Thrombotic markers in pregnant patients with and without SARS-CoV-2 infection

Introduction: COVID-19 is associated with coagulation abnormalities and increased risk for venous and arterial thrombi. To evaluate D-dimer levels and lupus anticoagulant (LAC) positivity in pregnant individuals with and without SARS-CoV-2 infection. Materials and Methods: 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 to those without (mean 2.03 μg/mL [95% 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. Conclusions: Thrombotic markers did not differ in pregnant individuals by SARS-CoV-2 infection; however, high rates of LAC positivity were detected.