Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.
Am J Perinatol. 2024 Jan;41(2):199-207. doi: 10.1055/s-0042-1749666. Epub 2022 Jun 23.
This study aimed to examine whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy is associated with increased odds of perinatal complications and viral transmission to the infant.
A retrospective cohort study of women who delivered at Kaiser Permanente Southern California hospitals (April 6, 2020-February 28, 2021) was performed using data extracted from electronic health records (EHRs). During this time polymerize chain reaction (PCR)-based tests for SARS-CoV-2 was universally offered to all pregnant women at labor and delivery admission, as well as earlier in the pregnancy, if they were displaying symptoms consistent with SARS-CoV-2 infection or a possible exposure to the virus. Adjusted odds ratio (aOR) was used to estimate the strength of associations between positive test results and adverse perinatal outcomes.
Of 35,123 women with a singleton pregnancy, 2,203 (6%) tested positive for SARS-CoV-2 infection with 596 (27%) testing positive during the first or second trimester and 1,607 (73%) during the third trimester. Women testing positive were younger than those who tested negative (29.7 [5.4] vs. 31.1 [5.3] years; mean [standard deviation (SD)]; < .001). The SARS-CoV-2 infection tended to increase the odds of an abnormal fetal heart rate pattern (aOR: 1.10; 95% confidence interval [CI]: 1.00, 1.21; = 0.058), spontaneous preterm birth (aOR: 1.28; 95% CI: 1.03, 1.58; = 0.024), congenital anomalies (aOR: 1.69; 95% CI: 1.15, 2.50; = 0.008), and maternal intensive care unit admission at delivery (aOR: 7.44; 95% CI: 4.06, 13.62; < 0.001) but not preeclampsia/eclampsia (aOR: 1.14; 95% CI: 0.98, 1.33; = 0.080). Eighteen (0.8%) neonates of mothers who tested positive also had a positive SARS-CoV-2 test after 24 hours of birth, but all were asymptomatic during the neonatal period.
These findings suggest that prenatal SARS-CoV-2 infection increases the odds of some adverse perinatal outcomes. The likelihood of vertical transmission from the mother to the fetus was low (0.3%), suggesting that pregnancy complications resulting from SARS-CoV-2 infection pose more risk to the baby than transplacental viral transmission.
· SARS-CoV-2 infection is associated with increased odds of adverse perinatal outcomes.. · The odds of specific adverse outcomes were greater when a mother was infected earlier in pregnancy.. · The proportion of vertical transmission from mother to fetus was 0.3%.
本研究旨在探讨孕妇感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）是否与围产期并发症和病毒向婴儿传播的风险增加相关。
对 2020 年 4 月 6 日至 2021 年 2 月 28 日期间在凯撒永久南加州医院分娩的妇女进行了一项回顾性队列研究，研究数据从电子健康记录（EHR）中提取。在此期间，所有产妇在临产时和分娩时以及妊娠早期，如果出现与 SARS-CoV-2 感染一致的症状或可能接触病毒，均进行基于聚合酶链反应（PCR）的 SARS-CoV-2 检测。采用调整优势比（aOR）来估计阳性检测结果与不良围产期结局之间的关联强度。
在 35123 名单胎妊娠妇女中，2203 名（6%）检测出 SARS-CoV-2 感染阳性，其中 596 名（27%）在妊娠早期或中期检测出阳性，1607 名（73%）在妊娠晚期检测出阳性。与检测阴性的妇女相比，检测阳性的妇女更年轻（29.7[5.4]岁与 31.1[5.3]岁；均值[标准差]； < 0.001）。SARS-CoV-2 感染倾向于增加胎儿胎心监护异常模式（aOR：1.10；95%置信区间[CI]：1.00，1.21； = 0.058）、自发性早产（aOR：1.28；95% CI：1.03，1.58； = 0.024）、先天性异常（aOR：1.69；95% CI：1.15，2.50； = 0.008）和产妇分娩时入住重症监护病房（aOR：7.44；95% CI：4.06，13.62； < 0.001）的风险，但不包括子痫前期/子痫（aOR：1.14；95% CI：0.98，1.33； = 0.080）。18 名（0.8%）母亲检测阳性的新生儿在出生后 24 小时也有 SARS-CoV-2 检测阳性，但在新生儿期均无症状。
这些发现表明产前 SARS-CoV-2 感染增加了一些不良围产期结局的风险。母亲向胎儿垂直传播的可能性较低（0.3%），这表明 SARS-CoV-2 感染引起的妊娠并发症对婴儿的风险大于胎盘内病毒传播。
· SARS-CoV-2 感染与不良围产期结局的风险增加相关。
· 母亲妊娠早期感染时，特定不良结局的风险更大。
· 母婴垂直传播的比例为 0.3%。
