Perinatal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitario "12 de Octubre", Madrid, Spain.
Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain.
J Matern Fetal Neonatal Med. 2022 Jul;35(14):2648-2654. doi: 10.1080/14767058.2020.1793320. Epub 2020 Jul 20.
There is little evidence about how novel coronavirus (SARS-CoV-2) affects pregnant women and their newborns. Comparisons with other members of the coronavirus family responsible for severe acute respiratory syndrome (SARS) have been done to predict maternal and neonatal outcomes; however, more information is required to establish clinical patterns, disease evolution and pregnancy prognosis in this group of patients.
This paper is reporting a series of 91 women diagnosed with SARS-CoV-2 infection during pregnancy and puerperium. The analysis showed that 40 patients developed pneumonia, bilateral in most cases, with a 46.2% rate of hospitalization and 4 patients requiring intensive care unit (ICU) admission. In confront with previous publications, we have found a higher rate of coronavirus disease (COVID-19) severe forms, even when compared to non-pregnant women with the same baseline characteristics. We have analyzed the demographic characteristics, pregnancy-related conditions and presenting symptoms to identify features that could determine which patients will need hospitalization because of COVID-19 (Group 1-G1) and those who not (Group 2-G2). We have found that obesity and Latin-American origin behave as risk factors: OR: 4.3; 95% CI: 1.4-13.2, and OR: 2.6; 95% CI: 1.1 - 6.2, respectively. Among the 23 patients that delivered with active SARS-CoV-2, the overall rate of cesarean section (CS) and preterm birth were 52.2% and 34.8%, respectively, but we observed that the rate of CS was even higher in G1 compared to G2: 81.8% versus 25%, = .012. However, prematurity was equally distributed in both groups and only one preterm delivery was determined by poor maternal condition. There were no deaths among the patients neither their newborns.
In conclusion, the results of our cohort reveal that SARSC-CoV-2 infection may not behave as mild as suggested during pregnancy, especially when factors as obesity or Latin-American origin are present. No evidence of late vertical transmission was noticed but prematurity and high CS rate were common findings, although it is difficult to establish any causality between these conditions and COVID-19. Further evidence is required to establish if pregnancy itself can lead to severe forms of COVID-19 disease and whether risk factors for the general population are applicable to obstetric patients. Until larger studies are available, pregnant women should be monitored carefully to anticipate severe complications.
关于新型冠状病毒（SARS-CoV-2）如何影响孕妇及其新生儿，目前相关证据有限。为预测母婴结局，我们将其与引发严重急性呼吸综合征（SARS）的其他冠状病毒进行了比较；但是，为明确该人群的临床模式、疾病进展和妊娠预后，我们还需要更多信息。
本研究报道了 91 例在妊娠期和产褥期诊断为 SARS-CoV-2 感染的孕妇。分析显示，40 例患者发生肺炎，多为双侧肺炎，住院率为 46.2%，4 例患者需入住重症监护病房（ICU）。与既往文献相比，我们发现即使与具有相同基线特征的非妊娠女性相比，COVID-19 严重程度更高。我们分析了人口统计学特征、妊娠相关情况和临床表现，以确定可能导致 COVID-19 患者需要住院（第 1 组-G1）和无需住院（第 2 组-G2）的特征。我们发现肥胖和拉丁美洲裔是危险因素：OR：4.3；95%CI：1.4-13.2，OR：2.6；95%CI：1.1-6.2。在 23 例有活动性 SARS-CoV-2 分娩的患者中，剖宫产（CS）和早产的总体发生率分别为 52.2%和 34.8%，但我们观察到 G1 组的 CS 发生率明显高于 G2 组：81.8%比 25%，=0.012。然而，两组的早产发生率相同，且只有 1 例早产是由于母亲病情不佳所致。患者及其新生儿均无死亡。
总之，我们的研究结果表明，SARS-CoV-2 感染在妊娠期间可能不像之前认为的那样轻微，尤其是当存在肥胖或拉丁美洲裔等因素时。我们没有发现垂直传播的迟发证据，但早产和高 CS 发生率是常见的发现，尽管很难确定这些情况与 COVID-19 之间的因果关系。需要进一步的证据来确定妊娠本身是否会导致 COVID-19 疾病的严重形式，以及一般人群的危险因素是否适用于产科患者。在更大规模的研究结果出来之前，应密切监测孕妇以预测严重并发症。
