Comparison of Severe Maternal Morbidities Associated With Delivery During Periods of Circulation of Specific SARS-CoV-2 Variants.
Comparison of Severe Maternal Morbidities Associated With Delivery During Periods of Circulation of Specific SARS-CoV-2 Variants.
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DOI：
10.1001/jamanetworkopen.2022.26436
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发表时间：
2022-08-01
影响因子：
13.8
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中科院分区：
文献类型：
--
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SARS-CoV-2感染与包括非呼吸道并发症在内的严重孕产妇发病率（SMM）之间的关系是否因病毒株而异？在这项回顾性队列研究中，在2020年3月至2022年1月期间，在美国一个大型卫生系统中，3129名SARS-CoV-2感染患者和12504名未感染的分娩患者进行了研究，结果显示，在Delta型变异占主导地位的大流行阶段（2021年7月至2021年11月），SMM与SARS-CoV-2感染相关的风险显著更高。这种关联也特别注意到呼吸和非呼吸性SMM。这些发现强调了预防孕妇感染SARS-CoV-2的重要性，并将感染视为围产期产妇不良结局的一个危险因素。本队列研究评估了在4个以主要病毒株为特征的大流行期间分娩的患者中SARS-CoV-2感染与严重孕产妇发病率的关系。导致COVID-19的SARS-CoV-2感染与不良孕产妇结局有关。虽然已知COVID-19的严重程度因病毒株而异，但这种差异在产妇不良结局（包括非肺部产妇结局）中反映的程度尚未得到很好的表征。评估在4个以主要病毒株为特征的大流行期间分娩的妊娠患者中，SARS-CoV-2感染与严重孕产妇发病率（SMM）的关系。这项回顾性队列研究纳入了2020年3月至2022年1月期间在多中心、地理位置多样化的美国卫生系统中分娩的患者。基于SARS-CoV-2优势毒株，在4个时间段内，基于人口统计学和临床变量，将SARS-CoV-2感染个体与多达4名无感染证据的个体进行倾向匹配：2020年3月至12月（野生型）；2021年1月至6月（Alpha [B.1.1.7]）；2021年7月至11月（Delta [B.1.617.2]）；2021年12月至2022年1月（Omicron [B.1.1.529]）。数据分析时间为2021年10月至2022年6月。分娩过程中新冠病毒核酸扩增检测阳性。根据美国疾病控制和预防中心的定义，主要结局是住院分娩期间发生的任何SMM事件。次要结局是SMM、呼吸性SMM、非呼吸性SMM和非输血性SMM事件的数量。在所有时间段内，有3129例SARS-CoV-2患者，中位（IQR）年龄为29.1（24.6-33.2）岁。他们与12 504例无SARS-CoV-2的患者倾向匹配，中位（IQR）年龄为29.2（24.7-33.2）岁。除欧米克隆期间外，在所有时间段内，SARS-CoV-2感染患者的SMM事件发生率均显著高于未感染患者。尽管野生型菌株与SARS-CoV-2感染相关的任何SMM的风险增加（优势比[OR]， 2.74 [95% CI, 1.85-4.03]）和α变异（OR, 2.57 [95% CI, 1.69-4.01]），但δ期的风险更高（OR, 7.69 [95% CI, 5.19-11.54]; P < .001）。呼吸系统并发症、非呼吸系统并发症和非输血结果的研究结果相似。例如，与未感染SARS-CoV-2的患者相比，野生型菌株（OR, 2.16 [95% CI, 1.40-3.27]）和α变异（OR, 1.96 [95% CI, 1.20-3.12]）的非呼吸道SMM事件风险相似，δ变异最高（OR, 4.65 [95% CI, 2.97-7.29]），在欧米克隆期（OR, 1.21 [95% CI, 0.67-2.08]; P < 0.001）没有显著升高。该队列研究发现，与其他菌株相比，SARS-CoV-2 Delta变体与更高的SMM事件发生率相关。考虑到新菌株的可能性，这些发现强调了预防措施的重要性。
Does the association between SARS-CoV-2 infection and severe maternal morbidity (SMM), including nonrespiratory complications, vary by viral strain? In this retrospective cohort study of 3129 patients with SARS-CoV-2 infection and 12 504 patients without infection giving birth in a large US health system between March 2020 and January 2022, the risk of SMM associated with SARS-CoV-2 infection was significantly higher during the phase of the pandemic when the Delta variant was predominant (July 2021-November 2021). This association was also noted specifically for both respiratory and nonrespiratory SMM. These findings highlight the importance of the prevention of SARS-CoV-2 infection in pregnant individuals and the consideration of infection as a risk factor for adverse peripartum maternal outcomes. This cohort study evaluates the association of SARS-CoV-2 infection and severe maternal morbidities in patients giving birth during 4 pandemic periods characterized by predominant viral strains. Infection with SARS-CoV-2, which causes COVID-19, is associated with adverse maternal outcomes. While it is known that severity of COVID-19 varies by viral strain, the extent to which this variation is reflected in adverse maternal outcomes, including nonpulmonary maternal outcomes, is not well characterized. To evaluate the associations of SARS-CoV-2 infection with severe maternal morbidities (SMM) in pregnant patients delivering during 4 pandemic periods characterized by predominant viral strains. This retrospective cohort study included patients delivering in a multicenter, geographically diverse US health system between March 2020 and January 2022. Individuals with SARS-CoV-2 infection were propensity-matched with as many as 4 individuals without evidence of infection based on demographic and clinical variables during 4 time periods based on the dominant strain of SARS-CoV-2: March to December 2020 (wild type); January to June 2021 (Alpha [B.1.1.7]); July to November 2021 (Delta [B.1.617.2]); and December 2021 to January 2022 (Omicron [B.1.1.529]). Data were analyzed from October 2021 to June 2022. Positive SARS-CoV-2 nucleic acid amplification test result during the delivery encounter. The primary outcome was any SMM event, as defined by the US Centers for Disease Control and Prevention, during hospitalization for delivery. Secondary outcomes were number of SMM, respiratory SMM, nonrespiratory SMM, and nontransfusion SMM events. Over all time periods, there were 3129 patients with SARS-CoV-2, with a median (IQR) age of 29.1 (24.6-33.2) years. They were propensity matched with a total of 12 504 patients without SARS-CoV-2, with a median (IQR) age of 29.2 (24.7-33.2) years. Patients with SARS-CoV-2 infection had significantly higher rates of SMM events than those without in all time periods, except during Omicron. While the risk of any SMM associated with SARS-CoV-2 infection was increased for the wild-type strain (odds ratio [OR], 2.74 [95% CI, 1.85-4.03]) and Alpha variant (OR, 2.57 [95% CI, 1.69-4.01]), the risk during the Delta period was higher (OR, 7.69 [95% CI, 5.19-11.54]; P for trend < .001). The findings were similar for respiratory complications, nonrespiratory complications, and nontransfusion outcomes. For example, the risk of nonrespiratory SMM events for patients with vs without SARS-CoV-2 infection were similar for the wild-type strain (OR, 2.16 [95% CI, 1.40-3.27]) and Alpha variant (OR, 1.96 [95% CI, 1.20-3.12]), highest for the Delta variant (OR, 4.65 [95% CI, 2.97-7.29]), and not significantly higher in the Omicron period (OR, 1.21 [95% CI, 0.67-2.08]; P for trend < .001). This cohort study found that the SARS-CoV-2 Delta variant was associated with higher rates of SMM events compared with other strains. Given the potential of new strains, these findings underscore the importance of preventive measures.
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82.9
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Stock SJ;Carruthers J;Calvert C;Denny C;Donaghy J;Goulding A;Hopcroft LEM;Hopkins L;McLaughlin T;Pan J;Shi T;Taylor B;Agrawal U;Auyeung B;Katikireddi SV;McCowan C;Murray J;Simpson CR;Robertson C;Vasileiou E;Sheikh A;Wood R
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