Higher severe acute respiratory syndrome coronavirus 2 infection rate in pregnant patients.
Higher severe acute respiratory syndrome coronavirus 2 infection rate in pregnant patients.
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DOI：
10.1016/j.ajog.2021.02.011
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发表时间：
2021-07
影响因子：
9.8
通讯作者：
Washington COVID-19 in Pregnancy Collaborative
中科院分区：
文献类型：
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作者：
Lokken EM;Taylor GG;Huebner EM;Vanderhoeven J;Hendrickson S;Coler B;Sheng JS;Walker CL;McCartney SA;Kretzer NM;Resnick R;Kachikis A;Barnhart N;Schulte V;Bergam B;Ma KK;Albright C;Larios V;Kelley L;Larios V;Emhoff S;Rah J;Retzlaff K;Thomas C;Paek BW;Hsu RJ;Erickson A;Chang A;Mitchell T;Hwang JK;Gourley R;Erickson S;Delaney S;Kline CR;Archabald K;Blain M;LaCourse SM;Adams Waldorf KM;Washington COVID-19 in Pregnancy Collaborative
在2019年冠状病毒病大流行的最初几个月，与妊娠期严重急性呼吸综合征冠状病毒2相关的风险尚不确定。怀孕患者通常经常与医疗系统接触，因此可以作为突发公共卫生事件期间临床和公共卫生反应成功的典范。基于人群的妊娠期严重急性呼吸综合征冠状病毒2感染估计尚不清楚，因为妊娠状态未完全确定或仅纳入单一中心或住院病例。在大流行的最初几个月，孕妇是否受到公共卫生应对措施的保护，或通过她们与产科提供者的互动得到保护，目前尚不清楚。本研究旨在估计严重急性呼吸综合征冠状病毒2在怀孕期间的感染率，并检查华盛顿州种族和民族以及英语水平的差异。2020年3月1日至2020年6月30日期间，在35家医院和诊所发现了经聚合酶链反应确诊的严重急性呼吸综合征冠状病毒2型感染的孕妇，占华盛顿州年度分娩的61%。怀孕期间的感染率由华盛顿州负责任的卫生社区地区进行总体估计，并与华盛顿州同样年龄的成年人的严重急性呼吸综合征冠状病毒2感染率进行横断面比较。种族、民族和用于孕妇医疗护理的语言与华盛顿州最近的数据进行了比较。研究期间共发现严重急性呼吸综合征冠状病毒2型感染孕妇240例，其中少数民族占70.7%。本研究的主要发现如下：(1)华盛顿州20 ~ 39岁成人的严重急性呼吸综合征冠状病毒2型感染率为每1000例分娩13.9例（95%可信区间8.3 ~ 23.2），华盛顿州20 ~ 39岁成人的感染率为每1000例分娩7.3例（95%可信区间7.2 ~ 7.4）（比率比1.7,95%可信区间1.3 ~ 2.3）；(2)排除45例经无症状筛查检出的严重急性呼吸综合征冠状病毒2（率比为1.3,95%置信区间为0.96 ~ 1.9），新生儿冠状病毒2感染率降至11.3 / 1000(95%置信区间为6.3 ~ 20.3)；(3) 2018年，非白人族裔孕妇感染严重急性呼吸综合征冠状病毒病2型的比例是华盛顿州活产妇女种族和族裔分布的2- 4倍；(4)华盛顿州严重急性呼吸综合征冠状病毒2型感染孕妇接受非英语医疗护理的比例高于接受英语水平有限的孕妇护理的比例（30.4% vs 7.6%）。在华盛顿州，孕妇的严重急性呼吸综合征冠状病毒2感染率比同样年龄的成年人高70%，这并不能完全通过分娩时的普遍筛查来解释。来自几乎所有种族和少数民族群体的怀孕患者和接受非英语医疗服务的患者所占比例过高。在大流行的最初几个月，孕妇没有得到保护，免受严重急性呼吸综合征冠状病毒2的感染。此外，几乎所有种族和少数民族群体的感染负担最重。这些数据加上人们更广泛地认识到怀孕是严重疾病和孕产妇死亡的风险因素，这强烈表明，在美国，与一些州类似，孕妇应该被广泛优先考虑2019年冠状病毒病疫苗的分配。
During the early months of the coronavirus disease 2019 pandemic, risks associated with severe acute respiratory syndrome coronavirus 2 in pregnancy were uncertain. Pregnant patients can serve as a model for the success of clinical and public health responses during public health emergencies as they are typically in frequent contact with the medical system. Population-based estimates of severe acute respiratory syndrome coronavirus 2 infections in pregnancy are unknown because of incomplete ascertainment of pregnancy status or inclusion of only single centers or hospitalized cases. Whether pregnant women were protected by the public health response or through their interactions with obstetrical providers in the early months of pandemic is not clearly understood. This study aimed to estimate the severe acute respiratory syndrome coronavirus 2 infection rate in pregnancy and to examine the disparities by race and ethnicity and English language proficiency in Washington State. Pregnant patients with a polymerase chain reaction–confirmed severe acute respiratory syndrome coronavirus 2 infection diagnosed between March 1, 2020, and June 30, 2020 were identified within 35 hospitals and clinics, capturing 61% of annual deliveries in Washington State. Infection rates in pregnancy were estimated overall and by Washington State Accountable Community of Health region and cross-sectionally compared with severe acute respiratory syndrome coronavirus 2 infection rates in similarly aged adults in Washington State. Race and ethnicity and language used for medical care of pregnant patients were compared with recent data from Washington State. A total of 240 pregnant patients with severe acute respiratory syndrome coronavirus 2 infections were identified during the study period with 70.7% from minority racial and ethnic groups. The principal findings in our study were as follows: (1) the severe acute respiratory syndrome coronavirus 2 infection rate was 13.9 per 1000 deliveries in pregnant patients (95% confidence interval, 8.3–23.2) compared with 7.3 per 1000 (95% confidence interval, 7.2–7.4) in adults aged 20 to 39 years in Washington State (rate ratio, 1.7; 95% confidence interval, 1.3–2.3); (2) the severe acute respiratory syndrome coronavirus 2 infection rate reduced to 11.3 per 1000 deliveries (95% confidence interval, 6.3–20.3) when excluding 45 cases of severe acute respiratory syndrome coronavirus disease 2 detected through asymptomatic screening (rate ratio, 1.3; 95% confidence interval, 0.96–1.9); (3) the proportion of pregnant patients in non-White racial and ethnic groups with severe acute respiratory syndrome coronavirus disease 2 infection was 2- to 4-fold higher than the race and ethnicity distribution of women in Washington State who delivered live births in 2018; and (4) the proportion of pregnant patients with severe acute respiratory syndrome coronavirus 2 infection receiving medical care in a non-English language was higher than estimates of pregnant patients receiving care with limited English proficiency in Washington State (30.4% vs 7.6%). The severe acute respiratory syndrome coronavirus 2 infection rate in pregnant people was 70% higher than similarly aged adults in Washington State, which could not be completely explained by universal screening at delivery. Pregnant patients from nearly all racial and ethnic minority groups and patients receiving medical care in a non-English language were overrepresented. Pregnant women were not protected from severe acute respiratory syndrome coronavirus 2 infection in the early months of the pandemic. Moreover, the greatest burden of infections occurred in nearly all racial and ethnic minority groups. These data coupled with a broader recognition that pregnancy is a risk factor for severe illness and maternal mortality strongly suggested that pregnant people should be broadly prioritized for coronavirus disease 2019 vaccine allocation in the United States similar to some states.
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影响因子：
9.8
作者：
Lokken, Erica M.;Walker, Christie L.;Waldorf, Kristina M. Adams
通讯作者：
Waldorf, Kristina M. Adams
DOI：
10.15585/mmwr.mm6938e2
发表时间：
2020-09-23
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Panagiotakopoulos L;Myers TR;Gee J;Lipkind HS;Kharbanda EO;Ryan DS;Williams JTB;Naleway AL;Klein NP;Hambidge SJ;Jacobsen SJ;Glanz JM;Jackson LA;Shimabukuro TT;Weintraub ES
通讯作者：
Weintraub ES
影响因子：
11.8
作者：
LaCourse, Sylvia M.;John-Stewart, Grace;Waldorf, Kristina M. Adams
通讯作者：
Waldorf, Kristina M. Adams
影响因子：
33.9
作者：
Ellington, Sascha;Strid, Penelope;Gilboa, Suzanne M.
通讯作者：
Gilboa, Suzanne M.
影响因子：
13.8
作者：
Adhikari EH;Moreno W;Zofkie AC;MacDonald L;McIntire DD;Collins RRJ;Spong CY
通讯作者：
Spong CY