Thompson Kimberly M, Simons Emily A, Badizadegan Kamran, Reef Susan E, Cooper Louis Z
Kid Risk, Inc, 10524 Moss Park Road, Ste. 204-364, Orlando, FL 32832, USA.
University of Central Florida, College of Medicine, Orlando, FL, USA.
Risk Anal. 2016 Jul;36(7):1315-31. doi: 10.1111/risa.12264. Epub 2014 Aug 5.
Although most infections with the rubella virus result in relatively minor sequelae, rubella infection in early pregnancy may lead to severe adverse outcomes for the fetus. First recognized in 1941, congenital rubella syndrome (CRS) can manifest with a diverse range of symptoms, including congenital cataracts, glaucoma, and cardiac defects, as well as hearing and intellectual disability. The gestational age of the fetus at the time of the maternal rubella infection impacts the probability and severity of outcomes, with infection in early pregnancy increasing the risks of spontaneous termination (miscarriage), fetal death (stillbirth), birth defects, and reduced survival for live-born infants. Rubella vaccination continues to change the epidemiology of rubella and CRS globally, but no models currently exist to evaluate the economic benefits of rubella management. This systematic review provides an overall assessment of the weight of the evidence for the outcomes associated with rubella infections in the first 20 weeks of pregnancy. We identified, evaluated, and graded 31 studies (all from developed countries) that reported on the pregnancy outcomes of at least 30 maternal rubella infections. We used the available evidence to estimate the increased risks of spontaneous termination, fetal death, infant death, and CRS as a function of the timing of rubella infection in pregnancy and decisions about induced termination. These data support the characterization of the disability-adjusted life years for outcomes associated with rubella infection in pregnancy. We find significant impacts associated with maternal rubella infections in early pregnancy, which economic analyses will miss if they only focus on live births of CRS cases. Our estimates of fetal loss from increased induced terminations due to maternal rubella infections provide context that may help to explain the relatively low numbers of observed CRS cases per year despite potentially large burdens of disease. Our comprehensive review of the weight of the evidence of all pregnancy outcomes demonstrates the importance of including all outcomes in models that characterize rubella-related disease burdens and costs.
虽然大多数风疹病毒感染导致的后遗症相对较轻，但孕期早期的风疹感染可能会给胎儿带来严重不良后果。先天性风疹综合征（CRS）于1941年首次被发现，可表现出多种症状，包括先天性白内障、青光眼和心脏缺陷，以及听力和智力残疾。孕妇感染风疹时胎儿的孕周会影响结局的可能性和严重程度，孕期早期感染会增加自然流产（流产）、胎儿死亡（死产）、出生缺陷以及活产婴儿存活率降低的风险。风疹疫苗接种持续改变着全球风疹和先天性风疹综合征的流行病学情况，但目前尚无模型来评估风疹管理的经济效益。本系统评价全面评估了妊娠前20周内风疹感染相关结局的证据权重。我们识别、评估并分级了31项研究（均来自发达国家），这些研究报告了至少30例孕妇风疹感染的妊娠结局。我们利用现有证据估计了自然流产、胎儿死亡、婴儿死亡和先天性风疹综合征风险增加的情况，这是风疹感染孕周和人工流产决策的函数。这些数据支持了对妊娠风疹感染相关结局的伤残调整生命年的描述。我们发现孕期早期孕妇风疹感染存在显著影响，如果经济分析仅关注先天性风疹综合征病例的活产情况，就会忽略这些影响。我们对因孕妇风疹感染导致人工流产增加而造成的胎儿损失的估计提供了相关背景，这可能有助于解释尽管疾病负担可能很大，但每年观察到的先天性风疹综合征病例数量相对较少的原因。我们对所有妊娠结局证据权重的全面综述表明，在描述风疹相关疾病负担和成本的模型中纳入所有结局非常重要。
