Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic.
Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2021.20456
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发表时间：
2021-08-02
影响因子：
13.8
通讯作者：
Nguyen NT
中科院分区：
文献类型：
--
作者：
Chinn J;Sedighim S;Kirby KA;Hohmann S;Hameed AB;Jolley J;Nguyen NT
在美国大流行的第一年里，与新冠肺炎分娩相关的特征和结果是什么？这项队列研究调查了869名 079名成年女性，其中包括18名患有新冠肺炎的女性，她们在2020年3月1日至2021年2月28日期间在499个美国医疗中心分娩。患有新冠肺炎的女性死亡率、需要插管和呼吸机的需求以及重症监护病房的入院情况增加。这些发现表明，新冠肺炎与分娩妇女发病率和死亡率的增加有关。这项队列研究调查了美国新冠肺炎产妇的发病率和死亡率。之前关于新冠肺炎和怀孕的研究已经报告了更高的剖腹产率和早产率，以及更高的发病率和死亡率。需要包含更长时间段的额外数据。为了研究美国一大群使用新冠肺炎分娩和不使用新冠肺炎分娩的女性的特征和结局。这项队列研究比较了2020年3月1日至2021年2月28日期间，在499个美国学术医学中心或社区附属机构进行分娩的女性(年龄≥18岁)的特征和结局。随访仅限于住院病程和出院目的地。分娩由临床分类软件程序代码134-137定义。根据《国际疾病及相关健康问题统计分类》第十版U07.1的诊断，确诊为新冠肺炎。对2021年4月1日至4月30日的数据进行了分析。存在使用ICD-10进行新冠肺炎诊断的情况。分析比较了人口统计特征、胎龄和合并症。主要结果是住院死亡率。次要结果包括住院时间、重症监护病房(ICU)入院、机械通气和出院情况。连续变量用t检验，类别变量用χ2软件进行分析。在869名 079名女性中，18名 715(2.2%)有新冠肺炎，85 0名 364(97.8%)没有。大多数女性年龄在18至30岁之间(11 550名新冠肺炎患者[61.7%]；447名 534名未使用新冠肺炎的女性[52.6%])；白人(新冠肺炎队列中的8 060名白人女性[43.1%]；非新冠肺炎队列中的499名 501白人女性(58.7%))。在使用新冠肺炎的妇女中，剖宫产率没有显著增加(6088名妇女[32.5%]对273名 810妇女[32.3%]；P = .57)。患有新冠肺炎的妇女更有可能发生早产(3072名妇女[16.4%]对97名 967名妇女[11.5%]；P <； .001)。与未使用新冠肺炎的产妇相比，使用新冠肺炎分娩的产妇在ICU的住院率(977名妇女[5.2%]对7943名[0.9%]；优势比[OR]，5.84[95%CI，5.46-6.25]；P <； .001)、呼吸插管和机械通气(275名妇女[1.5%]vs884名妇女[0.1%]；OR，14.33[95%CI，12.50-16.42]；P <； .001)和住院死亡率(24名妇女[0.1%]vs71[<；0.01%]；OR，15.38[95%CI，9.68-24.43]；P <； .001)。这项回顾性队列研究发现，新冠肺炎分娩的妇女比没有新冠肺炎分娩的妇女有更高的死亡率、插管、入住ICU和早产。
What are the characteristics and outcomes associated with giving birth with COVID-19 over the first year of the pandemic in the US? This cohort study examines 869 079 adult women, including 18 715 women with COVID-19, who underwent childbirth at 499 US medical centers between March 1, 2020, and February 28, 2021. Women with COVID-19 had increased mortality, need for intubation and ventilation, and intensive care unit admission. These findings suggest that COVID-19 was associated with increased risk of morbidity and mortality for women giving birth. This cohort study examines morbidity and mortality outcomes among US women giving birth with COVID-19. Prior studies on COVID-19 and pregnancy have reported higher rates of cesarean delivery and preterm birth and increased morbidity and mortality. Additional data encompassing a longer time period are needed. To examine characteristics and outcomes of a large US cohort of women who underwent childbirth with vs without COVID-19. This cohort study compared characteristics and outcomes of women (age ≥18 years) who underwent childbirth with vs without COVID-19 between March 1, 2020, and February 28, 2021, at 499 US academic medical centers or community affiliates. Follow-up was limited to in-hospital course and discharge destination. Childbirth was defined by clinical classification software procedural codes of 134-137. A diagnosis of COVID-19 was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of U07.1. Data were analyzed from April 1 to April 30, 2021. The presence of a COVID-19 diagnosis using ICD-10. Analyses compared demographic characteristics, gestational age, and comorbidities. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, intensive care unit (ICU) admission, mechanical ventilation, and discharge status. Continuous variables were analyzed using t test, and categorical variables were analyzed using χ2. Among 869 079 women, 18 715 (2.2%) had COVID-19, and 850 364 (97.8%) did not. Most women were aged 18 to 30 years (11 550 women with COVID-19 [61.7%]; 447 534 women without COVID-19 [52.6%]) and were White (8060 White women [43.1%] in the COVID-19 cohort; 499 501 White women (58.7%) in the non–COVID-19 cohort). There was no significant increase in cesarean delivery among women with COVID-19 (6088 women [32.5%] vs 273 810 women [32.3%]; P = .57). Women with COVID-19 were more likely to have preterm birth (3072 women [16.4%] vs 97 967 women [11.5%]; P < .001). Women giving birth with COVID-19, compared with women without COVID-19, had significantly higher rates of ICU admission (977 women [5.2%] vs 7943 women [0.9%]; odds ratio [OR], 5.84 [95% CI, 5.46-6.25]; P < .001), respiratory intubation and mechanical ventilation (275 women [1.5%] vs 884 women [0.1%]; OR, 14.33 [95% CI, 12.50-16.42]; P < .001), and in-hospital mortality (24 women [0.1%] vs 71 [<0.01%]; OR, 15.38 [95% CI, 9.68-24.43]; P < .001). This retrospective cohort study found that women with COVID-19 giving birth had higher rates of mortality, intubation, ICU admission, and preterm birth than women without COVID-19.
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