Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection.
Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection.
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DOI：
10.1001/jamanetworkopen.2020.29256
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Spong CY
中科院分区：
文献类型：
--
作者：
Adhikari EH;Moreno W;Zofkie AC;MacDonald L;McIntire DD;Collins RRJ;Spong CY
在一个可以进行住院和门诊检测的大型县级卫生保健系统中，严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染是否与妊娠结局、孕产妇疾病严重程度、胎盘病理和新生儿感染有关？在这项队列研究中，252名SARS-CoV-2阳性和3122名阴性孕妇在一个大型县医疗中心的门诊和住院环境中接受了测试，不良妊娠结局相似，3%的婴儿发生新生儿感染，主要是无症状或轻微症状的妇女所生的婴儿。胎盘异常与疾病严重程度无关，住院率与非怀孕妇女的住院率相似。这些发现表明，妊娠期间感染SARS-CoV-2与不良妊娠结局无关。这项队列研究评估了孕妇感染严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)的不良结局，并描述了临床管理、疾病进展、住院、胎盘异常和新生儿结局。已公布的数据表明，2019年患有冠状病毒病的孕妇中住院人数增加、胎盘异常和罕见的新生儿传播(新冠肺炎)。评估与妊娠期间感染严重急性呼吸综合征冠状病毒(SARS-CoV-2)相关的不良结局，描述临床处理、疾病进展、住院、胎盘异常和新生儿结局。这项关于怀孕期间感染和不感染SARS-CoV-2的产妇和新生儿结局的观察性队列研究于2020年3月18日至8月22日在Parkland Health and Hospital System(德克萨斯州达拉斯)进行，Parkland Health and Hospital System是一家高容量产前诊所系统和公立妇产科医院，门诊部、急诊科和住院部普遍可以获得SARS-CoV-2检测。如果女性在怀孕和分娩期间接受SARS-CoV-2检测，就包括在内。对于胎盘分析，病理学家对疾病的严重性视而不见。孕期感染SARS-CoV-2。主要结果是早产、有严重特征的先兆子痫，或在怀孕20周后分娩的妇女因胎心率异常而剖宫产。描述了母体疾病的严重程度、新生儿感染和胎盘异常。从2020年3月18日至8月22日，共接生3,374名孕妇(平均年龄27.6 [6]岁)，其中2 52人检测为阳性，3 122人检测为阴性。队列包括2520名西班牙裔(75%)、619名黑人(18%)和125名白人(4%)女性。患有和不患有SARS-CoV-2的女性在年龄、产次、体重指数或糖尿病方面没有差异。西班牙裔妇女中SARS-CoV-2阳性更为常见(230vs2290[73%]阴性；差异为17.9%；95%可信区间为12.3%-23.5%；P <； .001)。综合主要结果无差异(52名女性[21%]对684名女性[23%]；相对危险度为0.94；95%可信区间为0.73-1.21；P = 为0.64)。在188名接受测试的婴儿中，有6名(3%)发生了早期新生儿SARS-CoV-2感染，主要是无症状或轻微症状的妇女所生。不同疾病严重程度的胎盘病理没有差异。在239名妇女(95%)中，最初出现的产妇疾病是无症状或轻微的，其中6名妇女(3%)发展为严重或危重疾病。14名女性(6%)因新冠肺炎的适应症而住院。在一项大型的单机构队列研究中，孕期感染SARS-CoV-2与不良妊娠结局无关。新生儿感染可能高达3%，主要发生在无症状或轻微症状的妇女中。胎盘异常与疾病严重程度无关，住院频率与非怀孕妇女的发生率相似。
In a large county health care system with access to inpatient and outpatient testing, is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection associated with pregnancy outcomes, maternal illness severity, placental pathology, and neonatal infections? In this cohort study of 252 SARS-CoV-2–positive and 3122 negative pregnant women tested in outpatient and inpatient settings at a large county medical center, adverse pregnancy outcomes were similar, and neonatal infection occurred in 3% of infants, predominantly among infants born to asymptomatic or mildly symptomatic women. Placental abnormalities were not associated with disease severity, and the rate of hospitalization was similar to rates among nonpregnant women. These findings suggest that SARS-CoV-2 infection in pregnancy is not associated with adverse pregnancy outcomes. This cohort study evaluates the adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among pregnant women and describes clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity. SARS-CoV-2 infection during pregnancy. The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described. From March 18 through August 22, 2020, 3374 pregnant women (mean [SD] age, 27.6 [6] years) tested for SARS-CoV-2 were delivered, including 252 who tested positive for SARS-CoV-2 and 3122 who tested negative. The cohort included 2520 Hispanic (75%), 619 Black (18%), and 125 White (4%) women. There were no differences in age, parity, body mass index, or diabetes among women with or without SARS-CoV-2. SARS-CoV-2 positivity was more common among Hispanic women (230 [91%] positive vs 2290 [73%] negative; difference, 17.9%; 95% CI, 12.3%-23.5%; P < .001). There was no difference in the composite primary outcome (52 women [21%] vs 684 women [23%]; relative risk, 0.94; 95% CI, 0.73-1.21; P = .64). Early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. There were no placental pathologic differences by illness severity. Maternal illness at initial presentation was asymptomatic or mild in 239 women (95%), and 6 of those women (3%) developed severe or critical illness. Fourteen women (6%) were hospitalized for the indication of COVID-19. In a large, single-institution cohort study, SARS-CoV-2 infection during pregnancy was not associated with adverse pregnancy outcomes. Neonatal infection may be as high as 3% and may occur predominantly among asymptomatic or mildly symptomatic women. Placental abnormalities were not associated with disease severity, and hospitalization frequency was similar to rates among nonpregnant women.
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影响因子：
7.2
作者：
Tolcher, Mary Catherine;McKinney, Jennifer R.;Nates, Joseph L.
通讯作者：
Nates, Joseph L.
DOI：
10.15585/mmwr.mm6938e1
发表时间：
2020-09-25
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
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COVID-NET Surveillance Team
影响因子：
39.2
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作者：
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通讯作者：
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