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.