Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT.
Am J Obstet Gynecol MFM. 2020 Nov;2(4):100246. doi: 10.1016/j.ajogmf.2020.100246. Epub 2020 Oct 7.
BACKGROUND: Older age and medical comorbidities are identified risk factors for developing severe coronavirus disease 2019. However, there are limited data on risk stratification, clinical and laboratory course, and optimal management of coronavirus disease 2019 in pregnancy. OBJECTIVE: Our study aimed to describe the clinical course of coronavirus disease 2019, effect of comorbidities on disease severity, laboratory trends, and pregnancy outcomes of symptomatic and asymptomatic severe acute respiratory syndrome coronavirus 2-positive pregnant women. STUDY DESIGN: This is a case series of pregnant and postpartum women who received positive test results for severe acute respiratory syndrome coronavirus 2 between March 3, 2020, and May 11, 2020, within 3 hospitals of the Yale New Haven Health delivery network. Charts were reviewed for basic sociodemographic and prepregnancy characteristics, coronavirus disease 2019 course, laboratory values, and pregnancy outcomes. RESULTS: Of the 1567 tested pregnant and postpartum women between March 3, 2020, and May 11, 2020, 9% (n=141) had a positive severe acute respiratory syndrome coronavirus 2 result. Hispanic women were overrepresented in the severe acute respiratory syndrome coronavirus 2-positive group (n=61; 43.8%). In addition, Hispanic ethnicity was associated with a higher rate of moderate and severe diseases than non-Hispanic (18% [11/61] vs 3.8% [3/78], respectively; odds ratio, 5.5; 95% confidence interval, 1.46-20.7; =.01). Of note, 44 women (31.2%) were asymptomatic, 37 of whom (26.2%) were diagnosed on universal screening upon admission for delivery. Moreover, 59% (n=83) were diagnosed before delivery, 36% (n=51) upon presentation for childbirth, and 5% (n=7) after delivery. Severe disease was diagnosed in 6 cases (4.3%), and there was 1 maternal death. Obese women were more likely to develop moderate and severe diseases than nonobese women (16.4% [9/55] vs 3.8% [3/79]; odds ratio, 4.96; 95% confidence interval, 1.28-19.25; =.02). Hypertensive disorders of pregnancy were diagnosed in 22.3% of women (17/77) who delivered after 20 weeks' gestation. Higher levels of C-reactive protein during antepartum coronavirus disease 2019-related admission were more common in women with worse clinical course; however, this association did not reach statistical significance. CONCLUSION: Coronavirus disease 2019 in pregnancy may result in severe disease and death. Hispanic women were more likely to receive a positive test result for severe acute respiratory syndrome 2 than other ethnic groups. Obesity and Hispanic ethnicity represent risk factors for moderate and severe diseases.
背景:年龄较大和合并症被认为是罹患 2019 年冠状病毒病(COVID-19)重症的危险因素。然而,关于妊娠合并 COVID-19 的风险分层、临床和实验室病程以及最佳管理,数据有限。
目的:我们的研究旨在描述 COVID-19 的临床病程、合并症对疾病严重程度的影响、实验室趋势以及症状性和无症状性严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)阳性孕妇的妊娠结局。
研究设计:这是一项对 2020 年 3 月 3 日至 5 月 11 日期间在耶鲁纽黑文健康分娩网络的 3 家医院内接受 SARS-CoV-2 阳性检测的妊娠和产后妇女进行的病例系列研究。对基本社会人口学和孕前特征、COVID-19 病程、实验室值和妊娠结局进行图表回顾。
结果:在 2020 年 3 月 3 日至 5 月 11 日期间接受检测的 1567 名妊娠和产后妇女中,9%(n=141)的 SARS-CoV-2 检测结果为阳性。西班牙裔妇女在 SARS-CoV-2 阳性组中占比过高(n=61;43.8%)。此外,与非西班牙裔相比,西班牙裔与中度和重度疾病的发生率更高(分别为 18%[11/61]和 3.8%[3/78];比值比,5.5;95%置信区间,1.46-20.7;=0.01)。值得注意的是,44 名妇女(31.2%)无症状,其中 37 名(26.2%)在分娩入院时通过普遍筛查诊断。此外,59%(n=83)在分娩前确诊,36%(n=51)在分娩时确诊,5%(n=7)在分娩后确诊。6 例(4.3%)诊断为重症疾病,有 1 例孕产妇死亡。肥胖妇女比非肥胖妇女更有可能发展为中度和重度疾病(分别为 16.4%[9/55]和 3.8%[3/79];比值比,4.96;95%置信区间,1.28-19.25;=0.02)。在妊娠 20 周后分娩的妇女中,22.3%(17/77)诊断为妊娠高血压疾病。在与 COVID-19 相关的产前入院期间,C 反应蛋白水平较高的妇女临床病程更差;然而,这种关联没有达到统计学意义。
结论:妊娠合并 COVID-19 可能导致重症疾病和死亡。西班牙裔妇女比其他族裔更有可能检测出 SARS-CoV-2 阳性。肥胖和西班牙裔是中度和重度疾病的危险因素。
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