Abstract
Objective: Second- and third-trimester SARS-CoV-2 infections may have an increased risk of obstetric complications. However, data on first-trimester infections are scarce. We sought to characterize the clinical and inflammatory presentations and pregnancy outcomes of first-trimester infections.
Methods: A population-based multicenter study including 817 singleton pregnancies with SARS-CoV-2 serologic testing at 8-14 weeks between March and May 2020. Blood count, uterine artery Doppler, and pregnancy-associated plasma protein A (PAPP-A) were performed in all women. Placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), IL-6, and ferritin were determined in positive women. Obstetric outcomes were evaluated.
Results: The prevalence of first-trimester infection was 15.2% (n = 124). 72.6% of positive women were asymptomatic. Symptomatic women had higher rates of lymphopenia (1.91 × 109/L vs. 2.16 × 109/L, p = 0.017) and increased levels of IL-6 (9.1% vs. 1.2%, p = 0.051), but lower rates of decreased ferritin (6.3% vs. 19.8%, p = 0.015). PAPP-A was higher in symptomatic women compared with asymptomatic and negative women (1.44 [IQR 0.90-1.82] vs. 1.08 [IQR 0.66-1.61] p = 0.014, vs. 1.08 [IQR 0.77-1.55] p = 0.019, respectively). Obstetric outcomes were not increased.
Conclusions: First-trimester SARS-CoV-2 infections are mostly asymptomatic, with a mild increase of inflammatory markers in symptomatic women. Obstetric complications were not increased, but PAPP-A levels were higher in symptomatic women.
Keywords: COVID-19; First trimester; Obstetric outcomes; Preeclampsia; Severe acute respiratory syndrome coronavirus 2.
【저자키워드】 COVID-19, severe acute respiratory syndrome coronavirus 2, preeclampsia, first trimester, Obstetric outcomes, 【초록키워드】 severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, coronavirus, IL-6, multicenter study, SARS-COV-2 infection, Infection, inflammatory markers, ferritin, outcome, severe acute respiratory syndrome Coronavirus, preeclampsia, lymphopenia, Prevalence, Pregnancy, infections, Asymptomatic, symptomatic, Complication, Mild, complications, Inflammatory marker, women, multicenter, respiratory, serologic testing, first trimester, blood count, Inflammatory, Obstetric, tyrosine, plasma protein, not increased, acute respiratory syndrome, uterine artery, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, increased risk, growth factor, positive, second, Doppler, performed, evaluated, uterine, 【제목키워드】 SARS-CoV-2, clinical, presentation,