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Erol SA, Tanacan A, Anuk AT, Tokalioglu EO, Biriken D, Keskin HL, Tekin OM, Yazihan N, Sahin D. Evaluation of Maternal Serum Afamin and Vitamin E Levels in Pregnant Women with COVID-19 and Its Association with Composite Adverse Perinatal Outcomes. J Med Virol. 2020 Dec 12. doi: 10.1002/jmv.26725. Epub ahead of print. PMID: 33314206.

Objective: To evaluate the maternal serum afamin and vitamin E levels in pregnant women with coronavirus disease 2019 (COVID-19) and to investigate their association with composite adverse perinatal outcomes.

Methods: This prospective, case-control study consisted of 60 pregnant women with COVID-19 infection and 36 age-matched pregnant women without any defined risk factors. Demographic features, laboratory test results, afamin and vitamin E levels were compared between the groups. Receiver operating characteristic (ROC) curve was used to assess the relationship of afamin and vitamin E levels in predicting composite adverse perinatal outcomes. A correlation analysis was performed between afamin and C-reactive protein (CRP) levels in pregnant women with COVID-19.

Results: Obstetric complication rate was higher in the COVID-19 group (13.3% vs 2.8%) (p=0.01). Afamin levels were higher and vitamin E levels were lower in the COVID-19 group (p=0.02, p<0.001, respectively). Vitamin E levels were lower in the COVID-19 group for the all trimesters (p<0.001, p<0.001, p=0.004, respectively). Afamin levels were higher in the COVID-19 group for the all trimesters without reaching statistical significance (p>0.05). The values in ROC curves with the best balance of sensitivity/specificity for afamin and vitamin E were 0.424 mg/l (70.6% sensitivity, 44.3% specificity) and 3.150 µg/ml (76.5% sensitivity, 58.2% specificity), respectively. A positive moderate statistically significant correlation was found between afamin and CRP levels (r= 0.264, p=0.009).

Conclusion: Higher afamin and lower vitamin E levels may support the elevated oxidative stress in the etiopathogenesis of COVID-19 and the relationship with composite adverse perinatal outcomes.

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