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

项目总结 在全国范围内，南卡罗来纳州因妊娠结局差、产妇死亡率高而名列前茅。 婴儿死亡率，存在巨大的种族/族裔差异。感染新型SARS-CoV-2 怀孕与妊娠并发症和不良的婴儿和产妇结局有关，包括 死亡率。此外，社会决定因素和医疗保健方面的不平等的影响以及健康结果 由SARS-CoV-2引起的新冠肺炎大流行加剧了这种情况。期间的心血管危险因素 怀孕(如肥胖、糖尿病和高血压)和妊娠并发症，如先兆子痫 常见的，可导致母亲和婴儿的发病率和死亡率，是众所周知的危险因素 母体心血管疾病的短期和长期。孕期感染SARS-CoV-2 也与并发症有关(例如，重症监护病房(ICU)入院、有创呼吸机、心肌梗死 梗塞、栓塞症)。有关新冠肺炎大流行影响的信息较少，或者 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 了解新冠肺炎大流行和感染SARS-CoV-2对孕妇感染SARS-CoV风险的影响 婴儿发病率和死亡率，包括妊娠并发症(例如，先兆子痫、ICU入院、 机械通风)、不良分娩结局(如早产、小于胎龄)和产妇 怀孕期间和怀孕后的心血管事件(如冠心病、中风、血栓)。数据来自 全州范围的行政数据集(例如，住院、生命记录、医疗补助、新冠肺炎阳性检测)将是 联系起来创造了一个多样化的纵向队列，这些女性在2018-2021年间至少生育了一名 到2022年的后续行动年。南卡罗来纳州每年大约有45,000例活产怀孕 预计在4年的研究期内总共交付约180,000份。截至2021年6月1日，2600名孕妇 在SC中，被诊断为新冠肺炎。拟议的项目旨在评估新冠肺炎的影响 大流行(目标1)和南加州人口层面的SARS-CoV-2感染(目标2)对(1)怀孕的影响 并发症、不良分娩结局、产妇心血管事件以及母婴死亡率；(2) 孕妇孕后一年的心血管和死亡率结果；以及(3)通过以下方式检查差异 种族/族裔、社会脆弱性、距离主要医疗设施的距离以及孕前肥胖和糖尿病。 这项研究将是第一批评估新冠肺炎大流行和SARS-CoV-2感染的研究之一 在一项以人群为基础的研究中，怀孕与母婴发病率和死亡率的关系。确定 新冠肺炎疫情和SARS-CoV-2感染对母婴发病率和死亡率的影响 社会和种族差异的程度对改善妊娠结局和健康至关重要 美国研究结果的差异预计将为孕妇的临床护理和公共卫生政策提供参考。

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.