PP-039 COVID-19 during pregnancy and systemic inflammatory response syndrome

During pregnancy, almost all body systems undergo physiological changes, but changes in the immune system and the hemostasis system, inflammation play a special role in the adaptation of pregnancy from its early stages. From the point of view of the functioning of the immune system, pregnancy is a unique condition during which the mother's body must, on the one hand, provide protection from pathogens, and on the other, show tolerance to fetal antigens. SARS-CoV-2 infection has selective effects on both the immune system and the hemostasis system, therefore pregnant women are at high risk of complications associated with SARS-CoV-2 and its effects on the mother and fetus. Therefore, the purpose of our study was to determine the relationship between disorders of the hemostatic system and immunity after suffering from COVID-19 during pregnancy.

The study included 90 pregnant women and their newborn children, who were divided into two groups, the first 45 women with COVID-19 during pregnancy and a control group of 45 healthy pregnant women. In all pregnant women, the levels of fibrinogen, von Willebrand factor (vWF), ADAMTS-13, platelet aggregation, concentration of the activation marker NETs (myeloperoxidase MPO), cytokines, chemokines, cell markers, and functional activity of T-reg cells were evaluated in the peripheral blood, as well as in the umbilical cord blood of their unborn.

In group I, hyperfibrinogenemia (p<0.001), high concentrations of vWF antigen (p<0.001), disorders in the ADAMTS-13/vWF axis (p=0.001) (fig 1) were detected in pregnant women, platelet aggregation with aggregation stimulators was increased: ADP (p<0.001), ristomycin (p<0.001), collagen (p<0.001), adrenaline (p<0.001), high MPO levels (p=0.046). High levels of cytokines and chemokines (IL 1a (p=0.018), IL 6 (p=0.032), IL-10 (p=0.003), MIP-1 (p<0.001), TNF a (p<0.001), CXCL10 (p<0.001)), MPO (p<0.001), increased expression of CD80 (p<0.001) and CD86 (p<0.001) on dendritic cells, decreased functional activity of T-reg (p<0.001) in the umbilical cord blood of group I newborns compared with the control group (Table 1).

COVID-19 causes systemic inflammatory response syndrome in both mother and fetus. In the mother, we see such changes as hyperfibrinogenemia, high concentrations of D-dimer, von Willebrand factor, a violation in the ADAMTS-13/vWF axis, platelet hyperactivation. Despite the normalization of immunological parameters and cytokine profile in mothers, by the time of delivery, the immune system is dysregulated in newborns with the development of inflammatory status and activation of the immune system and a high risk of severe systemic inflammatory response syndrome.