新型冠状病毒2型感染与早产之间的关联：一项多变量分析的前瞻性研究。
The association between SARS-CoV-2 infection and preterm delivery: a prospective study with a multivariable analysis.
作者信息
Martinez-Perez Oscar, Prats Rodriguez Pilar, Muner Hernandez Marta, Encinas Pardilla Maria Begoña, Perez Perez Noelia, Vila Hernandez Maria Rosa, Villalba Yarza Ana, Nieto Velasco Olga, Del Barrio Fernandez Pablo Guillermo, Forcen Acebal Laura, Orizales Lago Carmen Maria, Martinez Varea Alicia, Muñoz Abellana Begoña, Suarez Arana Maria, Fuentes Ricoy Laura, Martinez Diago Clara, Janeiro Freire Maria Jesus, Alférez Alvarez-Mallo Macarena, Casanova Pedraz Cristina, Alomar Mateu Onofre, Lesmes Heredia Cristina, Wizner de Alva Juan Carlos, Bernardo Vega Rut, Macia Badia Montserrat, Alvarez Colomo Cristina, Sanchez Muñoz Antonio, Pratcorona Alicart Laia, Alonso Saiz Ruben, Lopez Rodriguez Monica, Del Carmen Barbancho Lopez Maria, Meca Casbas Marta Ruth, Vaquerizo Ruiz Oscar, Moran Antolin Eva, Nuñez Valera Maria Jose, Fernandez Fernandez Camino, Tubau Navarra Albert, Cano Garcia Alejandra Maria, Baena Luque Carmen, Soldevilla Perez Susana, Gastaca Abasolo Irene, Adanez Garcia Jose, Teulon Gonzalez Maria, Puertas Prieto Alberto, Ostos Serna Rosa, Del Pilar Guadix Martin Maria, Catalina Coello Monica, Ferriols Perez Elena, Caño Aguilar Africa, De la Cruz Conty Maria Luisa, Sainz Bueno Jose Antonio
机构信息
Department Gynaecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Madrid, Spain.
Department Reproductive Medicine and Gynaecology, Obstetrics, Dexeus University Hospital, Barcelona, Catalunya, Spain.
出版信息
BMC Pregnancy Childbirth. 2021 Apr 1;21(1):273. doi: 10.1186/s12884-021-03742-4.
BACKGROUND
To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the cause of COVID-19 disease) exposure in pregnancy, compared to non-exposure, is associated with infection-related obstetric morbidity.
METHODS
We conducted a multicentre prospective study in pregnancy based on a universal antenatal screening program for SARS-CoV-2 infection. Throughout Spain 45 hospitals tested all women at admission on delivery ward using polymerase-chain-reaction (PCR) for COVID-19 since late March 2020. The cohort of positive mothers and the concurrent sample of negative mothers was followed up until 6-weeks post-partum. Multivariable logistic regression analysis, adjusting for known confounding variables, determined the adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) of the association of SARS-CoV-2 infection and obstetric outcomes.
MAIN OUTCOME MEASURES
Preterm delivery (primary), premature rupture of membranes and neonatal intensive care unit admissions.
RESULTS
Among 1009 screened pregnancies, 246 were SARS-CoV-2 positive. Compared to negative mothers (763 cases), SARS-CoV-2 infection increased the odds of preterm birth (34 vs 51, 13.8% vs 6.7%, aOR 2.12, 95% CI 1.32-3.36, p = 0.002); iatrogenic preterm delivery was more frequent in infected women (4.9% vs 1.3%, p = 0.001), while the occurrence of spontaneous preterm deliveries was statistically similar (6.1% vs 4.7%). An increased risk of premature rupture of membranes at term (39 vs 75, 15.8% vs 9.8%, aOR 1.70, 95% CI 1.11-2.57, p = 0.013) and neonatal intensive care unit admissions (23 vs 18, 9.3% vs 2.4%, aOR 4.62, 95% CI 2.43-8.94, p < 0.001) was also observed in positive mothers.
CONCLUSION
This prospective multicentre study demonstrated that pregnant women infected with SARS-CoV-2 have more infection-related obstetric morbidity. This hypothesis merits evaluation of a causal association in further research.
背景
为了确定孕期感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2，新冠病毒病的病原体）与未感染者相比，是否与感染相关的产科发病率有关。
方法
我们基于一项针对SARS-CoV-2感染的通用产前筛查计划，开展了一项多中心前瞻性孕期研究。自2020年3月下旬起，西班牙的45家医院对所有入住产房的妇女使用聚合酶链反应（PCR）检测新冠病毒。对阳性母亲队列和阴性母亲的同期样本进行随访，直至产后6周。多变量逻辑回归分析在对已知混杂变量进行调整后，确定了SARS-CoV-2感染与产科结局关联的调整优势比（aOR）及95%置信区间（95%CI）。
主要观察指标
早产（主要指标）、胎膜早破和新生儿重症监护病房收治情况。
结果
在1009例接受筛查的孕妇中，246例SARS-CoV-2呈阳性。与阴性母亲（763例）相比，SARS-CoV-2感染增加了早产几率（34例对51例，13.8%对6.7%，aOR 2.12，95%CI 1.32 - 3.36，p = 0.002）；感染妇女的医源性早产更常见（4.9%对1.3%，p = 0.001），而自发性早产的发生率在统计学上相似（6.1%对4.7%）。足月胎膜早破风险增加（39例对75例，15.8%对9.8%，aOR 1.70，95%CI 1.11 - 2.57，p = 0.013），阳性母亲中新生儿重症监护病房收治情况也增加（23例对18例，9.3%对2.4%，aOR 4.62，95%CI 2.43 - 8.94，p < 0.001）。
结论
这项前瞻性多中心研究表明，感染SARS-CoV-2的孕妇有更多与感染相关的产科发病率。这一假设值得在进一步研究中评估因果关系。
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