Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Institut de Recerca Sant Joan de Deu, Barcelona, Spain.
Clin Infect Dis. 2021 Nov 16;73(10):1768-1775. doi: 10.1093/cid/ciab104.
We performed a population-based study to describe the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on pregnancy outcomes.
This prospective, population-based study included pregnant women who consecutively presented at first/second trimester visits or at delivery at 3 hospitals in Barcelona, Spain. SARS-CoV-2 antibodies (immunoglobulin [Ig] G and IgM/IgA) were measured in all participants, and nasopharyngeal real-time polymerase chain reaction (RT-PCR) was performed at delivery. The primary outcome was a composite of pregnancy complications in SARS-CoV-2-positive vs negative women that included miscarriage, preeclampsia, preterm delivery, perinatal death, small-for-gestational-age newborn, or neonatal admission. Secondary outcomes were components of the primary outcome plus abnormal fetal growth, malformation, or intrapartum fetal distress. Outcomes were also compared between positive symptomatic and positive asymptomatic SARS-CoV-2 women.
Of 2225 pregnant women, 317 (14.2%) were positive for SARS-CoV-2 antibodies (n = 314, 99.1%) and/or RT-PCR (n = 36, 11.4%). Among positive women, 217 (68.5%) were asymptomatic, 93 (29.3%) had mild coronavirus disease 2019 (COVID-19), and 7 (2.2%) had pneumonia, of whom 3 required intensive care unit admission. In women with and without SARS-CoV-2 infection, the primary outcome occurred in 43 (13.6%) and 268 (14%), respectively (risk difference, -0.4%; 95% confidence interval, -4.1% to 4.1). Compared with noninfected women, those with symptomatic COVID-19 had increased rates of preterm delivery (7.2% vs 16.9%, P = .003) and intrapartum fetal distress (9.1% vs 19.2%, P = .004), while asymptomatic women had rates that were similar to those of noninfected cases. Among 143 fetuses from infected mothers, none had anti-SARS-CoV-2 IgM/IgA in cord blood.
The overall rate of pregnancy complications in women with SARS-CoV-2 infection was similar to that of noninfected women. However, symptomatic COVID-19 was associated with modest increases in preterm delivery and intrapartum fetal distress.
我们进行了一项基于人群的研究，以描述严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染对妊娠结局的影响。
这项前瞻性、基于人群的研究纳入了连续在西班牙巴塞罗那的 3 家医院就诊于首次/二次妊娠检查或分娩的孕妇。所有参与者均检测 SARS-CoV-2 抗体（免疫球蛋白[Ig]G 和 IgM/IgA），分娩时进行鼻咽实时聚合酶链反应（RT-PCR）。主要结局是 SARS-CoV-2 阳性与阴性女性的妊娠并发症复合结局，包括流产、子痫前期、早产、围产儿死亡、小于胎龄儿或新生儿入院。次要结局是主要结局的组成部分，加上胎儿生长异常、畸形或产时胎儿窘迫。还比较了 SARS-CoV-2 阳性有症状和无症状女性的结局。
在 2225 名孕妇中，317 名（14.2%）SARS-CoV-2 抗体阳性（n=314，99.1%）和/或 RT-PCR 阳性（n=36，11.4%）。在阳性女性中，217 名（68.5%）无症状，93 名（29.3%）有轻度 2019 年冠状病毒病（COVID-19），7 名（2.2%）有肺炎，其中 3 名需要入住重症监护病房。在 SARS-CoV-2 感染与未感染者中，主要结局分别发生于 43 名（13.6%）和 268 名（14%）女性（风险差，-0.4%；95%置信区间，-4.1%至 4.1%）。与未感染者相比，有症状 COVID-19 的女性早产（7.2% vs 16.9%，P=0.003）和产时胎儿窘迫（9.1% vs 19.2%，P=0.004）发生率更高，而无症状女性的发生率与未感染者相似。在 143 名感染母亲的胎儿中，均未在脐血中检测到 SARS-CoV-2 IgM/IgA。
SARS-CoV-2 感染女性的妊娠并发症总体发生率与未感染者相似。然而，有症状 COVID-19 与早产和产时胎儿窘迫的发生率适度增加有关。
