Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (Drs Hill, Patrick, and Brandt, Ms Schwebel, and Dr Rosen); Prenatal Testing Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT (Dr Hill).
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (Drs Hill, Patrick, and Brandt, Ms Schwebel, and Dr Rosen).
Am J Obstet Gynecol MFM. 2021 Nov;3(6):100454. doi: 10.1016/j.ajogmf.2021.100454. Epub 2021 Aug 8.
Universal testing for COVID-19 on admission to the labor and delivery unit identifies asymptomatic patients. Whether or not these patients are at increased risk for adverse outcomes and go on to develop clinically significant disease is uncertain.
This study aimed to assess the prevalence of asymptomatic COVID-19 presentation among pregnant patients admitted for delivery and to determine whether these patients become symptomatic or require hospital readmission after discharge.
We performed a multicenter, prospective cohort study of pregnant patients who delivered between 20 and 41 weeks' gestation and who were found to have COVID-19 based on universal screening on admission for delivery at 1 of 4 medical centers in New Jersey (exposed group). The unexposed group, comprising patients who tested negative for COVID-19, were identified at the primary study site. The primary outcomes were the rates of asymptomatic COVID-19 presentation, the development of symptoms among the asymptomatic positive patients, and hospital readmission rates in the 2 weeks following discharge. We compared the frequency of the distribution of risk factors and outcomes in relation to the COVID-19 status among patients with COVID-19 across all centers and among those without COVID-19 at the primary site. Associations between categorical risk factors and COVID-19 status were expressed as relative risks with 95% confidence intervals.
Between April 10, 2020, and June 15, 2020, there were 218 patients with COVID-19 at the 4 sites and 413 patients without COVID-19 at the primary site. The majority (188 [83.2%]) of patients with COVID-19 were asymptomatic. Compared with the negative controls, these asymptomatic patients were not at increased risk for obstetrical complications that may increase the risk associated with COVID-19, including gestational diabetes (8.2% vs 11.4%; risk ratio, 0.72; 95% confidence interval, 0.24-2.01) and gestational hypertension (6.1% vs 7.0%; risk ratio, 0.88; 95% confidence interval, 0.29-2.67). Postpartum follow-ups via telephone surveys revealed that these patients remained asymptomatic and had low rates of family contacts acquiring the disease, but their adherence to social distancing guidelines waned during the 2-week postpartum period. Review of inpatient and emergency department records revealed low rates of hospital readmission.
Most of the pregnant patients who screened positive for COVID-19 are asymptomatic and do not go on to develop clinically significant infection after delivery. Routine surveillance of these patients after hospital discharge appears to be sufficient.
在进入产房时对 COVID-19 进行普遍检测可识别出无症状患者。这些患者是否有发生不良后果和出现临床显著疾病的风险增加尚不确定。
本研究旨在评估在分娩时接受入院的孕妇中无症状 COVID-19 表现的患病率，并确定这些患者在出院后是否出现症状或需要再次住院。
我们进行了一项多中心前瞻性队列研究，纳入了在新泽西州的 4 家医疗中心中的 1 家接受分娩入院时进行普遍筛查时发现 COVID-19 的 20 至 41 周妊娠孕妇（暴露组）。在主要研究地点，我们确定了未感染 COVID-19 的未暴露组患者。主要结局是无症状 COVID-19 表现率、无症状阳性患者出现症状的发生率以及出院后 2 周内的住院再入院率。我们比较了在所有中心中与 COVID-19 相关的患者中 COVID-19 状态的风险因素和结局分布频率，以及在主要研究地点未感染 COVID-19 的患者。将分类风险因素与 COVID-19 状态的关联表示为 95%置信区间的相对风险。
2020 年 4 月 10 日至 6 月 15 日，4 个地点有 218 例 COVID-19 患者，主要研究地点有 413 例未感染 COVID-19 的患者。大多数（188 [83.2%]）COVID-19 患者无症状。与阴性对照组相比，这些无症状患者没有增加发生可能增加与 COVID-19 相关风险的产科并发症的风险，包括妊娠期糖尿病（8.2%比 11.4%；风险比，0.72；95%置信区间，0.24-2.01）和妊娠期高血压（6.1%比 7.0%；风险比，0.88；95%置信区间，0.29-2.67）。通过电话调查进行的产后随访显示，这些患者仍然无症状，其家庭成员感染疾病的比例较低，但在产后 2 周内，他们对社会隔离指南的遵守情况有所减弱。回顾住院和急诊部的记录发现，再次住院的比例较低。
在接受 COVID-19 筛查的孕妇中，大多数呈阳性的患者无症状，分娩后不会出现临床显著感染。在出院后对这些患者进行常规监测似乎就足够了。
