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. 2022 Jul 14;11(14):4067.
doi: 10.3390/jcm11144067.

Impact of COVID-19 on Subclinical Placental Thrombosis and Maternal Thrombotic Factors

Marie Carbonnel  1   2 , Camille Daclin  1 , Morgan Tourne  2   3 , Emmanuel Roux  4 , Mathilde Le-Marchand  4 , Catherine Racowsky  1   5 , Titouan Kennel  4 , Eric Farfour  6 , Marc Vasse  6   7 , Jean-Marc Ayoubi  1   2
Affiliations

Impact of COVID-19 on Subclinical Placental Thrombosis and Maternal Thrombotic Factors

Marie Carbonnel et al. J Clin Med. .

Abstract

Background: In the context of the SARS-CoV-2 pandemic, our interest was to evaluate the effect of COVID-19 during pregnancy on placenta and coagulation factors.

Methods: a prospective cohort study between January and July 2021 of 55 pregnant women stratified into: Group O, 16 patients with ongoing SARS-CoV-2 infection at delivery; Group R, 21 patients with a history of SARS-CoV-2 infection during pregnancy but who recovered prior to delivery; Group C, 18 control patients with no infection at any time. All women had nasopharyngeal SARS-CoV-2 RT-PCR tests performed within 72 h of delivery. Obstetrical complications were recorded and two physiological inhibitors of coagulation, protein Z (PZ) and dependent protease inhibitor (ZPI), were analyzed in maternal and cord blood. All placentae were analyzed by a pathologist for vascular malperfusion.

Results: No patient in any group had a severe COVID-19 infection. More obstetrical complications were observed in Group O (O: n = 6/16 (37%), R: n = 2/21 (10%), C: n = 1/18 (6%), p = 0.03). The incidence of placental vascular malperfusion was similar among the groups (O: n = 9/16 (56%), R: n = 8/21 (42%), C: n = 8/18 (44%), p = 0.68). No PZ or ZPI deficiency was associated with COVID-19. However, an increased ZPI/PZ ratio was observed in neonates of Group R (O: 82.6 (min 41.3-max 743.6), R: 120.7 (29.8-203.5), C: 66.8 (28.2-2043.5), p = 0.04).

Conclusion: COVID-19 was associated with more obstetrical complications, but not an increased incidence of placental lesions or PZ and ZPI abnormalities.

Keywords: COVID-19; ZPI; estradiol; placental vascular pathology; pregnancy; protein Z; thrombotic.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study outline of the recruitment of neonates and mothers.
Figure 2
Figure 2
Clinical data of SARS-CoV-2 infection. HELLP: hemolysis, elevated liver enzymes, low platelet count; IUGR: intra uterine growth restriction; HBP: high blood pressure; TPD: threat of premature delivery, * p < 0.05.
Figure 3
Figure 3
Maternal vascular malperfusion lesions associated with fibrinonecrotic microthrombi at different stages of formation ((A): HES ×20) within capillary vascular structures (arrows) and avascular terminal villi ((B): HES ×20).
Figure 4
Figure 4
Concentrations of estradiol (pg/mL) and progesterone (ng/mL) in mothers. Data are shown for healthy controls (n = 18; C: crosses), recovered patients (n = 21; R: open squares) and patients with ongoing infection (n = 16; O: circles). Black lines represent the median. * p < 0.05.
Figure 5
Figure 5
Pearson correlation test between ZPI/Z ratio in neonate and of the concentration of estradiol (A) and progesterone (B) in mothers, * p < 0.05.
See this image and copyright information in PMC

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