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Am J Perinatol 2024; 41(S 01): e3202-e3209
DOI: 10.1055/a-2211-5052
Original Article

Thrombotic Markers in Pregnant Patients with and without SARS-CoV-2 Infection

Ann M. Bruno
1   Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
2   Department of Obstetrics & Gynecology, Intermountain Health, Salt Lake City, Utah
,
Amanda A. Allshouse
1   Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
,
Ashley E. Benson
3   Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, Oregon
,
Christian Con Yost
1   Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
4   Molecular Medicine Program, Molecular Medicine Program, University of Utah, Salt Lake City, Utah
,
Torri D. Metz
1   Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
2   Department of Obstetrics & Gynecology, Intermountain Health, Salt Lake City, Utah
,
Michael W. Varner 
1   Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
,
Robert M. Silver
1   Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
,
D. Ware Branch
1   Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, Utah
2   Department of Obstetrics & Gynecology, Intermountain Health, Salt Lake City, Utah
› Author Affiliations Funding This work was supported by the James R. and Jo Scott Research Chair Endowment and the H.A. and Edna Benning Presidential Chair Endowment. C.C.Y. has received research support from Peel Therapeutics, Inc.
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Abstract

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.

Keywords

thromboembolism - thrombotic biomarkers - SARS-CoV-2 infection - lupus anticoagulant - D-dimer

Supplementary Material



Publication History

Received: 02 May 2023

Accepted: 13 November 2023

Accepted Manuscript online:
15 November 2023

Article published online:
07 December 2023

© 2023. Thieme. All rights reserved.

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