Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls.
Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls.
复制标题
DOI：
10.1016/j.ajog.2020.11.022
复制
发表时间：
2021-05
影响因子：
9.8
通讯作者：
Stone J
中科院分区：
文献类型：
--
作者：
DeBolt CA;Bianco A;Limaye MA;Silverstein J;Penfield CA;Roman AS;Rosenberg HM;Ferrara L;Lambert C;Khoury R;Bernstein PS;Burd J;Berghella V;Kaplowitz E;Overbey JR;Stone J
2020年3月，随着严重急性呼吸综合征冠状病毒2的社区传播日益流行，孕妇似乎同样容易患上2019年冠状病毒疾病。虽然病程通常看起来很轻，但2019年冠状病毒病的严重和危重病例似乎会导致实质性的发病率，包括长时间住院的重症监护病房、插管、机械呼吸，甚至死亡。尽管最近有关于2019年冠状病毒病对妊娠影响的报告，但缺乏关于2019年孕妇与非孕妇冠状病毒病严重程度的信息。我们的目标是描述2019年严重和危重的冠状病毒疾病病例在怀孕和非怀孕的育龄妇女中的结果。这是一项多中心的回顾性病例对照研究，研究对象是2019年在纽约市4个学术医疗中心和费城1个学术医疗中心于2020年3月12日至2020年5月5日期间因严重或危重冠状病毒病住院的实验室确诊的严重急性呼吸综合征冠状病毒2型感染的女性。这些病例包括2019年专门因严重或危重冠状病毒疾病入院的孕妇，而不是产科指征。对照组包括2019年因严重或危重冠状病毒疾病入院的育龄非怀孕妇女。主要结果是综合发病率，其中包括：死亡、需要插管、体外膜氧合、无创正压通气或需要高流量鼻管充氧。次要结果包括重症监护病房入院，住院时间，需要出院到长期的急性护理机构，以及出院时有家庭氧气要求。2019年共有38名患有严重急性呼吸综合征冠状病毒2型聚合酶链式反应确诊感染的孕妇被送往5家专门针对冠状病毒病的机构，其中29人(76.3%)符合严重疾病状态标准，9人(23.7%)符合危重疾病状态标准。非孕对照组的平均年龄和体重指数明显高于对照组。未怀孕的队列也增加了先前存在的内科合并症的频率，包括糖尿病、高血压和冠状动脉疾病。与非怀孕对照组相比，怀孕妇女更有可能经历主要结果(34.2%比14.9%；P=0.03；调整后的优势比为4.6；95%可信区间为1.2-18.2)。孕妇的重症监护病房入院率较高(39.5%比17.0%；P<；.01；调整后优势比5.2；95%可信区间1.5-17.5)。在接受分娩的孕妇中，72.7%是通过剖宫产发生的，严重疾病状态患者的分娩时平均孕周为33.8±5.5周，严重冠状病毒2019年状态患者的平均孕周为35±3.5周。与非妊娠对照组相比，患有2019年严重和危重冠状病毒疾病的孕妇患某些疾病的风险增加。尽管在非妊娠对照组中糖尿病和高血压的并存率较高，但怀孕病例的复合发病率、插管、机械通气和重症监护病房入院的风险增加。这些发现表明，在2019年患有严重和危重冠状病毒疾病的妇女中，怀孕可能与更糟糕的结局有关。我们的研究表明，与严重急性呼吸综合征冠状病毒和中东呼吸综合征冠状病毒等其他病毒感染类似，孕妇可能面临更高的发病率和疾病严重性的风险。
In March 2020, as community spread of severe acute respiratory syndrome coronavirus 2 became increasingly prevalent, pregnant women seemed to be equally susceptible to developing coronavirus disease 2019. Although the disease course usually appears mild, severe and critical cases of coronavirus disease 2019 seem to lead to substantial morbidity, including intensive care unit admission with prolonged hospital stay, intubation, mechanical ventilation, and even death. Although there are recent reports regarding the impact of coronavirus disease 2019 on pregnancy, there is a lack of information regarding the severity of coronavirus disease 2019 in pregnant vs nonpregnant women. We aimed to describe the outcomes of severe and critical cases of coronavirus disease 2019 in pregnant vs nonpregnant, reproductive-aged women. This is a multicenter, retrospective, case-control study of women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection hospitalized with severe or critical coronavirus disease 2019 in 4 academic medical centers in New York City and 1 in Philadelphia between March 12, 2020, and May 5, 2020. The cases consisted of pregnant women admitted specifically for severe or critical coronavirus disease 2019 and not for obstetrical indications. The controls consisted of reproductive-aged, nonpregnant women admitted for severe or critical coronavirus disease 2019. The primary outcome was a composite morbidity that includes the following: death, a need for intubation, extracorporeal membrane oxygenation, noninvasive positive pressure ventilation, or a need for high-flow nasal cannula O2 supplementation. The secondary outcomes included intensive care unit admission, length of stay, a need for discharge to long-term acute care facilities, and discharge with a home O2 requirement. A total of 38 pregnant women with severe acute respiratory syndrome coronavirus 2 polymerase chain reaction-confirmed infections were admitted to 5 institutions specifically for coronavirus disease 2019, 29 (76.3%) meeting the criteria for severe disease status and 9 (23.7%) meeting the criteria for critical disease status. The mean age and body mass index were markedly higher in the nonpregnant control group. The nonpregnant cohort also had an increased frequency of preexisting medical comorbidities, including diabetes, hypertension, and coronary artery disease. The pregnant women were more likely to experience the primary outcome when compared with the nonpregnant control group (34.2% vs 14.9%; P=.03; adjusted odds ratio, 4.6; 95% confidence interval, 1.2–18.2). The pregnant patients experienced higher rates of intensive care unit admission (39.5% vs 17.0%; P<.01; adjusted odds ratio, 5.2; 95% confidence interval, 1.5–17.5). Among the pregnant women who underwent delivery, 72.7% occurred through cesarean delivery and the mean gestational age at delivery was 33.8±5.5 weeks in patients with severe disease status and 35±3.5 weeks in patients with critical coronavirus disease 2019 status. Pregnant women with severe and critical coronavirus disease 2019 are at an increased risk for certain morbidities when compared with nonpregnant controls. Despite the higher comorbidities of diabetes and hypertension in the nonpregnant controls, the pregnant cases were at an increased risk for composite morbidity, intubation, mechanical ventilation, and intensive care unit admission. These findings suggest that pregnancy may be associated with a worse outcome in women with severe and critical cases of coronavirus disease 2019. Our study suggests that similar to other viral infections such as severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, pregnant women may be at risk for greater morbidity and disease severity.
登录
查看更多内容
影响因子：
14.6
作者：
Hilton, Rachel
通讯作者：
Hilton, Rachel
影响因子：
4.3
作者：
Collin, Julius;Bystrom, Emma;Ahrne, Malin
通讯作者：
Ahrne, Malin
影响因子：
168.9
作者：
Huang, Chaolin;Wang, Yeming;Cao, Bin
通讯作者：
Cao, Bin
影响因子：
9.8
作者：
Easter, Sarah Rae;Bateman, Brian T.;Robinson, Julian N.
通讯作者：
Robinson, Julian N.
影响因子：
9.8
作者：
Plante, Lauren A.;Pacheco, Luis D.;Louis, Judette M.
通讯作者：
Louis, Judette M.