Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications
Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications
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DOI：
10.1001/jama.2022.1190
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发表时间：
2022-02-07
影响因子：
120.7
通讯作者：
Macones, George A.
中科院分区：
文献类型：
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作者：
Metz, Torri D.;Clifton, Rebecca G.;Macones, George A.
目的评估SARS-CoV-2感染与严重孕产妇发病率或常见产科并发症死亡率之间的关系。设计、背景和参与者：对17家美国医院参与Eunice Kennedy ShRiver国立儿童健康与人类发展研究所的《新冠肺炎孕期研究评估》(Gravid)的14 104名孕妇和产后患者进行了回顾性队列研究。纳入所有SARS-CoV-2感染患者，并与随机选择同一时间分娩的SARS-CoV-2检测结果为阳性的患者进行比较。二次分析进一步根据疾病严重程度对感染SARS-CoV-2的患者进行分层。主要结果和测量主要结果是孕妇死亡或与妊娠高血压疾病、产后出血或SARS-CoV-2以外的感染有关的严重发病率的组合。结果14104例患者中，有2352例SARS-CoV-2感染，11752例SARS-CoV-2检测阴性。与SARS-CoV-2检测结果为阴性的患者相比，SARS-CoV-2感染与主要预后显著相关(13.4%vs9.2%；差异4.2%[95%CI，2.8%~5.6%]；调整后相对风险[ARR]，1.41[95%CI，1.23~1.61])。所有5例孕产妇死亡均在SARS-CoV-2组。SARS-CoV-2感染与剖宫产无显著相关性(34.7%比32.4%；ARR，1.05[95%CI，0.99~1.11])。与SARS-CoV-2检测结果为阴性的患者相比，中度或以上新冠肺炎感染与初次结局(26.1%vs 9.2%；差异16.9%[95%CI，13.3%~20.4%]；ARR2.06[95%CI，1.73~2.46])和剖宫产主要继发结局(45.4%vs 32.4%；差异12.8%[95%CI，8.7%~16.8%]；ARR，1.17[95%CI，1.07~1.28]，但轻度或无症状感染(n=1766)与初次结局(9.2%vs 9.2%；差异0%[95%CI，-1.4%~1.4%]；ARR 1.11[95%CI，0.94~1.32])或剖宫产(31.2%vs 32.4%；差异-1.4%[95%CI，-3.6%~0.8%]；ARR，1.00[95%CI，0.93-1.07]。结论在美国17家医院的孕妇和产后个体中，SARS-CoV-2感染与产妇死亡或产科并发症严重发病率的综合结果风险增加相关。
IMPORTANCE It remains unknown whether SARS-CoV-2 infection specifically increases the risk of serious obstetric morbidity.OBJECTIVE To evaluate the association of SARS-CoV-2 infection with serious maternal morbidity or mortality from common obstetric complications.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 14 104 pregnant and postpartum patients delivered between March 1, 2020, and December 31, 2020 (with final follow-up to February 11, 2021), at 17 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Gestational Research Assessments of COVID-19 (GRAVID) Study. All patients with SARS-CoV-2 were included and compared with those without a positive SARS-CoV-2 test result who delivered on randomly selected dates over the same period.EXPOSURES SARS-CoV-2 infection was based on a positive nucleic acid or antigen test result. Secondary analyses further stratified those with SARS-CoV-2 infection by disease severity.MAIN OUTCOMES AND MEASURES The primary outcome was a composite of maternal death or serious morbidity related to hypertensive disorders of pregnancy, postpartum hemorrhage, or infection other than SARS-CoV-2. The main secondary outcome was cesarean birth.RESULTS Of the 14 104 included patients (mean age, 29.7 years), 2352 patients had SARS-CoV-2 infection and 11 752 did not have a positive SARS-CoV-2 test result. Compared with those without a positive SARS-CoV-2 test result, SARS-CoV-2 infection was significantly associated with the primary outcome (13.4% vs 9.2%; difference, 4.2% [95% CI, 2.8%-5.6%]; adjusted relative risk [aRR], 1.41 [95% CI, 1.23-1.61]). All 5 maternal deaths were in the SARS-CoV-2 group. SARS-CoV-2 infection was not significantly associated with cesarean birth (34.7% vs 32.4%; aRR, 1.05 [95% CI, 0.99-1.11]). Compared with those without a positive SARS-CoV-2 test result, moderate or higher COVID-19 severity (n = 586) was significantly associated with the primary outcome (26.1% vs 9.2%; difference, 16.9% [95% CI, 13.3%-20.4%]; aRR, 2.06 [95% CI, 1.73-2.46]) and the major secondary outcome of cesarean birth (45.4% vs 32.4%; difference, 12.8% [95% CI, 8.7%-16.8%]; aRR, 1.17 [95% CI, 1.07-1.28]), but mild or asymptomatic infection (n = 1766) was not significantly associated with the primary outcome (9.2% vs 9.2%; difference, 0% [95% CI, -1.4% to 1.4%]; aRR, 1.11 [95% CI, 0.94-1.32]) or cesarean birth (31.2% vs 32.4%; difference, -1.4% [95% CI, -3.6% to 0.8%]; aRR, 1.00 [95% CI, 0.93-1.07]).CONCLUSIONS AND RELEVANCE Among pregnant and postpartum individuals at 17 US hospitals, SARS-CoV-2 infection was associated with an increased risk for a composite outcome of maternal mortality or serious morbidity from obstetric complications.