孕妇感染严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）后的母婴和新生儿不良结局：一项个体参与者数据荟萃分析。

Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis.

机构信息

Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA

Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA.

出版信息

BMJ Glob Health. 2023 Jan;8(1). doi: 10.1136/bmjgh-2022-009495.

DOI:10.1136/bmjgh-2022-009495

PMID:36646475

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9895919/

Abstract

INTRODUCTION

Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.

METHODS

We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.

RESULTS

We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.

CONCLUSIONS

This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

摘要

简介

尽管越来越多的研究关注 SARS-CoV-2 感染在妊娠期间的风险，但由于已发表研究的质量和设计存在异质性，因此仍存在争议。

方法

我们在连续的前瞻性荟萃分析中筛选正在进行的研究。我们汇总了个体参与者的数据，以估计 SARS-CoV-2 感染孕妇与确诊阴性妊娠相比不良结局的绝对风险和相对风险（RR）。我们使用改良的纽卡斯尔-渥太华量表评估偏倚风险。

结果

我们筛选了 137 项研究，并纳入了来自 12 个国家的 12 项研究，涉及 13136 名孕妇。与未感染的孕妇相比，SARS-CoV-2 感染的孕妇发生以下情况的风险显著增加：孕产妇死亡率（10 项研究；n=1490；RR 7.68，95%CI 1.70 至 34.61）；入住重症监护病房（8 项研究；n=6660；RR 3.81，95%CI 2.03 至 7.17）；接受机械通气（7 项研究；n=4887；RR 15.23，95%CI 4.32 至 53.71）；接受任何重症监护（7 项研究；n=4735；RR 5.48，95%CI 2.57 至 11.72）；诊断为肺炎（6 项研究；n=4573；RR 23.46，95%CI 3.03 至 181.39）和血栓栓塞性疾病（8 项研究；n=5146；RR 5.50，95%CI 1.12 至 27.12）。SARS-CoV-2 感染孕妇所生的新生儿更有可能在出生后入住新生儿重症监护病房（7 项研究；n=7637；RR 1.86，95%CI 1.12 至 3.08）；早产（7 项研究；n=6233；RR 1.71，95%CI 1.28 至 2.29）或中度早产（7 项研究；n=6071；RR 2.92，95%CI 1.88 至 4.54）；以及低出生体重（12 项研究；n=11930；RR 1.19，95%CI 1.02 至 1.40）。感染与死产无关。研究的偏倚风险通常较低或中度。