Objective
We aimed to compare laboratory findings among symptomatic and asymptomatic pregnant women infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2).
Study Design
In this prospective cohort study at a large, academic urban U.S. hospital, we evaluated pregnant women with positive polymerase-chain reaction testing for SARS-CoV-2 between March and September 2020. Testing was performed for reported symptoms or on admission by universal screening protocol. Women were systematically queried using a standardized review of symptoms. In our hospital, all patients who tested positive for SARS-CoV-2, irrespective of pregnancy, were recommended to have baseline labs – leukocytes, hemoglobin, platelets, aspartate aminotransferase, alanine aminotransferase (ALT), creatinine, C-reactive protein, procalcitonin, lactate dehydrogenase, D-dimer, and ferritin – as these markers of inflammation were felt to potentially stratify disease severity. Labs were repeated if the clinical course worsened. Mann-Whitney U tests compared peak biomarker levels between symptomatic and asymptomatic pregnant women.
Results
We identified 157 pregnant women with SARS-CoV-2 of whom 83 (53%) were symptomatic. Of symptomatic women, the most commonly reported symptoms were cough, congestion or sore throat (29%); fever (22%); respiratory distress or dyspnea (15%); and myalgias (15%). Compared to asymptomatic women, women with symptomatic SARS-CoV-2 infection had increased procalcitonin and ALT levels (Table 1). However, only 38% and 6% of symptomatic patients developed a clinical elevation in procalcitonin or ALT, respectively. There were no significant differences between symptomatic and asymptomatic women for all other biomarkers.
Conclusion
Inflammatory biomarkers used to differentiate morbidity in non-pregnant patients with SARS-CoV-2 may not have the same utility in pregnant women. Given the severity of infection in pregnant women, future research should continue to evaluate markers of SARS-CoV-2 that account for pregnancy physiology.
