Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis.
Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis.
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DOI：
10.1016/j.ajog.2022.08.038
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发表时间：
2023-03
影响因子：
9.8
通讯作者：
中科院分区：
文献类型：
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作者：
这项连续的前瞻性荟萃分析旨在确定COVID-19孕妇和产后妇女与疾病严重程度、孕产妇发病率、新生儿死亡率和发病率以及不良出生结局相关的不良结局的风险因素。我们从2020年3月开始，通过专业研究网络前瞻性地邀请研究人员加入序列前瞻性荟萃分析。符合条件的研究包括在规定的集水区内招募至少25例连续COVID-19妊娠病例的研究。我们纳入了来自21项参与研究的个体患者数据。评估数据质量，并构建风险因素和结局的协调变量。删除了重复病例。采用2阶段荟萃分析，比较有和无每种风险因素时不良结局的绝对和相对风险的汇总估计值。我们收集了来自33个国家和地区的数据，包括21，977例妊娠或产后SARS-CoV-2感染病例。我们发现，患有合并症（既存糖尿病、高血压、心血管疾病）的女性与没有合并症的女性相比，患COVID-19严重程度和不良妊娠结局（胎儿死亡、早产、低出生体重）的风险更高。患有COVID-19和HIV的参与者被送入重症监护室的可能性高出1.74倍（95%置信区间，1.12-2.71）。怀孕前体重过轻的孕妇入住重症监护室的风险更高（相对风险，5.53; 95%置信区间，2.27-13.44），通气（相对危险度，9.36; 95%可信区间，3.87-22.63），妊娠相关死亡（相对危险度，14.10; 95%可信区间，2.83-70.36）。孕前肥胖也是导致严重COVID-19后果的风险因素，包括入住重症监护室（相对风险，1.81; 95%置信区间，1.26-2.60），通气（相对风险，2.05; 95%置信区间，1.20-3.51），任何重症监护（相对危险度，1.89; 95%置信区间，1.28-2.77）和肺炎（相对危险度，1.66; 95%置信区间，1.18-2.33）。患有COVID-19的贫血孕妇入住重症监护室（相对风险，1.63; 95%置信区间，1.25-2.11）和死亡（相对风险，2.36; 95%置信区间，1.15-4.81）的风险也增加。我们发现，患有糖尿病、高血压和心血管疾病等合并症的孕妇发生严重COVID-19相关结局、孕产妇发病率和不良出生结局的风险增加。我们还确定了几个不太常见的风险因素，包括艾滋病毒感染，孕前体重不足和贫血。虽然孕妇已被视为高危人群，但应特别优先预防和治疗有这些额外风险因素的孕妇。
This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12–2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27–13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87–22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83–70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26–2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20–3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28–2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18–2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25–2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15–4.81). We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19–related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.
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DOI：
10.1111/1471-0528.14027
发表时间：
2016-11
期刊：
BJOG : an international journal of obstetrics and gynaecology
影响因子：
--
作者：
Girsen AI;Mayo JA;Carmichael SL;Phibbs CS;Shachar BZ;Stevenson DK;Lyell DJ;Shaw GM;Gould JB;March of Dimes Prematurity Research Center at Stanford University School of Medicine
通讯作者：
March of Dimes Prematurity Research Center at Stanford University School of Medicine
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
影响因子：
7.7
作者：
Han, Zhen;Mulla, Sohail;McDonald, Sarah D.
通讯作者：
McDonald, Sarah D.
COVID-19 与妊娠：对临床表现、垂直传播以及孕产妇和围产期结局的总体回顾。
影响因子：
3.7
作者：
Ciapponi A;Bardach A;Comandé D;Berrueta M;Argento FJ;Rodriguez Cairoli F;Zamora N;Santa María V;Xiong X;Zaraa S;Mazzoni A;Buekens P
通讯作者：
Buekens P
影响因子：
34.3
作者：
Lee, Anne C. C.;Katz, Joanne;Blencowe, Hannah;Cousens, Simon;Kozuki, Naoko;Vogel, Joshua P.;Adair, Linda;Baqui, Abdullah H.;Bhutta, Zulfiqar A.;Caulfield, Laura E.;Christian, Parul;Clarke, Sian E.;Ezzati, Majid;Fawzi, Wafaie;Gonzalez, Rogelio;Huybregts, Lieven;Kariuki, Simon;Kolsteren, Patrick;Lusingu, John;Marchant, Tanya;Merialdi, Mario;Mongkolchati, Aroonsri;Mullany, Luke C.;Ndirangu, James;Newell, Marie-Louise;Nien, Jyh Kae;Osrin, David;Roberfroid, Dominique;Rosen, Heather E.;Sania, Ayesha;Silveira, Mariangela F.;Tielsch, James;Vaidya, Anjana;Willey, Barbara A.;Lawn, Joy E.;Black, Robert E.
通讯作者：
Black, Robert E.