Objective To explore the impact of SARS-CoV-2 infection on the antiphospholipid antibodies (aPLs) and perinatal outcomes of pregnant women with antiphospholipid syndrome (APS). Methods A prospective study that included pregnant women with APS who received perinatal care and delivered at our hospital from 2022 to 2023 was conducted. In accordance with SARS-CoV-2 infection as the exposure factor, participants were categorized into a SARS-CoV-2 exposed group and an unexposed group, with a subsequent follow-up of serum aPL results and perinatal outcomes. Further stratification was performed within the study group based on the pregnancy stage during infection and changes in aPLs after infection. Results SARS-CoV-2 infection significantly increased the rate of aPL positivity in pregnant women with APS (50.00% vs. 77.50%, P = 0.011), primarily affecting anti-beta2-glycoprotein Ⅰ antibodies (aβ2GPⅠ) and lupus anticoagulant (LAC), with a higher effect on increased LAC positivity (Δ = + 0.571). However, cases with increased aPLs, defined as the development of new aPL subtypes not present at baseline, and these mostly involved a single type of antibody. The increase in aPL positivity after infection during the third trimester was higher (50.00% vs. 92.86%, P = 0.033). SARS-CoV-2 infection did not significantly elevate the risk of adverse perinatal outcomes in the standardized management for APS. However, the stratified analysis revealed that neonatal adverse outcomes were more common in late pregnancy infections than in early pregnancy infections (57.14% vs. 9.10%, P = 0.033). Conclusions SARS-CoV-2 increases the rate of positive aPLs among pregnant women with APS. A numerical increase in adverse perinatal outcomes was observed in patients with newly positive aPLs post-infection, but the potential association with aPL-mediated pathological hypercoagulation remains speculative and requires further validation. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • SARS-CoV-2 infection, especially in the third trimester, increased aPLs positivity in pregnant APS patients, mostly as a single aPLs subtype. • A numerical increase in adverse maternal-fetal outcomes was observed among APS patients who developed newly positive aPLs post-infection, though no statistical significance was achieved. • Standard APS management during pregnancy mitigated the impact on adverse maternal-fetal outcomes of SARS-CoV-2 infection. </entry> </row> </tbody> </tgroup> </Table>

Effect of SARS-CoV-2 infection on the antiphospholipid antibodies and perinatal outcomes of pregnant patients with antiphospholipid syndrome

期刊论文
发表日期：

2026年3月14日

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Shenglong Ye,
Xue Xu,
Yang Zhang,
Jingjing Yang,
Zhe Chen,
Yuke Hou,
Ran Hu,
Chun Li,
Meiying Liang

摘要

Objective

To explore the impact of SARS-CoV-2 infection on the antiphospholipid antibodies (aPLs) and perinatal outcomes of pregnant women with antiphospholipid syndrome (APS).

Methods

A prospective study that included pregnant women with APS who received perinatal care and delivered at our hospital from 2022 to 2023 was conducted. In accordance with SARS-CoV-2 infection as the exposure factor, participants were categorized into a SARS-CoV-2 exposed group and an unexposed group, with a subsequent follow-up of serum aPL results and perinatal outcomes. Further stratification was performed within the study group based on the pregnancy stage during infection and changes in aPLs after infection.

Results

SARS-CoV-2 infection significantly increased the rate of aPL positivity in pregnant women with APS (50.00% vs. 77.50%, P = 0.011), primarily affecting anti-beta2-glycoprotein Ⅰ antibodies (aβ2GPⅠ) and lupus anticoagulant (LAC), with a higher effect on increased LAC positivity (Δ = + 0.571). However, cases with increased aPLs, defined as the development of new aPL subtypes not present at baseline, and these mostly involved a single type of antibody. The increase in aPL positivity after infection during the third trimester was higher (50.00% vs. 92.86%, P = 0.033). SARS-CoV-2 infection did not significantly elevate the risk of adverse perinatal outcomes in the standardized management for APS. However, the stratified analysis revealed that neonatal adverse outcomes were more common in late pregnancy infections than in early pregnancy infections (57.14% vs. 9.10%, P = 0.033).

Conclusions

SARS-CoV-2 increases the rate of positive aPLs among pregnant women with APS. A numerical increase in adverse perinatal outcomes was observed in patients with newly positive aPLs post-infection, but the potential association with aPL-mediated pathological hypercoagulation remains speculative and requires further validation.

Key Points

• SARS-CoV-2 infection, especially in the third trimester, increased aPLs positivity in pregnant APS patients, mostly as a single aPLs subtype.

• A numerical increase in adverse maternal-fetal outcomes was observed among APS patients who developed newly positive aPLs post-infection, though no statistical significance was achieved.

• Standard APS management during pregnancy mitigated the impact on adverse maternal-fetal outcomes of SARS-CoV-2 infection.