Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis.
Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis.
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COVID-19大流行对孕产妇和围产期结局的影响：系统回顾和荟萃分析
DOI：
10.1016/s2214-109x(21)00079-6
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Khalil A
中科院分区：
文献类型：
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作者：
Chmielewska B;Barratt I;Townsend R;Kalafat E;van der Meulen J;Gurol-Urganci I;O'Brien P;Morris E;Draycott T;Thangaratinam S;Le Doare K;Ladhani S;von Dadelszen P;Magee L;Khalil A
新冠肺炎大流行对卫生保健系统产生了深远影响，并可能对妊娠结局产生影响，但尚未对这种影响的证据进行系统的综合。我们的目标是评估关于大流行对母体、胎儿和新生儿结局影响的集体证据。我们对大流行对母体、胎儿和新生儿结局的影响进行了系统的综述和荟萃分析。我们根据Prisma指南搜索了2020年1月1日至2021年1月8日期间的MEDLINE和EMBASE，以获取病例对照研究、队列研究以及比较大流行前和大流行期间孕产妇和围产期死亡率、孕产妇发病率、妊娠并发症以及分娩和新生儿结局的简要报告。我们还计划记录所确定的任何额外的母子结局。对单纯感染SARS-CoV-2的孕妇的研究，以及病例报告，没有对照组的研究，叙述性或系统性的文献综述，预印本，以及关于重叠人群的研究报告都被排除在外。当一项以上的研究提供相关数据时，对结果进行定量荟萃分析。使用Mantel-Haenszel方法生成每个结果的合并优势比(OR)的随机效应估计。这篇综述已在Propero(CRD42020211753)上注册。搜索确定了3592条引文，其中包括40项研究。我们发现，与大流行前相比，死产(合并OR 1·28[95%CI 1·07-1·54]；I2=63%；12项研究，168295次怀孕和大流行前的198993例)和孕产妇死亡(1·37[1·22-1·53；I2=0%，两项研究[均来自低收入和中等收入国家]，1 237 018和2 224 859妊娠)显著增加。妊娠37周前的早产儿总体上没有显著变化(0·94[0·87-1·02]；I2=75%；15项研究，170个 640和656个 423妊娠)，但在高收入国家(0·91[0·84-0·99]；I2=63%；12个研究，159个 987和635个 118个妊娠)，自然早产也减少(0·81[0·67-0·97]；两个研究，4204和6818个怀孕)。爱丁堡产后抑郁量表的平均得分较高，表明与大流行前相比，精神健康状况较差(合并平均差异0·42[95%可信区间0·02-0·81；三项研究，2330次和6517次怀孕]。在大流行期间，通过手术处理的异位妊娠增加(OR 5·81[2·16-15·6]；I2=26%；三项研究，37和272例怀孕)。定量分析中未发现对其他结局的总体显著影响：产妇妊娠期糖尿病；妊娠高血压疾病；妊娠34周、32周或28周之前早产；医源性早产；引产；分娩方式(自然阴道分娩、剖腹产或器质性分娩)；产后出血；新生儿死亡；低出生体重(<；2500克)；新生儿重症监护病房入院；或5分钟Apgar评分低于7分。在新冠肺炎大流行期间，全球孕产妇和胎儿结局恶化，孕产妇死亡、死产、宫外孕破裂和孕产妇抑郁增加。一些结果显示，高资源和低资源环境之间存在着相当大的差距。迫切需要在应对这一流行病和未来的卫生危机的战略对策中优先考虑安全、可获得和公平的产妇保健。没有。
The COVID-19 pandemic has had a profound impact on health-care systems and potentially on pregnancy outcomes, but no systematic synthesis of evidence of this effect has been undertaken. We aimed to assess the collective evidence on the effects on maternal, fetal, and neonatal outcomes of the pandemic. We did a systematic review and meta-analysis of studies on the effects of the pandemic on maternal, fetal, and neonatal outcomes. We searched MEDLINE and Embase in accordance with PRISMA guidelines, from Jan 1, 2020, to Jan 8, 2021, for case-control studies, cohort studies, and brief reports comparing maternal and perinatal mortality, maternal morbidity, pregnancy complications, and intrapartum and neonatal outcomes before and during the pandemic. We also planned to record any additional maternal and offspring outcomes identified. Studies of solely SARS-CoV-2-infected pregnant individuals, as well as case reports, studies without comparison groups, narrative or systematic literature reviews, preprints, and studies reporting on overlapping populations were excluded. Quantitative meta-analysis was done for an outcome when more than one study presented relevant data. Random-effects estimate of the pooled odds ratio (OR) of each outcome were generated with use of the Mantel-Haenszel method. This review was registered with PROSPERO (CRD42020211753). The search identified 3592 citations, of which 40 studies were included. We identified significant increases in stillbirth (pooled OR 1·28 [95% CI 1·07–1·54]; I2=63%; 12 studies, 168 295 pregnancies during and 198 993 before the pandemic) and maternal death (1·37 [1·22–1·53; I2=0%, two studies [both from low-income and middle-income countries], 1 237 018 and 2 224 859 pregnancies) during versus before the pandemic. Preterm births before 37 weeks' gestation were not significantly changed overall (0·94 [0·87–1·02]; I2=75%; 15 studies, 170 640 and 656 423 pregnancies) but were decreased in high-income countries (0·91 [0·84–0·99]; I2=63%; 12 studies, 159 987 and 635 118 pregnancies), where spontaneous preterm birth was also decreased (0·81 [0·67–0·97]; two studies, 4204 and 6818 pregnancies). Mean Edinburgh Postnatal Depression Scale scores were higher, indicating poorer mental health, during versus before the pandemic (pooled mean difference 0·42 [95% CI 0·02–0·81; three studies, 2330 and 6517 pregnancies). Surgically managed ectopic pregnancies were increased during the pandemic (OR 5·81 [2·16–15·6]; I2=26%; three studies, 37 and 272 pregnancies). No overall significant effects were identified for other outcomes included in the quantitative analysis: maternal gestational diabetes; hypertensive disorders of pregnancy; preterm birth before 34 weeks', 32 weeks', or 28 weeks' gestation; iatrogenic preterm birth; labour induction; modes of delivery (spontaneous vaginal delivery, caesarean section, or instrumental delivery); post-partum haemorrhage; neonatal death; low birthweight (<2500 g); neonatal intensive care unit admission; or Apgar score less than 7 at 5 min. Global maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. Some outcomes show considerable disparity between high-resource and low-resource settings. There is an urgent need to prioritise safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises. None.