2020 年春季马萨诸塞州产妇分娩期间 SARS-CoV-2 感染与患者特征的相关性：一项前瞻性队列研究。
Patient characteristics associated with SARS-CoV-2 infection in parturients admitted for labour and delivery in Massachusetts during the spring 2020 surge: A prospective cohort study.
机构信息
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Paediatr Perinat Epidemiol. 2021 Jan;35(1):24-33. doi: 10.1111/ppe.12743.
BACKGROUND
While studies from large cities affected by coronavirus disease 2019 (COVID-19) have reported on the prevalence of SARS-CoV-2 in the context of universal testing during admission for delivery, the patient demographic, social and clinical factors associated with SARS-CoV-2 infection in pregnant women are not fully understood.
OBJECTIVE
To evaluate the epidemiological factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in women admitted for labour and delivery, in the context of universal screening at four Boston-area hospitals.
METHODS
In this prospective cohort study, we reviewed the health records of all women admitted for labour and delivery at four hospitals from the largest health system in Massachusetts between 19 April 2020 and 27 June 2020. We calculated the risk of SARS-CoV-2 infection, including asymptomatic infection. We calculated associations between SARS-CoV-2 infection and demographic and clinical characteristics.
RESULTS
A total of 93 patients (3.2%, 95% confidence interval 2.5, 3.8) tested positive for SARS-CoV-2 infection on admission for labour and delivery out of 2945 patients included in the analysis; 80 (86.0%) of the patients who tested positive were asymptomatic at the time of testing. Factors associated with SARS-CoV-2 infection included the following: younger age, obesity, African American or Hispanic race/ethnicity, residence in heavily affected communities (as measured in cases reported per capita), presence of a household member with known SARS-CoV-2 infection, non-health care essential worker occupation and MassHealth or Medicaid insurance compared to commercial insurance. 93.8% of patients testing positive for SARS-CoV-2 on admission had one or more identifiable factors associated with disease acquisition.
CONCLUSIONS
In this large sample of deliveries during the height of the surge in infections during the spring of 2020, SARS-CoV-2 infection was largely concentrated in patients with distinct demographic characteristics, those largely from disadvantaged communities. Racial disparities seen in pregnancy persist with respect to SARS-CoV-2 infection.
背景
虽然来自受 2019 年冠状病毒病（COVID-19）影响的大城市的研究报告了在普遍接受分娩入院检测时 SARS-CoV-2 的流行情况，但与孕妇 SARS-CoV-2 感染相关的患者人口统计学、社会和临床因素尚未完全了解。
目的
评估在马萨诸塞州最大的医疗系统的四家医院进行普遍筛查的情况下，与妇女分娩入院时严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染相关的流行病学因素。
方法
在这项前瞻性队列研究中，我们回顾了 2020 年 4 月 19 日至 6 月 27 日期间，马萨诸塞州最大的医疗系统四家医院收治的所有分娩入院妇女的健康记录。我们计算了 SARS-CoV-2 感染的风险，包括无症状感染。我们计算了 SARS-CoV-2 感染与人口统计学和临床特征之间的关联。
结果
在纳入分析的 2945 名患者中，共有 93 名（3.2%，95%置信区间 2.5，3.8）在分娩入院时检测出 SARS-CoV-2 感染阳性；在检测时，80 名（86.0%）检测呈阳性的患者无症状。与 SARS-CoV-2 感染相关的因素包括以下因素：年龄较小、肥胖、非裔美国人或西班牙裔种族/民族、居住在受感染严重的社区（以人均报告病例衡量）、家中有已知 SARS-CoV-2 感染的成员、非卫生保健必需工作者职业以及马萨诸塞州健康保险或医疗补助保险而非商业保险。在入院时检测出 SARS-CoV-2 阳性的 93.8%的患者具有一个或多个与疾病获得相关的可识别因素。
结论
在 2020 年春季感染激增期间的这次大型分娩样本中，SARS-CoV-2 感染主要集中在具有明显人口统计学特征的患者中，这些患者主要来自弱势社区。在 SARS-CoV-2 感染方面，妊娠中存在的种族差异仍然存在。
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