妊娠期新型冠状病毒病（COVID-19）患者的疾病严重程度和围产儿结局。

Disease Severity and Perinatal Outcomes of Pregnant Patients With Coronavirus Disease 2019 (COVID-19).

机构信息

Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, University of Texas Medical Branch at Galveston, Galveston, Texas, Northwestern University, Chicago, Illinois, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Columbia University, New York, New York, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas, University of Pennsylvania, Philadelphia, Pennsylvania, Brown University, Providence, Rhode Island, University of Alabama at Birmingham, Birmingham, Alabama, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, The Ohio State University, Columbus, Ohio, University of Pittsburgh, Pittsburgh, Pennsylvania, and University of Texas at Austin, Austin, Texas; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

出版信息

Obstet Gynecol. 2021 Apr 1;137(4):571-580. doi: 10.1097/AOG.0000000000004339.

DOI:10.1097/AOG.0000000000004339

PMID:33560778

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7984765/

Abstract

OBJECTIVE

To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes.

METHODS

We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling.

RESULTS

A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive neonatal SARS-CoV-2 test result did not differ by severity. Adverse perinatal outcomes were more frequent among patients with more severe illness, including 6% (95% CI 2-11%) incidence of venous thromboembolism among those with severe-critical illness compared with 0.2% in mild-moderate and 0% in asymptomatic (P<.001 for trend across severity). In adjusted analyses, severe-critical COVID-19 was associated with increased risk of cesarean birth (59.6% vs 34.0%, adjusted relative risk [aRR] 1.57, 95% CI 1.30-1.90), hypertensive disorders of pregnancy (40.4% vs 18.8%, aRR 1.61, 95% CI 1.18-2.20), and preterm birth (41.8% vs 11.9%, aRR 3.53, 95% CI 2.42-5.14) compared with asymptomatic patients. Mild-moderate COVID-19 was not associated with adverse perinatal outcomes compared with asymptomatic patients.

CONCLUSION

Compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications.

摘要

目的

描述 2019 年冠状病毒病（COVID-19）在孕妇中的严重程度，并评估疾病严重程度与围产期结局之间的关系。

方法

我们对 2020 年 3 月 1 日至 7 月 31 日期间在美国 14 个州的 33 家医院分娩的 1 名单胎妊娠且严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）检测呈阳性的所有孕妇进行了一项观察性队列研究。疾病严重程度按美国国立卫生研究院的标准分类。由经过中心培训和认证的围产期研究人员提取母婴、胎儿和新生儿结局。我们评估了 COVID-19 严重程度类别中母体特征和结局的趋势，以及严重程度与结局之间的关联通过多变量建模。

结果

共纳入 1219 例患者：无症状 47%，轻症 27%，中度 14%，重症 8%，危重症 4%。总体而言，53%为西班牙裔；疾病严重程度的种族分布没有趋势。病情较重的患者年龄较大，平均体重指数较高，且存在预先存在的合并症。4 例（0.3%）孕产妇死亡归因于 COVID-19。严重程度不同，围产儿死亡或新生儿 SARS-CoV-2 检测阳性结果的频率无差异。病情较重的患者更常发生不良围产儿结局，包括重症危重症患者静脉血栓栓塞的发生率为 6%（95%CI 2-11%），而轻症中度和无症状患者分别为 0.2%（P<.001 表示严重程度之间呈趋势）。在调整分析中，严重危重症 COVID-19 与剖宫产分娩（59.6% vs 34.0%，调整后的相对风险 [aRR] 1.57，95%CI 1.30-1.90）、妊娠高血压疾病（40.4% vs 18.8%，aRR 1.61，95%CI 1.18-2.20）和早产（41.8% vs 11.9%，aRR 3.53，95%CI 2.42-5.14）的风险增加相关，与无症状患者相比。轻度中度 COVID-19 与无症状患者相比，与不良围产儿结局无关。