SARS-CoV-2 infection in pregnant women and incidence of thromboembolic disease: an analysis of the Covid-19-Related Obstetric and Neonatal Outcome Study (CRONOS) in Germany
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE: The aim of the present study was to quantify the rate of thromboembolic events (TE) in pregnant women with SARS-CoV-2 infection and to characterize risk factors to provide a basis for individualized recommendation on prophylactic measures. METHODS: CRONOS is a multicenter, prospective observational study conducted in Germany and Austria during the COVID-19 pandemic. Pregnant women with confirmed SARS-CoV-2 infection were enrolled. Data on demographics, medical history, COVID-19-related aspects, and pregnancy and birth outcomes were collected. TE was particularly queried and used as the primary outcome. A combination of "TE," "maternal or fetal death," or "severe postpartum hemorrhage" was defined as a secondary endpoint. Risk analyses were performed using univariate and multivariable logistic regression models. RESULTS: Data from 8033 pregnant patients showed 40 TEs (0.5% incidence). TE rates were 10% in ICU patients, 0.2-0.4% in those with moderate-to-mild COVID-19, and < 0.1% in asymptomatic women. Pulmonary embolism occurred in 21 cases, deep vein thrombosis in 12, and 7 had atypical or arterial TE. Risk factors included advanced gestational age, COVID-19 symptoms, hospitalization or ICU admission, premature birth, cesarean section, delivery within 4 weeks of infection, higher weight gain, anemia, and chronic inflammatory bowel disease. COVID-19 vaccination reduced risk. The logistic risk model yielded an AUC of 0.87 (95% CI 0.81-0.94). CONCLUSION: The TE rate in pregnant women is largely determined by the severity of the disease. In asymptomatic or mild cases, other factors outweigh TE risk, while severe COVID-19 requiring ICU admission poses a high TE risk despite prophylaxis.
Authors: Ulrich Pecks, Michael K. Bohlmann, Kristin Andresen, Johanna Büchel, Catharina Bartmann, Magdalena Sitter, Anastasia Tihon, Peter Kranke, Achim Wöckel, Regina Hollweck, Iris Dressler-Steinbach, Susanne Gruessner, Teresa M. Gruber, Teresa Eichinger, Jula Manz, Ina M. Ruehl, Angela Lihs, Anna-Lena Biermann, Lea M. Bauerfeind, Kathleen M. Oberste, Babett Ramsauer, Eveline Russe, Susanne Schrey-Petersen, Filiz Markfeld Erol, Cahit Birdir, Lisa Kaup, Gregor Seliger, Christine Morfeld, Martin A. Berghaeuser, Manuela F. Richter, Peter Jakubowski, Birgit Linnemann, Werner Rath
Institutions: University of Würzburg, Universitätsklinikum Würzburg, Kliniken des Landkreises Lörrach, University Hospital Schleswig-Holstein, Stiftung Charité, Charité - Universitätsmedizin Berlin, Klinikum Wilhelmshaven, Johannes Kepler University of Linz, Klinikum Darmstadt, German Red Cross, Klinikum Sindelfingen-Böblingen, Medizinische Hochschule Hannover, LMU Klinikum, Ludwig-Maximilians-Universität München, University of Münster, University Hospital Münster, Vivantes Klinikum, Leipzig University, University of Freiburg, University Medical Center Freiburg, University Hospital Carl Gustav Carus, University Hospital in Halle, Diakovere, Kinderkrankenhaus auf der Bult, Universitätsklinikum Tübingen, University of Tübingen, Johannes Gutenberg University Mainz
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,590
Funder: Schleswig-Holstein
OpenAlex ID: W4408884887