Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study.
Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study.
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DOI：
10.1016/j.ajog.2021.05.016
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发表时间：
2021-11
影响因子：
9.8
通讯作者：
Khalil A
中科院分区：
文献类型：
--
作者：
Gurol-Urganci I;Jardine JE;Carroll F;Draycott T;Dunn G;Fremeaux A;Harris T;Hawdon J;Morris E;Muller P;Waite L;Webster K;van der Meulen J;Khalil A
一些研究表明，怀孕期间感染 SARS-CoV-2 的女性发生不良妊娠和新生儿结局的风险增加，但这些关联仍不清楚。本研究旨在确定出生时 SARS-CoV-2 感染与孕产妇和围产期结局之间的关联。这是一项在英国进行的基于人群的队列研究。纳入标准是国家入院数据库中2020年5月29日至2021年1月31日期间记录有单胎出生的女性。对出生时记录的经实验室确诊的 SARS-CoV-2 感染的孕妇与未感染的孕妇的孕产妇和围产期结局进行了比较。研究结果包括妊娠 24 周或超过 24 周的胎儿死亡（死产）、早产（<37 周妊娠）、小于胎龄儿（小于胎龄儿；出生体重<10%）、先兆子痫或子痫、引产、分娩方式、专科新生儿护理、综合新生儿不良结局指标、孕产妇和新生儿孕期长度。 出生后住院（3 天或以上），以及 28 天的新生儿和 42 天的产妇再次入院。使用逻辑回归计算调整后的比值比及其 SARS-CoV-2 感染状态与结果之间关联的 95% 置信区间，并根据孕产妇年龄、种族、产次、既往糖尿病、既往高血压以及使用 2019 年多重剥夺指数测量的社会经济剥夺进行调整。模型拟合了稳健的标准误差，以考虑医院水平 聚类。对足月出生（妊娠≥37周）的新生儿结局进行了重复分析，因为据报道，早产在感染 SARS-CoV-2 的孕妇中更为常见。该分析纳入了 342,080 名女性，其中 3527 名女性经实验室确诊感染 SARS-CoV-2。实验室确诊的 SARS-CoV-2 感染在年轻、非白人、初产或居住在最贫困地区或患有合并症的女性中更为常见。感染 SARS-CoV-2 的女性比未感染的女性更容易发生胎儿死亡（调整后的比值比，2.21；95% 置信区间，1.58-3.11；P<.001）和早产（调整后的比值比，2.17；95% 置信区间，1.96-2.42；P<.001）。先兆子痫或子痫的风险（调整后的比值比，1.55；95% 置信区间，1.29–1.85；P<.001）、紧急剖腹产分娩（调整后的比值比，1.63；95% 置信区间，1.51–1.76；P<.001）以及出生后入院时间延长（调整后的比值比，1.57；P<.001）。 95% 置信度 区间，1.44–1.72； P<.001）感染 SARS-CoV-2 的女性明显高于未感染的女性。其他孕产妇结局发生率没有显着差异（P>.05）。新生儿不良结局的风险（调整后比值比，1.45；95% 置信区间，1.27–1.66；P<.001）、需要专业新生儿护理（调整后比值比，1.24；95% 置信区间，1.02–1.51；P=.03）以及新生儿出生后入院时间延长（调整后比值比，1.61；95% 置信度） 区间，1.49–1.75；对于实验室确诊的 SARS-CoV-2 感染母亲所生的婴儿，P<.001）均显着较高。当分析仅限于足月分娩（≥37周）时，新生儿不良结局（P=.78）、出生后需要新生儿专科护理（P=.22）或新生儿在出生后4周内再次入院（P=.05）没有显着差异。经实验室确诊感染 SARS-CoV-2 的母亲足月出生的新生儿更有可能在出生后延长入院时间（21.1% 与 14.6%；调整后优势比，1.61；95% 置信区间，1.49–1.75；P<.001）。出生时感染 SARS-CoV-2 与较高的胎儿死亡率、早产、先兆子痫和紧急剖宫产率相关。除与早产相关的不良后果外，没有其他不良新生儿结局。应向孕妇提供关于 SARS-CoV-2 感染风险的咨询，并应优先考虑接种疫苗。
Some studies have suggested that women with SARS-CoV-2 infection during pregnancy are at increased risk of adverse pregnancy and neonatal outcomes, but these associations are still not clear. This study aimed to determine the association between SARS-CoV-2 infection at the time of birth and maternal and perinatal outcomes. This is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between May 29, 2020, and January 31, 2021, in a national database of hospital admissions. Maternal and perinatal outcomes were compared between pregnant women with a laboratory-confirmed SARS-CoV-2 infection recorded in the birth episode and those without. Study outcomes were fetal death at or beyond 24 weeks’ gestation (stillbirth), preterm birth (<37 weeks’ gestation), small for gestational age infant (small for gestational age; birthweight at the <tenth centile), preeclampsia or eclampsia, induction of labor, mode of birth, specialist neonatal care, composite neonatal adverse outcome indicator, maternal and neonatal length of hospital stay after birth (3 days or more), and 28-day neonatal and 42-day maternal hospital readmission. Adjusted odds ratios and their 95% confidence interval for the association between SARS-CoV-2 infection status and outcomes were calculated using logistic regression, adjusting for maternal age, ethnicity, parity, preexisting diabetes mellitus, preexisting hypertension, and socioeconomic deprivation measured using the Index of Multiple Deprivation 2019. Models were fitted with robust standard errors to account for hospital-level clustering. The analysis of the neonatal outcomes was repeated for those born at term (≥37 weeks’ gestation) because preterm birth has been reported to be more common in pregnant women with SARS-CoV-2 infection. The analysis included 342,080 women, of whom 3527 had laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 infection was more common in women who were younger, of non-White ethnicity, primiparous, or residing in the most deprived areas or had comorbidities. Fetal death (adjusted odds ratio, 2.21; 95% confidence interval, 1.58–3.11; P<.001) and preterm birth (adjusted odds ratio, 2.17; 95% confidence interval, 1.96–2.42; P<.001) occurred more frequently in women with SARS-CoV-2 infection than those without. The risk of preeclampsia or eclampsia (adjusted odds ratio, 1.55; 95% confidence interval, 1.29–1.85; P<.001), birth by emergency cesarean delivery (adjusted odds ratio, 1.63; 95% confidence interval, 1.51–1.76; P<.001), and prolonged admission after birth (adjusted odds ratio, 1.57; 95% confidence interval, 1.44–1.72; P<.001) were significantly higher for women with SARS-CoV-2 infection than those without. There were no significant differences (P>.05) in the rate of other maternal outcomes. The risk of neonatal adverse outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.27–1.66; P<.001), need for specialist neonatal care (adjusted odds ratio, 1.24; 95% confidence interval, 1.02–1.51; P=.03), and prolonged neonatal admission after birth (adjusted odds ratio, 1.61; 95% confidence interval, 1.49–1.75; P<.001) were all significantly higher for infants with mothers with laboratory-confirmed SARS-CoV-2 infection. When the analysis was restricted to pregnancies delivered at term (≥37 weeks), there were no significant differences in neonatal adverse outcome (P=.78), need for specialist neonatal care after birth (P=.22), or neonatal readmission within 4 weeks of birth (P=.05). Neonates born at term to mothers with laboratory-confirmed SARS-CoV-2 infection were more likely to have prolonged admission after birth (21.1% compared with 14.6%; adjusted odds ratio, 1.61; 95% confidence interval, 1.49–1.75; P<.001). SARS-CoV-2 infection at the time of birth is associated with higher rates of fetal death, preterm birth, preeclampsia, and emergency cesarean delivery. There were no additional adverse neonatal outcomes, other than those related to preterm delivery. Pregnant women should be counseled regarding risks of SARS-CoV-2 infection and should be considered a priority for vaccination.
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DOI：
10.1136/archdischild-2018-315147
发表时间：
2019-09-01
影响因子：
4.4
作者：
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DOI：
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DOI：
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发表时间：
2021-05
期刊：
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
影响因子：
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作者：
Kalafat E;O'Brien P;Heath PT;Le Doare K;von Dadelszen P;Magee L;Ladhani S;Khalil A
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Khalil A
DOI：
10.1111/1471-0528.12508
发表时间：
2014-01-01
影响因子：
5.8
作者：
Knight, H. E.;Gurol-Urganci, I.;Cromwell, D. A.
通讯作者：
Cromwell, D. A.
DOI：
10.1136/bmj.n628
发表时间：
2021-03-18
期刊：
BMJ (Clinical research ed.)
影响因子：
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作者：
Forbes H;Morton CE;Bacon S;McDonald HI;Minassian C;Brown JP;Rentsch CT;Mathur R;Schultze A;DeVito NJ;MacKenna B;Hulme WJ;Croker R;Walker AJ;Williamson EJ;Bates C;Mehrkar A;Curtis HJ;Evans D;Wing K;Inglesby P;Drysdale H;Wong AYS;Cockburn J;McManus R;Parry J;Hester F;Harper S;Douglas IJ;Smeeth L;Evans SJW;Bhaskaran K;Eggo RM;Goldacre B;Tomlinson LA
通讯作者：
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