Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19
Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19
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DOI：
10.1515/jpm-2020-0355
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发表时间：
2020-11-01
影响因子：
2.4
通讯作者：
D'Antonio, Francesco
中科院分区：
文献类型：
--
作者：
Di Mascio, Daniele;Sen, Cihat;D'Antonio, Francesco
目的：评估实验室确诊的COVID-19孕妇的孕产妇和妊娠特征与不良围产期结局风险之间的相关性。方法：对来自22个不同国家的73个中心的2020年2月1日至2020年4月30日所有实验室确诊的COVID-19连续孕妇的多国队列研究进行二次分析。鼻咽拭子实时逆转录酶-聚合酶链式反应（RT-PCR）检测阳性为新冠肺炎确诊病例。主要结局为复合不良胎儿结局，定义为流产（妊娠22周前流产）、死产（妊娠22周后宫内胎儿死亡）、新生儿死亡（出生后28天内活产婴儿死亡）和围产期死亡（死产或新生儿死亡）。进行Logistic回归分析，评估与主要结局相关的独立参数。Logistic回归报告为优势比（OR）和95%可信区间（CI）。结果：确诊时的平均胎龄为30.6±9.5周，其中8.0%在妊娠早期确诊，22.2%在妊娠中期确诊，69.8%在妊娠晚期确诊。有6例流产（2.3%），6例宫内节育器（2.3%）和5例新生儿死亡（2.0%），围产期总死亡率为4.2%(11/265)，因此导致17例出现复合不良胎儿结局，226例未出现复合不良胎儿结局。在产前或产后评估中，死产和新生儿死亡均未发现先天性异常。此外，在动脉或静脉多普勒检查中，没有一例经历宫内节育器的病例有即将死亡的迹象。新生儿死亡都被认为是与早产相关的不良事件。在250名活产新生儿中，1名（0.4%）在分娩后进行的RT-PCR咽拭子检测中呈阳性。这位母亲在怀孕的最后三个月被检测出阳性。新生儿无症状，出生14天后RT-PCR检测呈阴性。在logistic回归分析中，诊断时胎龄（OR: 0.85, 95% CI 0.8-0.9 /周）增加
Objectives: To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19.Methods: Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase- polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI).Results: Mean gestational age at diagnosis was 30.6 +/- 9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p