PB1414 - COVID-19-associated hemostasis alterations in pregnancy: a prospective, case-control study

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

Zsuzsa Bagoly, MD, PhD

Professor (Associate)
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary

Presenting Author(s)

Eszter Lilla Tóth, MD

Resident doctor, PhD student
University of Debrecen, Faculty of Medicine, Department of Gynecology and Obstetrics
Debrecen, Hajdu-Bihar, Hungary

Co-Author(s)

Rita Orbán-Kálmándi

Junior research fellow
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary
TD

Tamás Deli

Assistant professor
University of Debrecen; Faculty of Medicine, Department of Gynecology and Obstetrics
Debrecen, Hajdu-Bihar, Hungary
OT

Olga Török

Associate professor
University of Debrecen; Faculty of Medicine, Department of Gynecology and Obstetrics
Debrecen, Hajdu-Bihar, Hungary
Linda Lóczi

PhD Student
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary
JT

Judit Tóth

Assistant lecturer
University of Debrecen; Faculty of Medicine, Department of Laboratory Medicine
Debrecen, Hajdu-Bihar, Hungary
SM

Szabolcs Molnár

Assistant lecturer
University of Debrecen; Faculty of Medicine, Department of Gynecology and Obstetrics
Debrecen, Hajdu-Bihar, Hungary
ZK

Zoárd Tibor Krasznai

Associate professor
University of Debrecen; Faculty of Medicine, Department of Gynecology and Obstetrics
Debrecen, Hajdu-Bihar, Hungary

Background: Coronavirus disease-19 (COVID-19) is associated with disturbed hemostasis balance. Little is known about COVID-19-associated hemostasis alterations in pregnancy and their associations with the clinical course.

Aims: We aimed to test hemostasis alterations in COVID-19-positive pregnant women as compared to non-infected pregnancies and to correlate results with maternal and perinatal outcomes.

Methods: In this single-center observational case-control study, 80 women with acute COVID-19 infection at 24-40 gestational weeks (COVID-19+ group) and 80 healthy age- and gestational week-matched pregnant women (COVID-19- group) were enrolled. All women were outpatients with mild/no symptoms at admission. Acute infection was confirmed/ruled out using SARS-CoV-2 RT-PCR and/or antigen test. Blood taken on admission was analyzed for markers of inflammation (CRP, ferritin, IL-6), D-dimer, fibrinogen, von Willebrand factor antigen, factor VIII (FVIII) and factor XIII (FXIII) activity, clot-lysis assay, thrombin generation, ACE1, ACE2 activity, and anti-SARS-CoV-2 antibody levels. Detailed clinical parameters of pregnancy, labor and post-partum period were registered. Pregnancies were followed for 6 weeks after childbirth.

Results: In the COVID-19+ group, APTT was significantly prolonged, while PT, fibrinogen, and D-dimer levels did not significantly differ from the non-infected group. FVIII activity was significantly lower in the COVID-19+ group as compared to COVID-19- group (183.7±55.9% vs. 201.7±49.2%, p=0.03). Similarly, FXIII activity was significantly reduced in COVID-19+ pregnant women (80.6±23.5% vs. COVID-19- group: 91.6±22.5%, p=0.04). Pregnancy-associated complications were observed in 5 COVID-19+ cases, with marked alterations of coagulation screening tests, clot-lysis assay, and increased D-dimer. Perinatal complications were observed in 6 cases and one newborn tested positive for SARS-CoV-2. Two cases of severe post-partum hemorrhage were observed in the COVID-19+ group. No post-partum thrombotic events occurred.

Conclusion(s): In this cohort, third-trimester COVID-19+ pregnancies were associated with reduced levels of FVIII and FXIII activity. In a few cases, marked alterations of hemostasis and fibrinolysis balance occurred, which were accompanied by pregnancy complications.