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.
【저자키워드】 COVID-19, Pregnancy, ADAMTS13, von Willebrand factor, AB0 blood group system, 【초록키워드】 Biomarker, Decision making, SARS-COV-2 infection, hospital, Infection, risk, Symptom, Italy, discharge, clinical outcomes, adverse outcomes, pregnant women, Pregnancy, Asymptomatic, ADAMTS13, von Willebrand factor, Laboratory parameters, Logistic regression, age, monitoring, Hospital admission, Follow-up, demographic, Admission, mechanism, COVID-19 patients, association, marker, thrombotic microangiopathy, COVID-19 patient, microangiopathy, preterm delivery, gestational age, Support, regression analysis, Imbalance, Logistic regression analysis, decision making process, symptom of infection, 95%CI, damage, laboratory data, clinical information, confounders, laboratory-confirmed, significantly lower, laboratory parameter, independent, Result, responsible, collected, evaluate, significantly, investigated, was performed, median, significantly higher, ADA, diagnosis of SARS-CoV-2, with COVID-19, 【제목키워드】 outcome, pregnant,