Decidual Cells Induce 15-Hydroxyprostaglandin Dehydrogenase Expression in Trophoblasts: A Novel Paracrine Mechanism for Uterine Quiescence

OBJECTIVE: Inflammatory markers are useful in assessing disease severity in the adult population with COVID-19.However, uncertainties exist about their prognostic role during pregnancy.Our objective was to evaluate inflammatory markers in COVID-19 and their association with disease severity in a pregnant cohort.STUDY DESIGN: This was a retrospective cohort study of women with confirmed intrauterine pregnancy and positive nasopharyngeal swab for SARS-CoV-2 who presented to an academic center in New York City from March 1 e July 1, 2020.Analysis was performed 6 weeks after last positive SARS-CoV-2 swab to ensure no additional sequelae developed.Women were categorized by degree of symptoms at presentation into one of three groups: asymptomatic, mild, or severe (defined as supplemental O2 requirement) and critical disease (requirement for mechanical ventilation).We collected inflammatory markers at the time of admission and again during the hospital course for symptomatic disease.The values at admission and highest during the hospital course were evaluated for significance (defined as p< 0.05) using ANOVA and Tukey adjusted mean differences were used to compare levels by disease status.RESULTS: 237 women met criteria for inclusion, 87 asymptomatic, 103 mild illness, 39 severe disease, and 8 critical illness.C-reactive protein (CRP), AST, and ferritin levels were significantly different between the asymptomatic, mild and severe groups (Table 1).For admission level, the difference in means between severe/critical and mild were 55.32 mg/L (12.96 -97.68) for CRP and 142.51 ng/L (23.28 -260.73) for ferritin.For highest level, the difference in means between severe/critical and mild were 70.35 mg/L (27.74 -112.95) for for ferritin.CRP is the only variable that had significant differences between all groups.CONCLUSION: Among pregnant women with COVID-19, CRP and ferritin were the inflammatory markers that most associated with disease severity.D-dimer was not associated with degree of COVID-19 illness, possibly due to the association of pregnancy with d-dimer elevation.