Impact of the COVID-19 pandemic, SARS-CoV-2 infection and social determinants of health on pregnancy complications, birth outcomes and post-pregnancy maternal cardiovascular and mortality outcomes

项目摘要 在全国范围内，南卡罗来纳州（SC）是妊娠结局最差和孕产妇死亡率最高的州之一。 婴儿死亡率，存在着巨大的种族/民族差异。新的SARS-CoV-2感染 妊娠与妊娠并发症和不良的婴儿和产妇结局有关，包括 mortality.此外，社会决定因素和医疗保健不公平的影响和健康结果 由SARS-CoV-2引起的COVID-19疫情加剧。心血管危险因素 怀孕（例如，肥胖、糖尿病和高血压）和妊娠并发症如先兆子痫， 常见，可导致母亲和婴儿的发病率和死亡率，是众所周知的风险因素， 产妇心血管和血管疾病的短期和长期。妊娠期SARS-CoV-2感染 也与并发症有关（例如，重症监护室（ICU）入院，有创通气，心肌 梗塞、栓塞）。有关COVID-19疫情影响的可用信息较少，或 特别是SARS-CoV-2感染对母婴发病率和死亡率的影响。我们研究的目的是 了解COVID-19大流行和SARS-CoV-2感染对孕产妇风险的影响， 以及婴儿发病率和死亡率，包括妊娠并发症（例如，先兆子痫，重症监护室入院 机械通气），不利的分娩结果（例如，早产、小于胎龄儿），以及 心血管事件（例如，冠心病、中风、栓塞）。数据从 全州范围的管理数据集（例如，住院，生命记录，医疗补助，阳性COVID-19测试）将被 建立一个多元化的纵向队列，这些女性在2018-2021年间生育， 到2022年的后续行动。每年约有45，000例活产妊娠发生在SC， 在4年的研究期间，预计总共有约180，000例分娩。截至2021年6月1日，2600名孕妇 被诊断为COVID-19。拟议项目旨在评估COVID-19的影响 大流行（目标1）和在SC人群水平上SARS-CoV-2感染（目标2）对（1）妊娠的影响 并发症、不良分娩结局、孕产妇心血管事件以及孕产妇和婴儿死亡率;（2） 孕妇怀孕后一年心血管和死亡率的结果;和（3）检查差异， 种族/民族、社会脆弱性、与主要医疗设施的距离以及孕前肥胖和糖尿病。 这项研究将是第一个评估COVID-19大流行和SARS-CoV-2感染的研究， 在一项基于人口的研究中，对怀孕与孕产妇和婴儿发病率和死亡率的关系进行了研究。确定 COVID-19大流行和SARS-CoV-2感染对婴儿和孕产妇发病率和死亡率的影响 社会和种族差异的程度对改善怀孕结果和健康至关重要 在美国的研究结果的差异，预计将告知孕妇和公共卫生政策的临床护理。

PROJECT SUMMARY Nationally, South Carolina (SC) ranks among the worst for poor pregnancy outcomes and high maternal and infant mortality rates, with vast racial/ethnic disparities present. Infection with the novel SARS-CoV-2 during pregnancy has been associated with pregnancy complications and poor infant and maternal outcomes including mortality. Moreover, the effect of social determinants and inequities in healthcare received and health outcomes have been heightened by the COVID-19 pandemic caused by SARS-CoV-2. Cardiovascular risk factors during pregnancy (e.g., obesity, diabetes, and hypertension) and pregnancy complications such as pre-eclampsia are common, can result in morbidity and mortality for the mother and the baby, and are well-known risk factors for maternal cardiovascular and vascular disease short and long-term. Infection with SARS-CoV-2 during pregnancy has also been related to complications (e.g., intensive care unit (ICU) admission, invasive ventilation, myocardial infarction, embolism). Less information is available regarding the impact of the COVID-19 pandemic or specifically SARS-CoV-2 infection on maternal and infant morbidity and mortality. The objective of our study is to understand the impact of both the COVID-19 pandemic and infection with SARS-CoV-2 on the risk of maternal and infant morbidity and mortality including pregnancy complications (e.g., pre-eclampsia, ICU admissions, mechanical ventilation), adverse birth outcomes (e.g., preterm birth, small for gestational age), and maternal cardiovascular events (e.g., coronary heart disease, stroke, embolism) during and post-pregnancy. Data from statewide administrative datasets (e.g., hospitalizations, vital records, Medicaid, positive COVID-19 tests) will be linked to create a diverse, longitudinal cohort of women who gave birth between 2018-2021 with at least one year of follow-up through 2022. Approximately 45,000 live birth pregnancies take place in SC each year for a total of ~180,000 deliveries anticipated over the 4-year study period. As of June 1, 2021, 2600 pregnant women in SC were diagnosed with COVID-19. The proposed project aims to evaluate the impact of the COVID-19 pandemic (Aim 1) and the impact of SARS-CoV-2 infection (Aim 2) at the population level in SC on (1) pregnancy complications, adverse birth outcomes, maternal cardiovascular events, and maternal and infant mortality; (2) maternal one-year post pregnancy cardiovascular and mortality outcomes; and (3) to examine differences by race/ethnicity, social vulnerability, distance to main medical facility, and pre-pregnancy obesity and diabetes. This study will be among the first to evaluate the COVID-19 pandemic and SARS-CoV-2 infection during pregnancy in relation to maternal and infant morbidity and mortality in a population-based study. Determining the impact of the COVID-19 pandemic and SARS-CoV-2 infection on infant and maternal morbidity and mortality and the extent of social and racial-ethnic differences is critical to improving pregnancy outcomes and health disparities in the U.S. Findings are expected to inform clinical care of pregnant women and public health policy.