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Thrombotic Markers in Pregnant Patients with and without SARS-CoV-2 Infection
Ann M Bruno1,2, Amanda A Allshouse1, Ashley E Benson3
1Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah.
Insights
COVID-19 in pregnant individuals did not alter D-dimer levels or increase thrombosis risk. However, higher than expected rates of lupus anticoagulant (LAC) positivity were observed in SARS-CoV-2 infected pregnancies.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Hematology
Background:
- Coronavirus disease 2019 (COVID-19) is linked to coagulation issues and a higher risk of blood clots.
- Pregnant individuals with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may face unique thrombotic risks.
Purpose of the Study:
- To investigate D-dimer levels and lupus anticoagulant (LAC) positivity in pregnant individuals with and without SARS-CoV-2 infection.
- To compare thrombotic markers between infected and non-infected pregnant individuals, considering disease severity.
Main Methods:
- A prospective cohort study included pregnant individuals delivering between April 2020 and March 2022.
- SARS-CoV-2 positive individuals were compared to a control group; D-dimer and LAC positivity were assessed at delivery.
- Thromboembolic events and disease severity were secondary outcomes.
Main Results:
- No significant difference in D-dimer levels was found between SARS-CoV-2 positive and negative pregnant individuals.
- A higher rate of LAC positivity was observed in the SARS-CoV-2 positive group (4%) compared to the negative group (0%), though not statistically significant.
- No clinically apparent thromboses occurred in either group, and D-dimer or LAC positivity did not correlate with COVID-19 severity.
Conclusions:
- SARS-CoV-2 infection in pregnancy did not significantly alter D-dimer levels or increase the incidence of thromboembolic events.
- Elevated rates of LAC positivity were noted in pregnant individuals with SARS-CoV-2 infection, warranting further investigation.
- Despite altered coagulation markers, clinically significant thrombosis was not observed in this cohort.
Background:
Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities and increased risk for venous and arterial thrombi. This study aimed to evaluate D-dimer levels and lupus anticoagulant (LAC) positivity in pregnant individuals with and without Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Study Design:
This was a prospective cohort study of pregnant individuals delivering at a single academic institution from April 2020 to March 2022. Individuals with a positive SARS-CoV-2 result during pregnancy were compared with a convenience sample of those without a positive SARS-CoV-2 result. For individuals with SARS-CoV-2 infection, severity was assessed based on the National Institutes of Health classification system. The primary outcome was D-dimer level measured during delivery admission. The secondary outcomes were LAC positivity and thromboembolic events. Outcomes were compared between individuals with and without a positive SARS-CoV-2 result, and further by disease severity.
Results:
Of 98 participants, 77 (78.6%) were SARS-CoV-2 positive during pregnancy. Among individuals with SARS-CoV-2 infection, severity was asymptomatic in 20 (26.0%), mild in 13 (16.9%), moderate in 4 (5.2%), severe in 38 (49.4%), and critical in 2 (2.6%). The D-dimer concentration at delivery did not significantly differ between those with a SARS-CoV-2 positive result compared with those without (mean 2.03 µg/mL [95% confidence interval {CI} 1.72-2.40] vs. 2.37 µg/mL [95% CI 1.65-3.40]; p = 0.43). Three individuals (4%) with SARS-CoV-2 infection and none (0%) without infection were LAC positive (p = 0.59). There were no clinically apparent thromboses in either group. D-dimer concentrations and LAC positive results did not differ by COVID-19 severity.
Conclusion:
Thrombotic markers did not differ in pregnant individuals by SARS-CoV-2 infection; however, high rates of LAC positivity were detected.
Key Points:
· Thrombotic markers did not differ in pregnant individuals by SARS-CoV-2 infection.. · Higher than expected rates of LAC positivity were detected.. · There were no clinically apparent thromboses..
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