Frequency of positive antiphospholipid antibodies in pregnant women with SARS-CoV-2 infection and impact on pregnancy outcome: A single-center prospective study on 151 pregnancies

Abstract

Background: At the beginning of the SARS-CoV-2 pandemic, there was a lack of information about the infection's impact on pregnancy and capability to induce de novo autoantibodies. It soon became clear that thrombosis was a manifestation of COVID-19, therefore the possible contribution of de novo antiphospholipid antibodies (aPL) raised research interest. We aimed at screening SARS-CoV-2 positive pregnant patients for aPL. Methods:The study included consecutive pregnant women who were hospitalized in our Obstetric Department between March 2020 and July 2021 for either a symptomatic SARS-CoV-2 infection or for other reasons (obstetric complications, labour, delivery) and found positive at the admission nasopharyngeal swab. All these women underwent the search for aPL by means of Lupus Anticoagulant (LA), IgG/IgM anti-cardiolipin (aCL), IgG/IgM anti-beta2glycoprotein I (aB2GPI). Data about comorbidities, obstetric and neonatal complications were collected.Results: 151 women were included. Sixteen (11%) were positive for aPL, mostly at low titre. Pneumonia was diagnosed in 20 women (5 with positive aPL) and 5 required ICU admission (2 with positive aPL). Obstetric complications occurred in 10/16 (63%) aPL positive and in 36/135 (27%) negative patients. The occurrence of HELLP syndrome and preeclampsia was significantly associated with positive aPL (p=0,004). One case of maternal thrombosis occurred in an aPL negative woman. aPL positivity was checked after at least Frontiers in Immunology frontiersin.org 01

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

“…In three LAC positive patients with 12-week follow-up testing, Gozzoli et al found all were LAC negative. 48 We identified LAC positivity persisted in one of two patients with follow-up data. It is unknown if persistent LAC positivity in this population has clinical implications for subsequent pregnancies or thrombotic risk.…”

“…In a single-center, prospective cohort study of 151 individuals admitted to Labor and Delivery with SARS-CoV-2 infection (symptomatic or asymptomatic) tested for antiphospholipid antibodies (LAC, anti-β2 glycoprotein I, and anticardiolipin), Gozzoli et al found that 16 patients had at least one positive antibody of which 9 individuals (6.0%) were LAC positive. 48 Those with a positive antiphospholipid antibody had a higher rate of preeclampsia compared with those without a positive antiphospholipid antibody (25 vs. 5%; p ¼ 0.004). There was a single thrombosis identified in an antiphospholipid antibody negative patient.…”

“…There was a single thrombosis identified in an antiphospholipid antibody negative patient. 48 Again, there was no uninfected comparison group. Our results are similar with a 4% LAC positivity rate among individuals with SARS-CoV-2 infection and no thromboses.…”