Pecks Ulrich, Bohlmann Michael K, Andresen Kristin, Büchel Johanna, Bartmann Catharina, Sitter Magdalena, Tihon Anastasia, Kranke Peter, Wöckel Achim, Hollweck Regina, Dressler-Steinbach Iris, Gruessner Susanne, Gruber Teresa M, Eichinger Teresa, Manz Jula, Ruehl Ina M, Lihs Angela, Biermann Anna-Lena, Bauerfeind Lea M, Oberste Kathleen M, Ramsauer Babett, Russe Eveline, Schrey-Petersen Susanne, Erol Filiz Markfeld, Birdir Cahit, Kaup Lisa, Seliger Gregor, Morfeld Christine, Berghaeuser Martin A, Richter Manuela F, Jakubowski Peter, Linnemann Birgit, Rath Werner
Department of Obstetrics and Gynecology, Germany AND Institut of Midwifery, University Hospital of Wuerzburg, Würzburg, Germany.
Department of Obstetrics and Gynecology, St. Elisabethen-Krankenhaus Lörrach, Lörrach, Germany.
Arch Gynecol Obstet. 2025 Jun;311(6):1667-1682. doi: 10.1007/s00404-025-08007-5. Epub 2025 Mar 25.
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.
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.
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).
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.
本研究旨在量化感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的孕妇发生血栓栓塞事件（TE）的发生率，并确定危险因素，为预防性措施的个体化推荐提供依据。
CRONOS是一项在新冠疫情期间于德国和奥地利开展的多中心前瞻性观察性研究。纳入确诊感染SARS-CoV-2的孕妇。收集人口统计学、病史、新冠相关情况以及妊娠和分娩结局的数据。特别询问了TE情况并将其作为主要结局。将“TE”、“孕产妇或胎儿死亡”或“严重产后出血”的组合定义为次要终点。使用单变量和多变量逻辑回归模型进行风险分析。
8033例孕妇的数据显示发生了40例TE（发生率为0.5%）。重症监护病房（ICU）患者的TE发生率为10%，中轻度新冠患者为0.2 - 0.4%，无症状女性<0.1%。21例发生肺栓塞，12例发生深静脉血栓形成，7例发生非典型或动脉性TE。危险因素包括孕晚期、新冠症状、住院或入住ICU、早产、剖宫产、感染后4周内分娩、体重增加较多、贫血和慢性炎症性肠病。接种新冠疫苗可降低风险。逻辑风险模型的曲线下面积（AUC）为0.87（95%置信区间0.81 - 0.94）。
孕妇的TE发生率很大程度上由疾病严重程度决定。在无症状或轻症病例中，其他因素超过TE风险，而尽管采取了预防措施，但需要入住ICU的重症新冠仍具有较高的TE风险。
