The epidemiology and pathogenesis of SARS-CoV-2 infection in pregnancy: More questions than answers.
The epidemiology and pathogenesis of SARS-CoV-2 infection in pregnancy: More questions than answers.
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DOI：
10.1016/j.eclinm.2020.100534
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发表时间：
2020-09
影响因子：
15.1
通讯作者：
Malaba TR
中科院分区：
文献类型：
--
作者：
Odayar J;Myer L;Malaba TR
随着COVID-19全球大流行的蔓延，对SARS-CoV-2的流行病学和病理生理学的了解正在迅速扩大。在对这种新型冠状病毒的新兴研究中，与非孕妇相比，孕妇更容易受到感染[1]，但受到的关注相对较少。怀孕的正常生理适应，特别是免疫和心肺系统的适应，可能使妇女易患流感等其他感染的呼吸系统并发症。来自先前冠状病毒爆发的有限数据表明，与非孕妇相比，患有严重急性呼吸综合征（SARS）和中东呼吸综合征（MERS）的孕妇的死亡率可能更高[2]。与SARS和MERS相比，SARS-CoV-2感染孕妇的结局似乎不那么严重[3]，尽管有一些迹象表明，SARS-CoV-2感染孕妇的不良妊娠结局，特别是早产（PTB）的发生率可能会增加[4]。在这一期的EClinicalMedicine中，Khalil及其同事对已发表的妊娠期SARS-CoV-2文献进行了系统回顾和荟萃分析，包括孕产妇，产科和围产期结局[5]。该审查包括全球超过2000名妇女，数据来自国家和区域登记处。总的来说，他们报告的产妇结果令人放心，数据表明，围产期和产妇死亡率很低。然而，与一般成年人群的研究结果相似，患有合并症和肥胖症的孕妇似乎有更高的风险。特别值得关注的是，SARS-CoV-2妇女的一些不良妊娠结局似乎很高：例如，22%的分娩报告了PTB，18%的分娩有医学指征。总的来说，48%的分娩是通过剖腹产，但很少有研究报告的适应症和医源性剖腹产早产率的贡献是不清楚的，虽然这篇综述开始提出这些重要问题的有价值的数据，最终它提供了更多的问题比答案。早产的风险，其病因，以及医源性剖腹产对早产率的贡献显然需要进一步的调查。该综述还指出了研究结果的实质性异质性，以及迄今为止发表的研究的基本局限性。本文纳入的大多数研究是回顾性病例系列，没有比较组;样本量小;缺乏SARS-CoV-2病例定义的标准化（实验室确认vs胸部CT扫描）和检测策略（分娩或其他适应症入院时的通用检测vs基于X线的检测）;使用不同的定义报告不同的结局。此外，大多数妇女在妊娠晚期被诊断出患有SARS-CoV-2，和/或在不同的入院标准下住院。总之，这些问题极大地使对研究结果的解释复杂化，反过来又限制了我们对SARS-CoV-2在怀孕期间的说法。
With the spread of the global COVID-19 pandemic, insights into the epidemiology and pathophysiology of SARS-CoV-2 are expanding rapidly. In the emerging body of research on this novel coronavirus, pregnant women À who are more susceptible to infections compared to non-pregnant women [1] À have received relatively little attention. The normal physiological adaptations of pregnancy, particularly of the immune and cardiopulmonary systems, can predispose women to the respiratory complications of other infections such as influenza. Limited data from previous coronavirus outbreaks suggest potentially higher mortality among pregnant women with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) compared to non-pregnant women [2]. Outcomes in pregnant women with SARS-CoV-2 infection appear less severe compared to SARS and MERS [3] though there is some suggestion that the incidence of adverse pregnancy outcomes, particularly preterm birth (PTB), may be increased in women with SARS-CoV-2 [4]. In this issue of EClinicalMedicine, Khalil and colleagues present a systematic review and meta-analysis of published literature on SARS-CoV-2 in pregnancy, including maternal, obstetric and perinatal outcomes [5]. This review includes> 2000 women globally with data from national and regional registries. Overall they report reassuring maternal outcomes and the data indicate that perinatal and maternal mortality were rare. However similar to findings in general adult populations, pregnant women with comorbidities and obesity appear at higher risk. Of particular concern, some adverse pregnancy outcomes appeared high in women with SARS-CoV-2: for example, PTB was reported in 22% of deliveries, and was medically indicated in 18%. Overall 48% of deliveries were via caesarean section, but few studies reported indications and the contribution of iatrogenic caesarean births to preterm rates is unclear.While this review begins to present valuable data on these important issues, ultimately it provides more questions than answers. The risk of preterm birth, its aetiology, and the contribution of iatrogenic caesarean section to preterm rates clearly require further investigation. The review also indicates substantial heterogeneity in findings, and the fundamental limitations of the studies published to date. The majority of studies included here were retrospective case series with no comparison groups; had small sample sizes; lacked standardization of case definitions (laboratory confirmation vs chest CT scans) and testing strategies (universal testing at admission for labor or other indications vs symptom-based) for SARS-CoV-2; and reported differing outcomes using differing definitions. Additionally, most women included were diagnosed with SARS-CoV-2 in their third trimester, and/or hospitalized in settings under varying admission criteria. Taken together, these issues greatly complicate interpretation of findings and in turn limit what we can say about SARS-CoV-2 in pregnancy.
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DOI：
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