COVID-19 抗体阳性率随时间推移与七个中低收入国家妊娠结局的关系：全球妇女儿童健康研究网络的一项前瞻性观察性研究。

COVID-19 antibody positivity over time and pregnancy outcomes in seven low-and-middle-income countries: A prospective, observational study of the Global Network for Women's and Children's Health Research.

机构信息

Columbia University School of Medicine, New York, New York, USA.

Aga Khan University, Karachi, Pakistan.

出版信息

BJOG. 2023 Mar;130(4):366-376. doi: 10.1111/1471-0528.17366. Epub 2023 Jan 2.

DOI:10.1111/1471-0528.17366

PMID:36504437

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9877904/

Abstract

OBJECTIVES

To determine COVID-19 antibody positivity rates over time and relationships to pregnancy outcomes in low- and middle-income countries (LMICs).

DESIGN

With COVID-19 antibody positivity at delivery as the exposure, we performed a prospective, observational cohort study in seven LMICs during the early COVID-19 pandemic.

SETTING

The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR), a prospective, population-based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Bangladesh, Pakistan, India (two sites), and Guatemala.

POPULATION

Pregnant women enrolled in an ongoing pregnancy registry at study sites.

METHODS

From October 2020 to October 2021, standardised COVID-19 antibody testing was performed at delivery among women enrolled in MNHR. Trained staff masked to COVID-19 status obtained pregnancy outcomes, which were then compared with COVID-19 antibody results.

MAIN OUTCOME MEASURES

Antibody status, stillbirth, neonatal mortality, maternal mortality and morbidity.

RESULTS

At delivery, 26.0% of women were COVID-19 antibody positive. Positivity increased over the four time periods across all sites: 13.8%, 15.4%, 21.0% and 40.9%. In the final period, positivity rates were: DRC 27.0%, Kenya 33.1%, Pakistan 32.8%, Guatemala 37.0%, Zambia 37.8%, Bangladesh 47.2%, Nagpur, India 57.4% and Belagavi, India 62.4%. Adjusting for site and maternal characteristics, stillbirth, neonatal mortality, low birthweight and preterm birth were not significantly associated with COVID-19. The adjusted relative risk (aRR) for stillbirth was 1.27 (95% CI 0.95-1.69). Postpartum haemorrhage was associated with antibody positivity (aRR 1.44; 95% CI 1.01-2.07).

CONCLUSIONS

In pregnant populations in LMICs, COVID-19 antibody positivity has increased. However, most adverse pregnancy outcomes were not significantly associated with antibody positivity.

摘要

目的

确定 COVID-19 抗体阳性率随时间的变化以及与中低收入国家（LMICs）妊娠结局的关系。

设计

以分娩时 COVID-19 抗体阳性为暴露因素，我们在 COVID-19 大流行早期在七个 LMICs 进行了一项前瞻性、观察性队列研究。

设置

该研究在肯尼亚、赞比亚、刚果民主共和国（DRC）、孟加拉国、巴基斯坦、印度（两个地点）和危地马拉的全球妇女和儿童健康网络的母婴健康登记处（MNHR）的妇女中进行，这是一项前瞻性、基于人群的研究。

人群

在研究地点参加正在进行的妊娠登记处的孕妇。

方法

从 2020 年 10 月至 2021 年 10 月，在 MNHR 中对参加的孕妇进行了标准化的 COVID-19 抗体检测。经过培训的工作人员对 COVID-19 状况进行了掩蔽，以获得妊娠结局，然后将这些结局与 COVID-19 抗体结果进行比较。

主要观察结果

抗体状态、死产、新生儿死亡率、孕产妇死亡率和发病率。

结果

分娩时，26.0%的妇女 COVID-19 抗体阳性。所有地点的四个时期的阳性率均有所增加：13.8%、15.4%、21.0%和 40.9%。在最后一个时期，阳性率分别为：刚果民主共和国 27.0%、肯尼亚 33.1%、巴基斯坦 32.8%、危地马拉 37.0%、赞比亚 37.8%、孟加拉国 47.2%、印度那格浦尔 57.4%和印度贝拉加维 62.4%。调整地点和产妇特征后，死产、新生儿死亡率、低出生体重和早产与 COVID-19 无显著关联。死产的调整后相对风险（aRR）为 1.27（95%CI 0.95-1.69）。产后出血与抗体阳性相关（aRR 1.44；95%CI 1.01-2.07）。