as well as the small size of our sample, and the retrospective nature.

CT lung lesions are more common in pregnant women compared with nonpregnant women of childbearing age who test positive for COVID-19 at DGOPH. Pseudonodular and linear banded images are the most significantly encountered lesions in our setting. Early CT diagnosis of key lung lesions would improve the outcome of pregnant women during this pandemic.

We thank all the physicians of the emergency department, the gyneco-obstetrics department, and the intensive care unit, as well as the technicians of the radiology department, who contributed to the collection of the data analyzed in this study.

The authors declare no conflicts of interest regarding the publication of this paper.

Onana, Y., Tambe, J., Balkissou, A.D., Aminou, M., Mvondo, S.M., Djomo, D.T., Ngalame, A.N., Inna, R., Moustapha, B., Ndongo, F.A., Tchounzou, R., Mballa Amougou, J.C., Amvene, J.M., Guena, M.N. and Mboudou, E.T. (2021) Comparison of Chest Computed Tomography Findings between Pregnant and Non-Pregnant Women with COVID-19 Infection in Douala Gyneco-Obstetric and Pediatric Hospital, Cameroon. Open Journal of Medical Imaging, 11, 132-144. https://doi.org/10.4236/ojmi.2021.114012