Schell Rachel C, Macias Devin A, Garner W Holt, White Alesha M, McIntire Donald D, Pruszynski Jessica, Adhikari Emily H
Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Drs Schell, Macias, White, McIntire, Pruszynski, and Adhikari); Parkland Health, Dallas, TX (Drs Schell, Macias, White, and Adhikari).
Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX (Drs Schell, Macias, White, McIntire, Pruszynski, and Adhikari); Parkland Health, Dallas, TX (Drs Schell, Macias, White, and Adhikari).
Am J Obstet Gynecol MFM. 2022 Nov;4(6):100728. doi: 10.1016/j.ajogmf.2022.100728. Epub 2022 Aug 20.
COVID-19 infection is associated with increased morbidity in pregnancy and adverse maternal and neonatal outcomes. Little is currently known about how the timing of infection during pregnancy affects these outcomes.
This study aimed to evaluate the effect of trimester of COVID-19 infection on disease progression and severity in pregnant patients.
This was a prospective cohort study of pregnant patients diagnosed with COVID-19 infection who delivered at a single urban hospital. Universal testing for SARS-CoV-2 was performed at hospital admission and for symptomatic patients in inpatient, emergency department, and outpatient settings. Disease severity was defined as asymptomatic, mild, moderate, severe, or critical on the basis of National Institutes of Health criteria. We evaluated disease progression from asymptomatic to symptomatic infection and from asymptomatic or mild infection to moderate, severe, or critical illness, and stratified by trimester of COVID-19 diagnosis. Primary outcomes included progression of COVID-19 disease severity and a composite obstetrical outcome, which included delivery at <37 weeks, preeclampsia with severe features, abruption, excess blood loss at delivery (>500 mL for vaginal or >1000 mL for cesarean delivery), and stillbirth.
From March 18, 2020 to September 30, 2021, 1326 pregnant patients were diagnosed with COVID-19 and delivered at our institution, including 103 (8%) first-, 355 (27%) second-, and 868 (65%) third-trimester patients. First-trimester patients were older and had more medical comorbidities; 86% of patients in all trimesters were Hispanic. Among patients admitted within 14 days of a positive test, 3 of 18 (17%) first-trimester, 20 of 47 (43%) second-trimester, and 34 of 574 (6%) third-trimester patients were admitted for the indication of COVID-19 illness. Across all trimesters, 1195 (90%) of 1326 COVID-19 infections were asymptomatic or mild, and 45 (10%) of 436 initially asymptomatic patients developed symptoms. Of patients with asymptomatic or mild symptoms at diagnosis, 4 (4%) of 93 first-, 18 (5%) of 337 second-, and 49 (6%) of 836 third-trimester patients developed moderate, severe, or critical illness (P=.80). There was no significant difference in composite obstetrical outcome with respect to trimester of COVID-19 diagnosis (24% first-trimester, 28% second-trimester, 28% third-trimester patients; P=.69).
Moderate, severe, or critical illness develops in almost 10% of pregnant patients. The frequency of COVID-19 disease progression in pregnancy does not differ by trimester of diagnosis.
新型冠状病毒肺炎（COVID-19）感染与孕期发病率增加以及不良的孕产妇和新生儿结局相关。目前对于孕期感染时间如何影响这些结局知之甚少。
本研究旨在评估COVID-19感染的孕期对妊娠患者疾病进展和严重程度的影响。
这是一项对在一家城市医院分娩的确诊COVID-19感染的妊娠患者进行的前瞻性队列研究。在入院时以及对住院、急诊科和门诊有症状的患者进行严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的普遍检测。根据美国国立卫生研究院标准，将疾病严重程度定义为无症状、轻度、中度、重度或危重型。我们评估了从无症状感染到有症状感染以及从无症状或轻度感染到中度、重度或危重型疾病的进展情况，并按COVID-19诊断的孕期进行分层。主要结局包括COVID-19疾病严重程度的进展以及一个综合产科结局，该综合产科结局包括孕<37周分娩、伴有严重特征的子痫前期、胎盘早剥、分娩时失血过多（阴道分娩>500 mL或剖宫产分娩>1000 mL）以及死产。
2020年3月18日至2021年9月30日，1326例妊娠患者在我们机构被诊断为COVID-19并分娩，其中包括103例（8%）孕早期、355例（27%）孕中期和868例（65%）孕晚期患者。孕早期患者年龄较大且合并更多内科疾病；所有孕期的患者中86%为西班牙裔。在检测呈阳性后14天内入院的患者中，18例孕早期患者中有3例（17%）、47例孕中期患者中有20例（43%）、574例孕晚期患者中有34例（6%）因COVID-19疾病入院。在所有孕期中，1326例COVID-19感染中有1195例（90%）为无症状或轻度，436例最初无症状的患者中有45例（10%）出现症状。诊断时无症状或症状轻微的患者中，93例孕早期患者中有4例（4%）、337例孕中期患者中有18例（5%）、836例孕晚期患者中有49例（6%）发展为中度、重度或危重型疾病（P = 0.80）。关于COVID-19诊断的孕期，综合产科结局无显著差异（孕早期患者为24%，孕中期患者为28%，孕晚期患者为28%；P = 0.69）。
近10%的妊娠患者会发展为中度、重度或危重型疾病。孕期COVID-19疾病进展的频率在诊断的孕期之间没有差异。
