Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State
Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State
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DOI：
10.1016/j.ajog.2020.05.031
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发表时间：
2020-12-01
影响因子：
9.8
通讯作者：
Waldorf, Kristina M. Adams
中科院分区：
文献类型：
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作者：
Lokken, Erica M.;Walker, Christie L.;Waldorf, Kristina M. Adams
背景：2019冠状病毒病对孕妇的影响尚不完全清楚，但病例系列的早期数据表明，从无症状或轻度疾病到孕产妇死亡，病程不一。目前尚不清楚孕妇是否表现出类似流感病毒感染的疾病加重，或者是否有特定的危险因素可能导致严重疾病。目的：描述与2019冠状病毒病相关的妊娠期孕产妇疾病和产科结局，以便快速为临床护理提供信息。研究设计：这是一项回顾性研究，研究对象是2020年1月21日至2020年4月17日期间来自华盛顿州6家医院系统的实验室确诊的严重急性呼吸综合征冠状病毒2型感染的孕妇。从医疗记录中提取人口统计、医疗和产科史以及2019冠状病毒病遭遇数据。结果：从医院系统中共鉴定出46例严重急性呼吸道综合征冠状病毒2感染的孕妇，占华盛顿州新生儿的40%。感染严重急性呼吸综合征冠状病毒2型的孕妇几乎全部出现症状（93.5%,n=43），且大多数出现在妊娠中期或晚期（43.5% [n=20]和50.0% [n=23]）。症状在24天内消失（四分位数范围13-37）。值得注意的是，有7名妇女住院（16%），其中1名住进了重症监护室。共有6例（15%）被归类为2019年严重冠状病毒病，几乎所有患者在怀孕前都超重或肥胖，或患有哮喘或其他合并症。在研究期间发生的8例分娩中，有1例妊娠33周早产，以改善III级肥胖妇女的肺部状况，还有1例原因不明的死产。结论：2019年严重冠状病毒病在约15%的妊娠患者中发生，主要发生在有基础疾病的超重或肥胖女性中。肥胖和2019冠状病毒病可能协同增加医学指征早产的风险，以改善妊娠后期孕产妇的肺部状况。这些发现支持将怀孕患者归类为高风险群体，特别是那些有慢性合并症的患者。
BACKGROUND: The impact of coronavirus disease 2019 on pregnant women is incompletely understood, but early data from case series suggest a variable course of illness from asymptomatic or mild disease to maternal death. It is unclear whether pregnant women manifest enhanced disease similar to influenza viral infection or whether specific risk factors might predispose to severe disease.OBJECTIVE: To describe maternal disease and obstetrical outcomes associated with coronavirus disease 2019 in pregnancy to rapidly inform clinical care.STUDY DESIGN: This is a retrospective study of pregnant patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 6 hospital systems in Washington State between Jan. 21, 2020, and April 17, 2020. Demographics, medical and obstetrical history, and coronavirus disease 2019 encounter data were abstracted from medical records.RESULTS: A total of 46 pregnant patients with a severe acute ratory syndrome coronavirus 2 infection were identified from hospital systems capturing 40% of births in Washington State. Nearly all pregnant individuals with a severe acute respiratory syndrome coronavirus 2 infection were symptomatic (93.5%, n=43) and the majority were in their second or third trimester (43.5% [n=20] and 50.0% [n=23], respectively). Symptoms resolved in a median of 24 days (interquartile range, 13-37). Notably, 7 women were hospitalized (16%) including 1 admitted to the intensive care unit. A total of 6 cases (15%) were categorized as severe coronavirus disease 2019 with nearly all patients being either overweight or obese before pregnancy or with asthma or other comorbidities. Of the 8 deliveries that occurred during the study period, there was 1 preterm birth at 33 weeks' gestation to improve pulmonary status in a woman with class III obesity, and 1 stillbirth of unknown etiology.CONCLUSION: Severe coronavirus disease 2019 developed in approximately 15% of pregnant patients and occurred primarily in overweight or obese women with underlying conditions. Obesity and coronavirus disease 2019 may synergistically increase risk for a medically indicated preterm birth to improve maternal pulmonary status in late pregnancy. These findings support categorizing pregnant patients as a higher-risk group, particularly those with chronic comorbidities.