新型冠状病毒对妊娠及新生儿结局的影响：巴西孕妇的一项开放性前瞻性研究。
Impact of SARS-CoV-2 on pregnancy and neonatal outcomes: An open prospective study of pregnant women in Brazil.
机构信息
Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Hospital Universitário da Universidade de São Paulo (USP), São Paulo, SP, Brazil.
出版信息
Clinics (Sao Paulo). 2022 Jun 27;77:100073. doi: 10.1016/j.clinsp.2022.100073. eCollection 2022.
OBJECTIVES
To determine the incidence and risk of adverse obstetric and neonatal outcomes according to SARS-CoV-2 infection severity in pregnant women.
METHOD
Open prospective study of pregnant women tested for SARS-CoV-2 by serological and molecular assays during pregnancy or delivery in two hospitals in Sao Paulo, Brazil from April 12, 2020, to February 28, 2021. Five groups were considered for analysis: C0, negative COVID-19 results and no COVID-19 symptoms; C1, positive COVID-19 results, and no symptoms; C2, positive COVID-19 results with mild symptoms; C3, positive COVID-19 results with moderate symptoms; and C4, positive COVID-19 results with severe symptoms. The association between obstetric and neonatal outcomes and COVID-19 severity was determined using multivariate analysis.
RESULTS
734 eligible pregnant women were enrolled as follows: C0 (n = 357), C1 (n = 127), C2 (n = 174), C3 (n = 37), and C4 (n = 39). The following pregnancy and neonatal outcomes were associated with severe COVID-19: oligohydramnios (adjusted Odds Ratio [aOR] = 6.18; 95% CI 1.87‒20.39), fetal distress (aOR = 4.01; 95% Confidence Interval [CI] 1.84‒8.75), preterm birth (aOR = 5.51; 95% CI 1.47‒20.61), longer hospital stay (aOR = 1.66; 95% CI 1.36‒2.02), and admission to the neonatal intensive care unit (aOR = 19.36; 95% CI, 5.86‒63.99). All maternal (n = 6, 15.4%, p < 0.001) and neonatal (n = 5, 12.5%, p < 0.001) deaths and most fetal deaths (n = 4, 9.8%, p < 0.001) occurred in C4 group. Moderate COVID-19 was associated with oligohydramnios (aOR = 6.23; 95% CI 1.93‒20.13) and preterm birth (aOR = 3.60; 95% CI 1.45‒9.27). Mild COVID-19 was associated with oligohydramnios (aOR = 3.77; 95% CI 1.56‒9.07).
CONCLUSION
Adverse pregnancy and neonatal outcomes were associated with maternal symptomatic COVID-19 status, and risk increased with disease severity.
目的
根据孕妇 SARS-CoV-2 感染严重程度，确定不良产科和新生儿结局的发生率和风险。
方法
对 2020 年 4 月 12 日至 2021 年 2 月 28 日在巴西圣保罗的两家医院进行的 SARS-CoV-2 血清学和分子检测的孕妇进行了一项开放的前瞻性研究。共分析了 5 组：C0（阴性 COVID-19 结果且无 COVID-19 症状）、C1（阳性 COVID-19 结果且无症状）、C2（阳性 COVID-19 结果伴轻微症状）、C3（阳性 COVID-19 结果伴中度症状）和 C4（阳性 COVID-19 结果伴严重症状）。采用多变量分析确定 COVID-19 严重程度与产科和新生儿结局之间的关系。
结果
共纳入 734 名符合条件的孕妇：C0（n=357）、C1（n=127）、C2（n=174）、C3（n=37）和 C4（n=39）。以下妊娠和新生儿结局与严重 COVID-19 相关：羊水过少（调整后的优势比[aOR]6.18；95%CI 1.87-20.39）、胎儿窘迫（aOR 4.01；95%CI 1.84-8.75）、早产（aOR 5.51；95%CI 1.47-20.61）、住院时间延长（aOR 1.66；95%CI 1.36-2.02）和新生儿重症监护病房（NICU）入住（aOR 19.36；95%CI，5.86-63.99）。所有产妇（n=6，15.4%，p<0.001）和新生儿（n=5，12.5%，p<0.001）死亡以及大多数胎儿死亡（n=4，9.8%，p<0.001）均发生在 C4 组。中度 COVID-19 与羊水过少（aOR 6.23；95%CI 1.93-20.13）和早产（aOR 3.60；95%CI 1.45-9.27）相关。轻度 COVID-19 与羊水过少（aOR 3.77；95%CI 1.56-9.07）相关。
结论
不良妊娠和新生儿结局与母体有症状的 COVID-19 状态相关，且风险随疾病严重程度增加而增加。
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