当前孕妇 COVID-19 治疗特征和结局的趋势及地域差异——一项系统评价和荟萃分析。
Current trends and geographical differences in therapeutic profile and outcomes of COVID-19 among pregnant women - a systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
出版信息
BMC Pregnancy Childbirth. 2021 Mar 24;21(1):247. doi: 10.1186/s12884-021-03685-w.
BACKGROUND
Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women.
METHODS
A PubMed search was performed to screen articles reporting therapeutics and outcomes of confirmed COVID-19 in pregnant women prior to August 27, 2020. We performed searches, quality assessments of eligible studies, extracted and reported data according to PRISMA guidelines. Meta-analyses and cumulative meta-analyses of proportions were performed for estimating each outcome and their pattern over time respectively.
RESULTS
One thousand two hundred thirty nine pregnant women with COVID-19 from 66 studies were analyzed. In case series analysis reflecting average-risk patients, the proportion of oxygen support, antibiotics, antivirals, and plasma therapy administration except for hydroxychloroquine was substantially higher in Asian studies (55, 78, 80, 6, and 0%) compared to the US (7, 1, 12, 0, and 7%) or European (33, 12, 14, 1, and 26%) studies, respectively. The highest preterm birth and the average length of hospital stay (35%, 11.9 days) were estimated in Asian studies compared to the US studies (13%, 9.4 days) and European studies (29%, 7.3 days), respectively. Even in case reports reflecting severe cases, the use of antivirals and antibiotics was higher in Asian studies compared to the US, Latin American, and European studies. A significant decline in the use of most therapeutics along with adverse outcomes of COVID-19 in pregnant women was observed.
CONCLUSIONS
Geographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes. Minimizing the use of some therapeutics particularly antibiotics, antivirals, oxygen therapy, immunosuppressants, and hydroxychloroquine by risk stratification and careful consideration may further improve maternal and clinical outcomes.
背景
冠状病毒病（COVID-19）与不良妊娠结局有关。由于缺乏针对 COVID-19 的有效治疗方法，评估当前 COVID-19 孕妇临床治疗和结局的地理差异和趋势变得至关重要。
方法
我们在 2020 年 8 月 27 日之前对 PubMed 进行了检索，以筛选报道 COVID-19 孕妇治疗方法和结局的文章。我们按照 PRISMA 指南进行了检索、合格研究的质量评估、提取和报告数据。我们分别对每个结局及其随时间变化的模式进行了荟萃分析和累积荟萃分析。
结果
共分析了来自 66 项研究的 1239 例 COVID-19 孕妇。在反映一般风险患者的病例系列分析中，与美国（7%、1%、12%、0%和 7%）或欧洲（33%、12%、14%、1%和 26%）研究相比，亚洲研究中给予氧支持、抗生素、抗病毒药物和血浆治疗的比例（除羟氯喹外）显著更高（55%、78%、80%、6%和 0%）。与美国研究（13%、9.4 天）和欧洲研究（29%、7.3 天）相比，亚洲研究中估计的早产率最高（35%）和平均住院时间最长（11.9 天）。即使在反映重症病例的病例报告中，亚洲研究中抗病毒药物和抗生素的使用也高于美国、拉丁美洲和欧洲研究。随着 COVID-19 孕妇不良结局的出现，观察到大多数治疗方法的使用显著下降。
结论
观察到 COVID-19 治疗实践存在地理差异，导致母婴临床结局存在差异。通过风险分层和仔细考虑，尽可能减少某些治疗方法（特别是抗生素、抗病毒药物、氧疗、免疫抑制剂和羟氯喹）的使用，可能会进一步改善母婴临床结局。
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