Research needed on pregnancy, hormonal birth control and blood clot risk in COVID-19
COVID-19 may increase the risk for blot clots in women who are pregnant or taking estrogen with birth control or hormone therapy, and more research is needed on the underlying mechanisms that could potentially drive risk, researchers wrote.
To date, no reports of increased incidence of venous thromboembolism among pregnant women or women taking estrogen preparations who also have COVID-19 have emerged; however, a preliminary report indicates that vascular abnormalities in the placenta can accompany SARS-CoV-2 infection, Daniel I. Spratt, MD, director of the division of reproductive endocrinology and infertility at Maine Medical Center in Portland, Maine, and Rachel J. Buchsbaum, MD, chief of the division of hematology/oncology at Tufts Medical Center in Boston, wrote in a commentary published in Endocrinology. A COVID-19 registry to assess outcomes for pregnant women could facilitate approaches to many unanswered questions regarding risk for hypercoagulation, they wrote.
“During this pandemic, we need additional research to determine if women who become infected with the coronavirus during pregnancy should receive anticoagulation therapy or if women taking birth control pills or hormone replacement therapy should discontinue them,” Spratt said in a press release. “Research that helps us understand how the coronavirus causes blood clots may also provide us with new knowledge regarding how blood clots form in other settings and how to prevent them.”
The researchers noted that establishing models for basic research into mechanisms of hypercoagulability in COVID-19, as well as the intersecting effects of COVID-19 and estrogen therapy or pregnancy, will require innovative, novel animal and tissue models.
“Several issues complicate matters,” Spratt and Buchsbaum wrote. “COVID-19 has a variety of coagulation effects that appear to differ between individuals. Coagulation physiology in nonhuman animals differs from humans. Hypercoagulability with pregnancy (and probably estrogen therapy) does not naturally occur in other animals.”
The researchers wrote that basic researchers, endocrinologists and hematologists should work together to explore potential interactions between COVID-19 and pregnancy or estrogen therapy that could guide clinical management.
Editor's Note: On August 4, 2020, we updated the article to indicate that Rachel J. Buchsbaum, MD, is chief of the division of hematology/oncology at Tufts Medical Center in Boston. The editors regret the error.