Journal Article

Obstetric outcomes in pregnant COVID-19 women: the imbalance of von Willebrand factor and ADAMTS13 axis

Ceci, Oronzo, Grandone, Elvira, Margaglione, Maurizio, Fischetti, Lucia, Cicinelli, Ettore, Sorrentino, Felice, Tiscia, Giovanni, Nappi, Luigi, Mastroianno, Mario, Capozza, Manuela, Ostuni, Angelo, Colaizzo, Donatella, Vimercati, Antonella, Cappucci, Filomena, De Laurenzo, Antonio

2022

Overview

Background Thrombotic microangiopathy has been invoked as one of the most important mechanisms of damage in COVID-19 patients. Protease ADAMTS13 is a marker of microangiopathy responsible for controlling von Willebrand multimers size. Von Willebrand factor/ADAMTS13 ratio has been found impaired in COVID-19 patients outside pregnancy. Methods We prospectively investigated 90 pregnant women admitted to two tertiary academic hospitals in Italy with a laboratory-confirmed diagnosis of SARS-CoV-2 infection. Demographic, clinical information and routine laboratory data were collected at the hospital admission and until discharge. We investigated whether vonWillebrand /ADAMTS13 axis imbalance is a predictor of adverse outcomes. Logistic regression analysis, which controlled for potential confounders, was performed to evaluate the association between laboratory parameters and clinical outcomes. Results Most women (55.6%) were parae, with median gestational age at admission of 39 weeks. At hospital admission, 63.3% were asymptomatic for COVID-19 and 24.4% showed more than one sign or symptom of infection. Nulliparae with group O showed Willebrand / ADA MTS-13 ratios significantly lower than non-O, whereas in multiparae this difference was not observed. Logistic regression showed that ratio von Willebrand to ADAMTS13 was significantly and independently associated with preterm delivery (OR 1.9, 95%CI 1.1–3.5). Conclusion This study shows an imbalance of vonWillebrand /ADAMTS13 axis in pregnant women with COVID-19, leading to a significantly higher and independent risk of preterm delivery. Monitoring these biomarkers might support decision making process to manage and follow-up pregnancies in this setting.

• Publisher: BioMed Central,BMC
• Subject: AB0 blood group system / Academic Medical Centers / ADAMTS13 / ADAMTS13 Protein - blood / Adolescent / Adult / Biomarkers - blood / COVID-19 / COVID-19 - blood / COVID-19 - complications / Female / Gynecology / Humans / Italy - epidemiology / Maternal and Child Health / Medicine / Medicine & Public Health / Middle Aged / Pregnancy / Pregnancy Complications - blood / Premature Birth - blood / Reproductive Medicine / SARS-CoV-2 / Tertiary Care Centers / Thrombotic Microangiopathies - etiology / von Willebrand factor / von Willebrand Factor - metabolism / Young Adult