Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study.
Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study.
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DOI：
10.1001/jamapediatrics.2021.1050
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发表时间：
2021-08-01
期刊：
影响因子：
26.1
通讯作者：
Papageorghiou AT
中科院分区：
文献类型：
--
作者：
Villar J;Ariff S;Gunier RB;Thiruvengadam R;Rauch S;Kholin A;Roggero P;Prefumo F;do Vale MS;Cardona-Perez JA;Maiz N;Cetin I;Savasi V;Deruelle P;Easter SR;Sichitiu J;Soto Conti CP;Ernawati E;Mhatre M;Teji JS;Liu B;Capelli C;Oberto M;Salazar L;Gravett MG;Cavoretto PI;Nachinab VB;Galadanci H;Oros D;Ayede AI;Sentilhes L;Bako B;Savorani M;Cena H;García-May PK;Etuk S;Casale R;Abd-Elsalam S;Ikenoue S;Aminu MB;Vecciarelli C;Duro EA;Usman MA;John-Akinola Y;Nieto R;Ferrazi E;Bhutta ZA;Langer A;Kennedy SH;Papageorghiou AT
这项队列研究评估了COVID-19诊断的孕妇与同期入组的未诊断COVID-19的孕妇相比，COVID-19与孕产妇和新生儿结局之间的相关性。与未患COVID-19的孕妇相比，COVID-19在怀孕期间在多大程度上改变了孕产妇和新生儿不良结局的风险？在这项对18个国家的2130名孕妇进行的多国队列研究中，诊断为COVID-19的妇女的孕产妇综合发病率和死亡率指数风险增加。与未确诊COVID-19的妇女的新生儿相比，确诊COVID-19的妇女的新生儿重度新生儿发病指数和重度围产期发病率和死亡率指数显著更高。这项研究表明，与未确诊COVID-19的孕妇相比，确诊COVID-19的孕妇与更高的不良结局发生率（包括孕产妇死亡率、先兆子痫和早产）之间存在一致的相关性。非常需要关于COVID-19与妊娠个体与未感染妊娠个体相比的结果之间关系的详细信息。评估妊娠期COVID-19对孕产妇和新生儿结局的相关风险，并与未感染的同期妊娠个体进行比较。在这项于2020年3月至10月进行的队列研究中，涉及18个国家的43家机构，在确定每名感染女性后立即同时招募2名不匹配的连续未感染女性，处于妊娠或分娩的任何阶段，并处于相同的护理水平，以最大限度地减少偏倚。随访妇女和新生儿直至出院。通过实验室确诊COVID-19和/或放射学肺部发现或2种或2种以上预先定义的COVID-19症状确定的妊娠期COVID-19。主要结局指标为（孕产妇和重度新生儿/围产期）发病率和死亡率指数;这些指数的各个组成部分为次要结局。这些结果的模型根据国家、进入研究的月份、产妇年龄和发病史进行了调整。共入组了706名确诊为COVID-19的孕妇和1424名未确诊为COVID-19的孕妇，所有孕妇的人口统计学特征大致相似（平均[SD]年龄，30.2 [6.1]岁）。323名（48.6%）确诊为COVID-19的妇女和554名（40.2%）未确诊的妇女在怀孕早期出现超重。COVID-19诊断的女性患先兆子痫/子痫的风险更高（相对风险[RR]，1.76; 95% CI，1.27-2.43），重度感染（RR，3.38; 95% CI，1.63-7.01），入住重症监护室（RR，5.04; 95% CI，3.13-8.10），孕产妇死亡率（RR，22.3; 95% CI，2.88-172），早产（RR，1.59; 95% CI，1.30-1.94），医学指征早产（RR，1.97; 95% CI，1.56-2.51），重度新生儿发病指数（RR，2.66; 95% CI，1.69-4.18），重度围产期发病和死亡指数（RR，2.14; 95% CI，1.66-2.75）。任何持续时间的发热和呼吸急促与严重母体并发症（RR，2.56; 95%CI，1.92-3.40）和新生儿并发症（RR，4.97; 95%CI，2.11-11.69）的风险增加相关。确诊为COVID-19的无症状女性仅在孕产妇发病率（RR，1.24; 95%CI，1.00-1.54）和先兆子痫（RR，1.63; 95%CI，1.01-2.63）方面仍处于较高风险。在检测呈阳性的妇女中（98.1%通过实时聚合酶链反应），54名（13%）新生儿检测呈阳性。剖腹产（RR，2.15; 95%CI，1.18-3.91）而非母乳喂养（RR，1.10; 95%CI，0.66-1.85）与新生儿检测阳性风险增加相关。在这项多国队列研究中，当对确诊和未确诊COVID-19的孕妇进行比较时，妊娠期COVID-19与严重孕产妇发病率和死亡率以及新生儿并发症的持续大幅增加相关。研究结果应提醒孕妇和临床医生严格执行所有建议的COVID-19预防措施。
This cohort study assesses the association between COVID-19 and maternal and neonatal outcomes in pregnant women with COVID-19 diagnosis compared with concomitantly enrolled pregnant women without COVID-19 diagnosis. To what extent does COVID-19 in pregnancy alter the risks of adverse maternal and neonatal outcomes compared with pregnant individuals without COVID-19? In this multinational cohort study of 2130 pregnant women in 18 countries, women with COVID-19 diagnosis were at increased risk of a composite maternal morbidity and mortality index. Newborns of women with COVID-19 diagnosis had significantly higher severe neonatal morbidity index and severe perinatal morbidity and mortality index compared with newborns of women without COVID-19 diagnosis. This study indicates a consistent association between pregnant individuals with COVID-19 diagnosis and higher rates of adverse outcomes, including maternal mortality, preeclampsia, and preterm birth compared with pregnant individuals without COVID-19 diagnosis. Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.
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DOI：
10.3389/fgwh.2020.00001
发表时间：
2020
期刊：
Frontiers in global women's health
影响因子：
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