Statistical Study on Maternal Immunological Adaptation During Normal Pregnancy

Background: The immune system of the mother’s body undergoes several modifications throughout pregnancy to protect the baby from harm and prevent the mother’s immune system from attacking it. In addition, physiological and immunological changes that occur during pregnancy increase the risk and severity of some infections. Aim of the study: Provide comprehensive documentation of immune system adaptation in pregnant mothers and variables associated with the immune system. Methods: In this study, 40 pregnant women between the ages of 15 and 43 participated. The Abu Alkhaseeb General Hospital in Basra City filed data from March 2023 to August 2023. The data gathered included age, the number of abortions, the impact of WBC levels during pregnancy, and frequent diseases during pregnancy. Results and Discussion: Urinary tract infection was found to be the most frequent referral among pregnant women, constituting about 62% of the data, and comparisons of proportions were performed. A p-value below 0.05 was considered statistically significant. The results indicated that the number of white blood cells in the first, second, and third trimesters does not differ significantly. The highest white blood cell count was recorded in the third trimester (10.34), while the percentages for the first and second trimesters were close at 9.935 and 9.510, respectively. Conclusion: There are no significant associations with maternal white blood cell count during the first, second, and third trimester. Urinary tract infection was indicated to be the most frequent among pregnant women. 86% of pregnant women did not miscarry.

Introduction

Maternal immune modifications throughout pregnancy are essential for promoting fetal growth and preserving tolerance to the semi-allogeneic fetus. Pregnancy is a unique immunological condition. Blood transfusions are frequently required for a variety of medical issues during pregnancy [1]. The mother’s immune system undergoes significant changes throughout pregnancy to defend against infections and prevent harmful reactions to the allogeneic fetus [2], [3]. The risk of infection is a difficult process that needs careful study because of the unique conditions surrounding a normal pregnancy; increased risks for certain infections suggest significant qualitative immunological alterations determining whether physiological and immunological variables rise [4], [5]. Some illnesses may be reported more frequently because of their severe clinical when deciding how best to employ vaccinations like pertussis and influenza to protect both the pregnant mother and the baby [6].

During a healthy pregnancy, leukocytosis is generally referred to as an increased percentage of neutrophils in the blood. However, there are many types of WBCs, and elevated levels of other WBCs may imply different diagnoses [7], [8]. Generally common diseases during pregnancy include group B streptococcus (GBS), bacterial vaginosis (BV), listeria, dermatitis, herpes, influenza, and vaginal yeast infections [9]. This elevated risk of infection may be brought about by modifications in immunological function, such as decreased activity of T-and B-cells, natural killer cells, and dendritic cells [10]. During pregnancy, the body becomes more susceptible to infections and major problems due to changes in immune system function and hormone levels [11]. The infant is also susceptible to problems with their health when this happens, such as miscarriage, premature labor, or birth abnormalities that may result from some illnesses that arise during pregnancy [7]. They could endanger the mother’s life, and serious adverse effects, particularly for the unborn child, might arise from the drugs used to treat infections, further complicating the situation. Pregnancy-related infections should be avoided in order to reduce the dangers to the mother and unborn child [12].

An imbalance of natural bacteria leads to vaginal infection, known as bacterial vaginosis (BV). 10% to 30% of expectant mothers are afflicted with bacterial vaginosis. The most often identified vaginal infection is bacteria that overgrows anaerobic respiration (BV), which is caused by an imbalance of the normal vaginal flora [13]. Identification and treatment may lower the risk of preterm delivery during pregnancy. However, infections can cause premature labor that is resistant to oncolytic therapy women may describe irregular vaginal discharge and an unpleasant odor. Because vaginal secretions contain more glycogen and have greater estrogen levels, yeast infections, also known as vulvovaginal candidiasis, are frequent during pregnancy [14]. Urinary tract infection is the most common pregnancy-related issue. Pregnant women between weeks six and twenty-four are more likely to have an infection. Untreated urinary tract infections (UTIs) may cause brain damage, early labor and delivery, intrauterine infection, newborn infection, and severe birth traumas [15]. With greater rates of morbidity and mortality, influenza is frequently the most prevalent viral infection during pregnancy and the most common respiratory tract sickness. A third-trimester pregnant woman’s risk of hospitalization for acute cardiovascular illness is three to four times higher than that of a non-pregnant or postpartum person [16]. Patients who do not respond to standard treatments, have significant pneumonia or have respiratory failure should be suspected of having influenza. There has been evidence of an increased risk of severe pneumonia, low birth weight babies, premature deliveries, and maternal fatalities [17]. Bacterial pneumonia: the most common bacteria that cause pneumonia, one of the main causes of indirect maternal mortality, are streptococcus pneumonia, Haemophilus influenza, and mycoplasma pneumonia. Although the clinical presentation is similar to that of a non-pregnant woman, the risk of respiratory failure and empyema is increased [18].

Methods

Data Collection

A retrospective study was conducted on 40 pregnant women at different stages of pregnancy (first trimester, second trimester, third trimester) aged between 15 to 43 years. The study included data on all pregnancy cases admitted to Abu Alkhaseeb General Hospital in Basra City between March 21, 2023, and August 16, 2023. The data included the name, age, type of inflammation, and the number of abortions.

Statistical Analysis

The parametric variables were normally distributed and reported as mean and standard deviation (SD), as well as quantitative descriptors (mean, standard deviation, maximum, and minimum value). Statistical analysis was done using SPSS v25 (IBM), data were expressed, and comparisons of proportions were performed. A P-value below 0.05 was considered statistically significant.

Results and Discussion

Estimation of the Number of Abortions among Pregnant Women

The results demonstrated how pregnant women were distributed according to the number of abortions performed. Of these, 8.20% had one abortion, 2.5% had two, and the same proportion had three, as shown in Fig. 1. The remaining percentage, 86.8%, consisted of women who had never had an abortion. This result can be consistent with the interpretation of the Saadaoui (2023), who explained that the composition of the vaginal microbiota may impact the likelihood of miscarriage [19].

Fig. 1. Number of abortions among pregnant women.

Estimation of the Common Infectious Diseases During Pregnancy

The result of this study (Fig. 2) recorded the highest percentage of urinary tract infections, reported at 62%. In contrast, vaginal infections and bronchitis constituent about 23% and 12%, respectively. Szweda et al. (2016) acknowledged that, behind anemia, they are the second most prevalent condition during pregnancy [20]. Higher UTI prevalence was associated even more strongly with low education; there is another opinion by Ansaldi and de Tejada (2022). Explain the cause of increasing urinary tract infection changes of the urinary tract and immunologic changes of pregnancy predispose women to urinary tract infection [21]. Also, the physiologic changes include dilation of the ureter and renal calyces due to progesterone-related smooth muscle relaxation and ureteral compression from the gravid uterus [22]. Ureteral dilation may be marked by decreased bladder capacity, commonly resulting in urinary frequency. Vesicoureteral reflux may be seen. These changes increase the risk of urinary tract infections and vaginal infections [23].

Fig. 2. Common infectious diseases during pregnancy.

Relationship between Age and WBC Count During First, Second, and Third Trimesters

All data were distributed according to the age groups of the pregnant women and white blood cell count concerning the period of pregnancy. The result showed there is no significance in the relation between them. Nevertheless, it is also crucial to remember that, as Table I shows, there was a noticeable rise in the white blood count during each of the three pregnancy stages.

Table I. Statistical Analysis of Age and WBC between First, Second, and Third Trimesters

Variable		First trimester (N = 17)	Second trimester (N = 10)	Third trimester (N = 13)	p
Age (Years)	Mean	24.24	25.00	25.54	0.853
	Standard deviation	7.782	3.651	5.710
WBC count (109\L)	Mean	9.935	9.510	10.34
	Standard deviation	1.796	1.035	1.521	0.453

White blood cells (WBC) are frequently examined in pregnant women to look into possible infections and inflammations; however, the outcome is in agreement. He et al. [24] and Dockree et al. [25] showed that in leukocytosis, the white blood cell count rises dramatically during a healthy pregnancy. From another point of view, both Zhu et al. [26] and Zhang et al. [27] showed that the increase in the number of white blood cells continues until the third trimester of pregnancy, an increase of up to 17 × 10⁹, while the study result was 10.34 × 10⁹, where was immune adaptation.

Conclusion

There are no significant associations with maternal white blood cell count during the first, second, and third trimester. In this study, urinary tract infection was indicated to be the most frequent among pregnant women. Eighty-six% of pregnant women did not miscarry. Due to regular treatment reviews and increased health awareness, their condition did not worsen even after vaginal infections, which are thought to be one of the causes of miscarriages, were discovered.