Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth
Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth
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DOI：
10.1016/j.ajog.2020.06.022
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发表时间：
2020-12-01
影响因子：
9.8
通讯作者：
Deruelle, Philippe
中科院分区：
文献类型：
--
作者：
Sentilhes, Loic;De Marcillac, Fanny;Deruelle, Philippe
背景：尽管之前的小样本病例系列报道的 2019 年冠状病毒病孕妇的结局主要令人放心，但最近一些需要插管的严重孕产妇发病和孕产妇死亡的报告表明，需要有关 2019 年冠状病毒病对妊娠结局影响的更多数据。 目的：本研究旨在报告 2019 年冠状病毒病孕妇的孕产妇特征和临床结果。 研究 设计：这项回顾性、单中心研究纳入了2020年3月1日至2020年4月3日入住斯特拉斯堡大学医院（法国）的所有确诊（实验室确诊）或疑似（根据中国管理指南[7.0版]）2019冠状病毒病的连续孕妇，无论诊断时的孕龄如何。 新生儿结局从病历中提取。 结果：该研究纳入了 54 名确诊（n = 38）和疑似（n = 16）2019 年冠状病毒病的孕妇。其中，32 名持续妊娠，1 名流产，21 名活产：12 名顺产，9 名剖腹产。在分娩的妇女中，21 名妇女中有 5 名 (23.8%) 因患有 2019 年冠状病毒病相关病症而在医学上表明需要早产：其中 3 名 (14.3%) 在妊娠 32 周之前，2 名 (9.5%) 在妊娠 28 周之前。 54 名女性中有 13 名 (24.1%) 需要氧气支持，包括高流量吸氧 (n=2)、无创 (n=1) 和有创 (n=3) 机械通气以及体外膜肺氧合 (n=1)。其中，3 名年龄在 35 岁或以上的患者，使用逆转录聚合酶链反应进行严重急性呼吸综合征冠状病毒 2 型检测结果呈阳性，并出现呼吸衰竭，需要在妊娠 29 周前进行分娩。所有 3 名女性均超重或肥胖，其中 2 名女性患有其他合并症。 结论：妊娠期 2019 年冠状病毒病与孕产妇发病和早产相关。它与其他众所周知的未感染孕妇严重孕产妇发病的危险因素（包括孕产妇年龄超过 35 岁、超重和肥胖）的相关性表明，需要进一步研究以确定这些危险因素是否也与这些妇女较差的孕产妇结局相关。
BACKGROUND: Despite the mainly reassuring outcomes for pregnant women with coronavirus disease 2019 reported by previous case series with small sample sizes, some recent reports of severe maternal morbidity requiring intubation and of maternal deaths show the need for additional data about the impact of coronavirus disease 2019 on pregnancy outcomes.OBJECTIVE: This study aimed to report the maternal characteristics and clinical outcomes of pregnant women with coronavirus disease 2019.STUDY DESIGN: This retrospective, single-center study includes all consecutive pregnant women with confirmed (laboratory-confirmed) or suspected (according to the Chinese management guideline [version 7.0]) coronavirus disease 2019, regardless of gestational age at diagnosis, admitted to the Strasbourg University Hospital (France) from March 1, 2020, to April 3, 2020. Maternal characteristics, laboratory and imaging findings, and maternal and neonatal outcomes were extracted from medical records.RESULTS: The study includes 54 pregnant women with confirmed (n = 38) and suspected (n = 16) coronavirus disease 2019. Of these, 32 had an ongoing pregnancy, 1 had a miscarriage, and 21 had live births: 12 vaginal and 9 cesarean deliveries. Among the women who gave birth, preterm deliveries were medically indicated for their coronavirus disease 2019-related condition for 5 of 21 women (23.8%): 3 (14.3%) before 32 weeks' gestation and 2 (9.5%) before 28 weeks' gestation. Oxygen support was required for 13 of 54 women (24.1%), including high-flow oxygen (n=2), noninvasive (n=1) and invasive (n=3) mechanical ventilation, and extracorporeal membrane oxygenation (n=1). Of these, 3, aged 35 years or older with positive test result for severe acute respiratory syndrome coronavirus 2 using reverse transcription polymerase chain reaction, had respiratory failure requiring indicated delivery before 29 weeks' gestation. All 3 women were overweight or obese, and 2 had an additional comorbidity.CONCLUSION: Coronavirus disease 2019 in pregnancy was associated with maternal morbidity and preterm birth. Its association with other well-known risk factors for severe maternal morbidity in pregnant women with no infection, including maternal age above 35 years, overweight, and obesity, suggests further studies are required to determine whether these risk factors are also associated with poorer maternal outcome in these women.