Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Ste A, Salt Lake City, UT, 84108, USA.
BMC Pregnancy Childbirth. 2021 Apr 16;21(1):305. doi: 10.1186/s12884-021-03772-y.
Pregnant women are potentially a high-risk population during infectious disease outbreaks such as COVID-19, because of physiologic immune suppression in pregnancy. However, data on the morbidity and mortality of COVID-19 among pregnant women, compared to nonpregnant women, are sparse and inconclusive. We sought to assess the impact of pregnancy on COVID-19 associated morbidity and mortality, with particular attention to the impact of pre-existing comorbidity.
We used retrospective data from January through June 2020 on female patients aged 18-44 years old utilizing the Cerner COVID-19 de-identified cohort. We used mixed-effects logistic and exponential regression models to evaluate the risk of hospitalization, maximum hospital length of stay (LOS), moderate ventilation, invasive ventilation, and death for pregnant women while adjusting for age, race/ethnicity, insurance, Elixhauser AHRQ weighted Comorbidity Index, diabetes history, medication, and accounting for clustering of results in similar zip-code regions.
Out of 22,493 female patients with associated COVID-19, 7.2% (n = 1609) were pregnant. Crude results indicate that pregnant women, compared to non-pregnant women, had higher rates of hospitalization (60.5% vs. 17.0%, P < 0.001), higher mean maximum LOS (0.15 day vs. 0.08 day, P < 0.001) among those who stayed < 1 day, lower mean maximum LOS (2.55 days vs. 3.32 days, P < 0.001) among those who stayed ≥1 day, and higher moderate ventilation use (1.7% vs. 0.7%, P < 0.001) but showed no significant differences in rates of invasive ventilation or death. After adjusting for potentially confounding variables, pregnant women, compared to non-pregnant women, saw higher odds in hospitalization (aOR: 12.26; 95% CI (10.69, 14.06)), moderate ventilation (aOR: 2.35; 95% CI (1.48, 3.74)), higher maximum LOS among those who stayed < 1 day, and lower maximum LOS among those who stayed ≥1 day. No significant associations were found with invasive ventilation or death. For moderate ventilation, differences were seen among age and race/ethnicity groups.
Among women with COVID-19 disease, pregnancy confers substantial additional risk of morbidity, but no difference in mortality. Knowing these variabilities in the risk is essential to inform decision-makers and guide clinical recommendations for the management of COVID-19 in pregnant women.
由于妊娠期间生理性免疫抑制，孕妇在传染病（如 COVID-19）爆发期间可能是高危人群。然而，与非孕妇相比，有关 COVID-19 孕妇发病率和死亡率的数据仍然稀少且尚无定论。我们旨在评估妊娠对 COVID-19 相关发病率和死亡率的影响，特别关注合并症的影响。
我们利用 2020 年 1 月至 6 月期间年龄在 18-44 岁的女性患者的回顾性数据，使用 Cerner COVID-19 去识别队列。我们使用混合效应逻辑和指数回归模型，在调整年龄、种族/民族、保险、Elixhauser AHRQ 加权合并症指数、糖尿病史、药物以及考虑类似邮政编码区域结果的聚类后，评估孕妇住院、最长住院时间（LOS）、中度通气、有创通气和死亡的风险。
在 22493 名患有 COVID-19 的女性患者中，有 7.2%（n=1609）为孕妇。初步结果表明，与非孕妇相比，孕妇的住院率（60.5% vs. 17.0%，P<0.001）、<1 天留院的平均最长 LOS（0.15 天 vs. 0.08 天，P<0.001）更高、≥1 天留院的平均最长 LOS（2.55 天 vs. 3.32 天，P<0.001）更低、中度通气使用率（1.7% vs. 0.7%，P<0.001）更高，但有创通气或死亡率无显著差异。在调整潜在混杂因素后，与非孕妇相比，孕妇住院（优势比：12.26；95%置信区间（10.69，14.06））、中度通气（优势比：2.35；95%置信区间（1.48，3.74））、<1 天留院的最长 LOS 更高、≥1 天留院的最长 LOS 更低的可能性更大。与有创通气或死亡无显著相关性。对于中度通气，在年龄和种族/民族组之间存在差异。
在患有 COVID-19 的女性中，妊娠会带来更高的发病率风险，但死亡率无差异。了解这些风险的可变性对于为决策者提供信息并指导 COVID-19 孕妇管理的临床建议至关重要。
