Perinatal Complications in Individuals in California With or Without SARS-CoV-2 Infection During Pregnancy
Perinatal Complications in Individuals in California With or Without SARS-CoV-2 Infection During Pregnancy
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DOI：
10.1001/jamainternmed.2022.0330
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发表时间：
2022-03-21
影响因子：
39
通讯作者：
Greenberg, Mara
中科院分区：
文献类型：
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作者：
Ferrara, Assiamira;Hedderson, Monique M.;Greenberg, Mara
重要性基于人群的研究需要额外的研究来告知妊娠期间SARS-CoV-2感染的治疗，并为妊娠个体提供健康风险信息。目的评估与SARS-CoV-2感染相关的围产期并发症的风险，并描述与住院相关的因素。和参与者这项基于人群的队列研究纳入了43，886名孕妇，这些孕妇具有从孕前到分娩的纵向电子健康记录数据，她们于2020年3月1日至2020年3月1日在北方加州凯撒医疗机构分娩。2021年3月16日携带COVID-19诊断代码且未进行SARS-CoV-2确证性聚合酶链反应检测的个人被排除在外。（从受孕前30天到分娩后7天）作为随时间变化的暴露。主要结果和测量妊娠或分娩期间任何时间发生的心血管疾病（例如，急性心肌梗死、急性肾衰竭、急性呼吸窘迫综合征和败血症）;早产;妊娠期高血压疾病;妊娠期糖尿病;静脉血栓栓塞（VTE）;死产;剖宫产;新生儿出生体重和呼吸系统疾病。计算有和没有SARS-CoV-2的个体之间的标准化平均差异。采用考克斯比例风险回归分析方法，估计SARS-CoV-2感染与围产期并发症和住院之间的风险比（HR）和95%CI，并考虑SARS-CoV-2感染的时间与结局的关系。（平均[SD]年龄，30.7 [5.2]岁），感染SARS-CoV-2的个体（1332 [3.0%]）更可能是年轻的、西班牙裔的、多产的个体，具有较高的邻里剥夺指数和肥胖或慢性高血压。在调整人口统计学特征、合并症和吸烟状况后，SARS-CoV-2感染者发生严重孕产妇发病率（HR，2.45; 95%CI，1.91-3.13）、早产（
IMPORTANCE Additional research from population-based studies is needed to inform the treatment of SARS-CoV-2 infection during pregnancy and to provide health risk information to pregnant individuals.OBJECTIVE To assess the risk of perinatal complications associated with SARS-CoV-2 infection and to describe factors associated with hospitalizations.DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included 43 886 pregnant individuals with longitudinal electronic health record data from preconception to delivery who delivered at Kaiser Permanente Northern California between March 1, 2020, and March 16, 2021. Individuals with diagnostic codes for COVID-19 that did not have a confirmatory polymerase chain reaction test for SARS-CoV-2 were excluded.EXPOSURES SARS-CoV-2 infection detected by polymerase chain reaction test (from 30 days before conception to 7 days after delivery) as a time varying exposure.MAIN OUTCOMES AND MEASURES Severe maternal morbidity including 21 conditions (eg, acute myocardial infarction, acute renal failure, acute respiratory distress syndrome, and sepsis) that occurred at any time during pregnancy or delivery; preterm birth; pregnancy hypertensive disorders; gestational diabetes; venous thromboembolism (VTE); stillbirth; cesarean delivery; and newborn birth weight and respiratory conditions. Standardized mean differences between individuals with and without SARS-CoV-2 were calculated. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) and 95% CIs for the association between SARS-CoV-2 infection and perinatal complications and hospitalization and to consider the timing of SARS-CoV-2 infection relative to outcomes.RESULTS In this study of 43 886 pregnant individuals (mean [SD] age, 30.7 [5.2) years), individuals with a SARS-CoV-2 infection (1332 [3.0%j) were more likely to be younger, Hispanic, multiparous individuals with a higher neighborhood deprivation index and obesity or chronic hypertension. After adjusting for demographic characteristics, comorbidities, and smoking status, individuals with SARS-CoV-2 infection had higher risk for severe maternal morbidity (HR, 2.45; 95% CI, 1.91-3.13), preterm birth (