Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan.
BMJ Open. 2022 Dec 30;12(12):e068575. doi: 10.1136/bmjopen-2022-068575.
To identify independent risk factors for severe COVID-19 in pregnant women and to evaluate the impact of disease severity on preterm birth.
A case-control study based on data from a nationwide questionnaire-based survey of maternity services in Japan.
A questionnaire was mailed to all 2135 delivery institutions in Japan between July and August 2021. A total of 1288 institutions responded (60% of all delivery institutions in Japan). 566 facilities reported having cared for pregnant women with COVID-19, and 722 facilities reported having had no such patients.
One thousand and forty-three hospitalised and non-hospitalised pregnant women diagnosed with COVID-19 between July 2020 and 30 June 2021.
The primary outcome was progression to severe COVID-19. The secondary outcome was preterm birth due to COVID-19 infection.
56 cases (5.4%) were severe, and 987 (94.6%) were non-severe. Multivariable logistic regression analysis showed that gestational age≥24 weeks (adjusted OR (aOR) 6.68, 95% CI 2.8 to 16.0) and maternal age≥32 years (aOR 2.40, 95% CI 1.3 to 4.3) were independently associated with severe cases. Using the Kaplan-Meier method, the probability of continued pregnancy at 14 days after diagnosis for severe cases was 0.57 between 24 and 31 weeks' gestation and 0.27 between 32 and 36 weeks' gestation. The probability for non-severe cases was 1.0 between 24 and 31 weeks' gestation and 0.8 between 32 and 36 weeks' gestation. Among the patients with COVID-19 in the preterm period, preterm birth due to infection was significantly more common in severe than non-severe cases (48% vs 6%, p< 0.0001).
Severe COVID-19 in pregnant women was associated with gestational age≥24 weeks and maternal age≥32. The rate of preterm delivery due to the infection was significantly higher in severe COVID-19 cases.
确定孕妇中严重 COVID-19 的独立危险因素，并评估疾病严重程度对早产的影响。
一项基于日本全国性产妇服务问卷调查数据的病例对照研究。
2021 年 7 月至 8 月间向日本的 2135 家分娩机构邮寄问卷。共有 1288 家机构做出回应（日本所有分娩机构的 60%）。566 家机构报告照顾过 COVID-19 孕妇，722 家机构报告没有此类患者。
2020 年 7 月至 2021 年 6 月 30 日期间在医院和非医院诊断为 COVID-19 的 1043 名孕妇。
主要结局是进展为严重 COVID-19。次要结局是 COVID-19 感染导致的早产。
56 例（5.4%）为重症，987 例（94.6%）为非重症。多变量逻辑回归分析显示，妊娠 24 周以上（调整后的 OR（aOR）6.68，95%CI 2.8 至 16.0）和产妇年龄≥32 岁（aOR 2.40，95%CI 1.3 至 4.3）与重症病例独立相关。使用 Kaplan-Meier 方法，重症病例在诊断后 14 天继续妊娠的概率在 24 至 31 周妊娠时为 0.57，在 32 至 36 周妊娠时为 0.27。非重症病例在 24 至 31 周妊娠时为 1.0，在 32 至 36 周妊娠时为 0.8。在 COVID-19 早产患者中，严重病例的感染性早产明显多于非严重病例（48%比 6%，p<0.0001）。
孕妇严重 COVID-19 与妊娠 24 周以上和产妇年龄≥32 岁有关。严重 COVID-19 病例的感染性早产率明显较高。
