Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study.
Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study.
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子痫前期与COVID-19：来自INTERCOVID前瞻性纵向研究的结果
DOI：
10.1016/j.ajog.2021.05.014
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发表时间：
2021-09
影响因子：
9.8
通讯作者：
Villar J
中科院分区：
文献类型：
--
作者：
Papageorghiou AT;Deruelle P;Gunier RB;Rauch S;García-May PK;Mhatre M;Usman MA;Abd-Elsalam S;Etuk S;Simmons LE;Napolitano R;Deantoni S;Liu B;Prefumo F;Savasi V;do Vale MS;Baafi E;Zainab G;Nieto R;Maiz N;Aminu MB;Cardona-Perez JA;Craik R;Winsey A;Tavchioska G;Bako B;Oros D;Rego A;Benski AC;Hassan-Hanga F;Savorani M;Giuliani F;Sentilhes L;Risso M;Takahashi K;Vecchiarelli C;Ikenoue S;Thiruvengadam R;Soto Conti CP;Ferrazzi E;Cetin I;Nachinab VB;Ernawati E;Duro EA;Kholin A;Firlit ML;Easter SR;Sichitiu J;Bowale A;Casale R;Cerbo RM;Cavoretto PI;Eskenazi B;Thornton JG;Bhutta ZA;Kennedy SH;Villar J
目前尚不清楚怀孕期间COVID-19与子痫前期之间的联系是否独立存在，还是由共同的风险因素引起。本研究旨在量化妊娠期COVID-19与子痫前期之间的任何独立关联，并确定这些变量对孕产妇和新生儿发病率和死亡率的影响。这是一项大型、纵向、前瞻性、无与伦比的诊断和未诊断观察性研究，评估了怀孕期间COVID-19对母亲和新生儿的影响。在每名确诊的妇女被确定后，在妊娠或分娩的任何阶段，在相同的护理水平下，同时招募两名连续的未确诊妇女，以尽量减少偏倚。使用标准化的intergrowth -21协议和电子数据管理系统对妇女和新生儿进行随访，直到出院。共有18个国家的43个机构参与了研究样本。两组之间的独立关联被量化，并分析了每组中已知的与子痫前期相关的危险因素。比较了单独患有COVID-19的妇女、单独患有子痫前期的妇女、两种情况的妇女和没有两种情况中的任何一种的妇女的结果。我们招募了2184名孕妇；其中，725人（33.2%）被纳入COVID-19诊断组，1459人（66.8%）被纳入COVID-19未诊断组。在这些妇女中，123名患有先兆子痫，其中725名中有59名（8.1%）属于COVID-19诊断组，1459名中有64名（4.4%）属于未诊断组（风险比为1.86；95%可信区间为1.32-2.61）。在对与COVID-19和子痫前期相关的社会人口因素和条件进行调整后，所有女性的子痫前期风险比（风险比，1.77；95%置信区间，1.25-2.52）和未生育女性的风险比（风险比，1.89；95%置信区间，1.17-3.05）仍然显著。有趋势但无统计学意义（风险比1.64；95%可信区间0.99 ~ 2.73）。所有被诊断为COVID-19和子痫前期的妇女的早产风险比为4.05(95%可信区间，2.99-5.49)，未生育妇女的早产风险比为6.26（95%可信区间，4.35-9.00）。与未诊断任何疾病的妇女相比，综合围产期不良结局显示，COVID-19无子痫前期、子痫前期无COVID-19、COVID-19合并子痫前期的风险比逐步增加（风险比2.16,95%可信区间1.63-2.86；风险比2.53,95%可信区间1.44-4.45；风险比2.84,95%可信区间1.67-4.82）。综合不良产妇结局的风险比为1.76（95%可信区间，1.32-2.35）、2.07（95%可信区间，1.20-3.57）和2.77（95%可信区间，1.66-4.63）。COVID-19与妊娠期高血压之间的关联以及对早产和不良围产期及孕产妇结局的影响方向与子痫前期相似，但仅限于风险比较低的未产妇女。怀孕期间的COVID-19与子痫前期密切相关，特别是在未生育妇女中。这种关联是独立于任何风险因素和先前存在的条件。COVID-19的严重程度似乎不是这种关联的一个因素。这两种情况都与早产、严重的围产期发病率和死亡率以及产妇不良结局独立相关，并以叠加的方式相关。在COVID-19带来的风险方面，应将患有先兆子痫的妇女视为特别脆弱的群体。
It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.
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影响因子：
9.8
作者：
Brosens, Ivo;Puttemans, Patrick;Benagiano, Giuseppe
通讯作者：
Benagiano, Giuseppe
影响因子：
158.5
作者：
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通讯作者：
Jonigk, Danny
DOI：
10.1111/1471-0528.16339
发表时间：
2020-06-21
影响因子：
5.8
作者：
Mendoza, M.;Garcia-Ruiz, I;Suy, A.
通讯作者：
Suy, A.
影响因子：
9.8
作者：
Brandt JS;Hill J;Reddy A;Schuster M;Patrick HS;Rosen T;Sauer MV;Boyle C;Ananth CV
通讯作者：
Ananth CV
DOI：
10.1111/1471-0528.16403
发表时间：
2020-08-13
影响因子：
5.8
作者：
Prabhu, M.;Cagino, K.;Riley, L. E.
通讯作者：
Riley, L. E.