Methods:
This was a case series at Westchester Medical Center, a tertiary care center located in Valhalla, New York, to compare maternal and neonatal outcomes between pregnant patients hospitalized with COVID-19, with and without transaminitis from March 25, 2020 to May 26th, 2020. This timeframe represents the initial peak of the pandemic in New York and was used to obtain preliminary data.
Data for this study was obtained from electronic medical records used at Westchester Medical Center and this project was approved by New York Medical College and Westchester Medical College Institutional Review Board (IRB). No funding was involved for this research.
All antepartum or postpartum patients diagnosed with COVID-19 who presented to Westchester Medical Center between March 25th, 2020 and May 26th, 2020 were screened for inclusion criteria. Patients who presented with COVID-19-like symptoms or those admitted for any obstetrical reason were all routinely screened and tested for COVID-19. The patients who tested positive for COVID-19 were then separated into two groups: patients with COVID-19 who had transaminitis at any point in their hospital course, and patients with COVID-19 without transaminitis. For the study, transaminitis was defined as aspartate transaminase (AST) > 35 U/L and alanine transaminase (ALT) > 55 U/L according to Westchester Medical Center’s laboratory reference range.
Patients with transaminitis who had a history of hepatitis, transaminitis of any etiology diagnosed before COVID-19 diagnosis, a diagnosed liver mass, HELLP syndrome or preeclampsia during current pregnancy, current diagnosis of cholelithiasis, or intrahepatic cholestasis of pregnancy, or a history of alcohol abuse or IV drug abuse were excluded from the study.
The primary outcome for the study was maternal ICU admission. Secondary outcomes included maternal and neonatal outcomes and laboratory values. Maternal outcomes were length of hospital stay, maternal death, supplemental oxygen requirement, intubation and need for cesarean delivery. Neonatal outcomes were birth weight, Apgar score <7 at 5 minutes of life, arterial cord blood acidosis (pH <7.2), preterm delivery and gestational age (GA) at delivery. Laboratory values of interest included AST, ALT, BUN, creatinine and glucose.
Data analysis was performed using SPSS version ‘X’ (IBM, Inc., Armonk New York). Continuous variables are presented as medians and interquartile ranges. Categorical variables are presented as frequencies, rates and percentages. The one tailed Mann-Whitney test was used for nonparametric data and the fisher’s exact test was used for categorical data. Statistical significance was defined as a p-value < 0.05.