Epidemiology of coronavirus disease 2019 in pregnancy: risk factors and associations with adverse maternal and neonatal outcomes.
Epidemiology of coronavirus disease 2019 in pregnancy: risk factors and associations with adverse maternal and neonatal outcomes.
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DOI：
10.1016/j.ajog.2020.09.043
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发表时间：
2021-04
影响因子：
9.8
通讯作者：
Ananth CV
中科院分区：
文献类型：
--
作者：
Brandt JS;Hill J;Reddy A;Schuster M;Patrick HS;Rosen T;Sauer MV;Boyle C;Ananth CV
2019年冠状病毒病可能与妊娠期不良孕产妇和新生儿结局相关，但几乎没有受控数据来量化这些风险的程度或描述流行病学和风险因素。这项研究旨在量化2019年冠状病毒病与妊娠期不良孕产妇和新生儿结局的相关性，并描述流行病学和风险因素。我们对2019例确诊为冠状病毒病的妊娠患者进行了一项匹配的病例对照研究，这些患者于2020年3月11日至6月11日在妊娠16至41周期间分娩。未感染的孕妇（对照组）根据分娩日期以2：1的比例与2019年冠状病毒病病例相匹配。对产妇人口统计学特征、冠状病毒病2019症状、实验室评估、产科和新生儿结局以及临床管理进行了图表摘要。主要结局包括（1）不良母体结局的复合终点，定义为先兆子痫、静脉血栓栓塞、产前入院、产妇重症监护室入院、需要机械通气、补充氧气或产妇死亡，以及（2）不良新生儿结局的复合终点，定义为呼吸窘迫综合征、脑室内出血、坏死性小肠结肠炎、5分钟Apgar评分<5，持续性2类胎心率描记，尽管宫内复苏，或新生儿死亡。为了量化2019年轻度和重度或危重冠状病毒病暴露与不良孕产妇和新生儿结局之间的相关性，使用条件logistic回归（考虑匹配）进行了未经调整和调整的分析，匹配对比值比和95%置信区间基于1000个偏倚校正的自举回归作为效应指标。调整了潜在混杂因素的相关性。研究期间共入组了61例确诊的冠状病毒病2019例（轻度疾病，n=54 [88.5%];重度疾病，n=6 [9.8%];危重疾病，n=1 [1.6%]）。病例组的不良复合孕产妇结局的比值比对照组高3.4倍（18.0% vs 8.2%;校正比值比，3.4; 95%置信区间，1.2-13.4）。病例组新生儿不良复合结局的比值比对照组高1.7倍（18.0% vs 13.9%;校正比值比，1.7; 95%置信区间，0.8-4.8）。按疾病严重程度进行的分层分析表明，妊娠期与2019冠状病毒病相关的发病率主要由严重或危重疾病表型驱动。相关发病率的主要风险因素是黑人和西班牙裔种族、高龄产妇、医学合并症以及与2019年冠状病毒病相关的产前入院。怀孕期间的2019冠状病毒病与孕产妇和新生儿不良结局的风险增加有关，这种关联主要是由与2019严重或危重冠状病毒病相关的发病率驱动的。黑人和西班牙裔种族、肥胖、高龄产妇、医学合并症以及与2019年冠状病毒病相关的产前入院是相关发病率的风险因素。
Coronavirus disease 2019 may be associated with adverse maternal and neonatal outcomes in pregnancy, but there are few controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors. This study aimed to quantify the associations of coronavirus disease 2019 with adverse maternal and neonatal outcomes in pregnancy and to characterize the epidemiology and risk factors. We performed a matched case-control study of pregnant patients with confirmed coronavirus disease 2019 cases who delivered between 16 and 41 weeks’ gestation from March 11 to June 11, 2020. Uninfected pregnant women (controls) were matched to coronavirus disease 2019 cases on a 2:1 ratio based on delivery date. Maternal demographic characteristics, coronavirus disease 2019 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, and clinical management were chart abstracted. The primary outcomes included (1) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death, and (2) a composite of adverse neonatal outcome, defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, 5-minute Apgar score of <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death. To quantify the associations between exposure to mild and severe or critical coronavirus disease 2019 and adverse maternal and neonatal outcomes, unadjusted and adjusted analyses were performed using conditional logistic regression (to account for matching), with matched-pair odds ratio and 95% confidence interval based on 1000 bias-corrected bootstrap resampling as the effect measure. Associations were adjusted for potential confounders. A total of 61 confirmed coronavirus disease 2019 cases were enrolled during the study period (mild disease, n=54 [88.5%]; severe disease, n=6 [9.8%]; critical disease, n=1 [1.6%]). The odds of adverse composite maternal outcome were 3.4 times higher among cases than controls (18.0% vs 8.2%; adjusted odds ratio, 3.4; 95% confidence interval, 1.2–13.4). The odds of adverse composite neonatal outcome were 1.7 times higher in the case group than to the control group (18.0% vs 13.9%; adjusted odds ratio, 1.7; 95% confidence interval, 0.8–4.8). Stratified analyses by disease severity indicated that the morbidity associated with coronavirus disease 2019 in pregnancy was largely driven by the severe or critical disease phenotype. Major risk factors for associated morbidity were black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019. Coronavirus disease 2019 during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, an association that is primarily driven by morbidity associated with severe or critical coronavirus disease 2019. Black and Hispanic race, obesity, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019 are risk factors for associated morbidity.
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影响因子：
168.9
作者：
Chen, Huijun;Guo, Juanjuan;Zhang, Yuanzhen
通讯作者：
Zhang, Yuanzhen
DOI：
10.1016/j.ajogmf.2020.100134
发表时间：
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影响因子：
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DOI：
10.1016/j.ajogmf.2020.100111
发表时间：
2020-05-01
影响因子：
6.3
作者：
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通讯作者：
D'Alton, Mary
DOI：
10.1016/j.ajogmf.2020.100118
发表时间：
2020-05-01
影响因子：
6.3
作者：
Breslin, Noelle;Baptiste, Caitlin;Goffman, Dena
通讯作者：
Goffman, Dena