Hematologic characteristics and coagulopathy in pregnancy with COVID-19 succeeding the first wave: a multicenter retrospective cross-sectional study

Background:Early reports have demonstrated an association of COVID-19 infectionduring pregnancy and postpartum period with coagulopathy and bleeding complicationsand indicated that pregnant people with COVID-19 are more likely to experiencecoagulopathy and venous thromboembolism. A recent report concerning such com-plications during thefirst wave of the pandemic was reassuring; however, no publica-tions have evaluated these issues in the context of increased illness severity with theemergence of SARS-CoV-2 variants of concern. Objectives:We performed a retrospective, multinational cohort study in Canada,Romania, and the United Kingdom, aiming to provide a comprehensive analysis of thehematologic test characteristics of pregnancies affected by COVID-19 after thefirstwave of the pandemic. Results:Three-hundred-seventy patients were evaluated. Markers of inflammation andendothelial dysfunction were significantly elevated, in keeping with observations in thenonpregnant population. Reassuringly, despite more severe disease noted in succeed-ing waves of the pandemic, there was no significant evidence of COVID-19-associatedcoagulopathy, and overall, no association was demonstrated between isolated coagu-lation abnormalities and bleeding risk. Notably,fibrinogen below 2g/L was again linkedwith the risk of postpartum hemorrhage. Finally, venous thromboembolism risk was lowbut noted more frequently in those with severe illness despite thromboprophylaxis. Conclusion:Ourfindings add valuable insights into the nature of hematologic testcharacteristics, bleeding, and thrombotic complications for those affected with COVID-19 in pregnancy, reassuring readers of the low incidence of bleeding and thromboticcomplications but inviting further debate as to the degree of thromboprophylaxis thatmay benefit the subgroup with severe disease.