Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
the George Washington University Biostatistics Center, Washington, DC.
Am J Obstet Gynecol. 2023 Feb;228(2):226.e1-226.e9. doi: 10.1016/j.ajog.2022.08.009. Epub 2022 Aug 13.
SARS-CoV-2 infection during pregnancy is associated with adverse pregnancy outcomes, including fetal death and preterm birth. It is not known whether that risk occurs only during the time of acute infection or whether the risk persists later in pregnancy.
This study aimed to evaluate whether the risk of SARS-CoV-2 infection during pregnancy persists after an acute maternal illness.
A retrospective cohort study of pregnant patients with and without SARS-CoV-2 infection delivering at 17 hospitals in the United States between March 2020 and December 2020. Patients experiencing a SARS-CoV-2-positive test at or before 28 weeks of gestation with a subsequent delivery hospitalization were compared with those without a positive SAR-CoV-2 test at the same hospitals with randomly selected delivery days during the same period. Deliveries occurring at <20 weeks of gestation in both groups were excluded. The study outcomes included fetal or neonatal death, preterm birth at <37 weeks of gestation and <34 weeks of gestation, hypertensive disorders of pregnancy (HDP), any major congenital malformation, and size for gestational age of <5th or <10th percentiles at birth based on published standards. HDP that were collected included HDP and preeclampsia with severe features, both overall and with delivery at <37 weeks of gestation.
Of 2326 patients who tested positive for SARS-CoV-2 during pregnancy and were at least 20 weeks of gestation at delivery from March 2020 to December 2020, 402 patients (delivering 414 fetuses or neonates) were SARS-CoV-2 positive before 28 weeks of gestation and before their admission for delivery; they were compared with 11,705 patients without a positive SARS-CoV-2 test. In adjusted analyses, those with SARS-CoV-2 before 28 weeks of gestation had a subsequent increased risk of fetal or neonatal death (2.9% vs 1.5%; adjusted relative risk, 1.97; 95% confidence interval, 1.01-3.85), preterm birth at <37 weeks of gestation (19.6% vs 13.8%; adjusted relative risk, 1.29; 95% confidence interval, 1.02-1.63), and HDP with delivery at <37 weeks of gestation (7.2% vs 4.1%; adjusted relative risk, 1.74; 95% confidence interval, 1.19-2.55). There was no difference in the rates of preterm birth at <34 weeks of gestation, any major congenital malformation, and size for gestational age of <5th or <10th percentiles. In addition, there was no significant difference in the rate of gestational hypertension overall or preeclampsia with severe features.
There was a modest increase in the risk of adverse pregnancy outcomes after SARS-CoV-2 infection.
SARS-CoV-2 感染孕妇与不良妊娠结局相关，包括胎儿死亡和早产。目前尚不清楚这种风险仅发生在急性感染期间，还是会持续到妊娠后期。
本研究旨在评估 SARS-CoV-2 感染孕妇在急性疾病后是否仍存在感染风险。
这是一项在美国 17 家医院进行的 SARS-CoV-2 感染孕妇的回顾性队列研究，这些孕妇于 2020 年 3 月至 2020 年 12 月期间分娩。将在妊娠 28 周前的 SARS-CoV-2 阳性检测结果且随后有分娩住院的患者与在同一医院随机选择的、同期分娩的 SARS-CoV-2 检测结果为阴性的患者进行比较。两组均排除妊娠<20 周分娩的患者。研究结局包括胎儿或新生儿死亡、妊娠<37 周和<34 周早产、妊娠高血压疾病（HDP）、任何重大先天性畸形，以及根据已发表标准出生时胎龄<第 5 百分位数或<第 10 百分位数。收集的 HDP 包括 HDP 和有严重特征的子痫前期，无论是否在妊娠<37 周时分娩。
在 2020 年 3 月至 2020 年 12 月期间，有 2326 名在妊娠期间检测到 SARS-CoV-2 阳性且分娩时至少 20 周的患者中，有 402 名（分娩 414 名胎儿或新生儿）在妊娠 28 周前且在分娩前的 SARS-CoV-2 检测结果为阳性；将其与 11705 名未进行 SARS-CoV-2 检测的患者进行比较。在调整分析中，在妊娠 28 周前感染 SARS-CoV-2 的患者随后有更高的胎儿或新生儿死亡风险（2.9%比 1.5%；调整后的相对风险为 1.97；95%置信区间为 1.01-3.85）、妊娠<37 周早产（19.6%比 13.8%；调整后的相对风险为 1.29；95%置信区间为 1.02-1.63）和妊娠<37 周分娩的 HDP（7.2%比 4.1%；调整后的相对风险为 1.74；95%置信区间为 1.19-2.55）。妊娠<34 周早产、任何重大先天性畸形和胎龄<第 5 百分位数或<第 10 百分位数的发生率无差异。此外，整体妊娠期高血压或严重特征子痫前期的发生率也无显著差异。
SARS-CoV-2 感染后不良妊娠结局的风险略有增加。
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