利用英国产科监测系统数据，分析奥密克戎变异株流行期间住院孕妇的新冠病毒感染严重程度及围产期结局：前瞻性全国队列研究
Severity of maternal SARS-CoV-2 infection and perinatal outcomes of women admitted to hospital during the omicron variant dominant period using UK Obstetric Surveillance System data: prospective, national cohort study.
作者信息
Engjom Hilde M, Ramakrishnan Rema, Vousden Nicola, Bunch Kathryn, Morris Eddie, Simpson Nigel A B, Gale Chris, O'Brien Patrick, Quigley Maria, Brocklehurst Peter, Kurinczuk Jennifer J, Knight Marian
机构信息
Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Bergen, Norway.
National Perinatal Epidemiology Unit, University of Oxford, Oxford, Oxfordshire, UK.
出版信息
BMJ Med. 2022 Aug 24;1(1):e000190. doi: 10.1136/bmjmed-2022-000190. eCollection 2022.
OBJECTIVES
To describe the severity of maternal infection when the omicron SARS-CoV-2 variant (B.1.1.529) was dominant (15 December 2021 to 14 March 2022) and describe outcomes by symptoms and vaccination status.
DESIGN
Prospective, national cohort study using the UK Obstetric Surveillance System.
SETTING
94 hospitals in the UK with a consultant led maternity unit.
PARTICIPANTS
Pregnant women admitted to hospital for any cause with a positive SARS-CoV-2 test.
MAIN OUTCOME MEASURES
Symptomatic or asymptomatic infection, vaccination status by doses before admission, and severity of maternal infection (moderate or severe infection according to modified World Health Organization's criteria).
RESULTS
Of 3699 women who were admitted to hospital, 986 (26.7%, 95% confidence interval 25.3% to 28.1%) had symptoms; of these, 144 (14.6%, 12.5% to 17.0%) had a moderate to severe infection, 99 (10.4%, 8.6% to 12.5%) of 953 received respiratory support, and 30 (3.0%, 2.1% to 4.3%) were admitted to an intensive care unit. Covid-19 specific drug treatment was given to 13 (43.3%) of the 30 women in intensive care. Four women with symptoms died (0.4%, 0.1% to 1.1%). Vaccination status was known for 845 (85.6%) women with symptoms; 489 (58.9%) were unvaccinated and only 55 (6.5%) had three doses. Moderate to severe infection was reported for 93 (19.0%) of 489 unvaccinated women with symptoms, decreasing to three (5.5%) of 55 after three doses. Among the 30 women with symptoms who were admitted to intensive care, 23 (76.7%) were unvaccinated and none had received three doses.
CONCLUSION
Most women with severe covid-19 disease were unvaccinated and vaccine coverage among pregnant women admitted to hospital with SARS-CoV-2 was low. Ongoing action to prioritise and advocate for vaccine uptake in pregnancy is essential. A better understanding of the persistent low use of drug treatments is an urgent priority.
TRIAL REGISTRATION
ISRCTN 40092247.
目的
描述2021年12月15日至2022年3月14日奥密克戎SARS-CoV-2变异株（B.1.1.529）占主导期间孕产妇感染的严重程度，并按症状和疫苗接种状况描述结局。
设计
使用英国产科监测系统进行的前瞻性全国队列研究。
地点
英国94家设有顾问主导产科病房的医院。
参与者
因任何原因住院且SARS-CoV-2检测呈阳性的孕妇。
主要结局指标
有症状或无症状感染、入院前按接种剂量划分的疫苗接种状况以及孕产妇感染的严重程度（根据世界卫生组织修订标准为中度或重度感染）。
结果
在3699名入院的女性中，986名（26.7%，95%置信区间25.3%至28.1%）有症状；其中，144名（14.6%，12.5%至17.0%）有中度至重度感染，953名中有99名（10.4%，8.6%至12.5%）接受了呼吸支持，30名（3.0%，2.1%至4.3%）入住重症监护病房。30名入住重症监护病房的女性中有13名（43.3%）接受了新冠病毒特异性药物治疗。4名有症状的女性死亡（0.4%，0.1%至1.1%）。845名（85.6%）有症状女性的疫苗接种状况已知；489名（58.9%）未接种疫苗，只有55名（6.5%）接种了三剂。489名有症状的未接种疫苗女性中有93名（19.0%）报告有中度至重度感染，接种三剂后降至55名中的3名（5.5%）。在30名有症状且入住重症监护病房的女性中，23名（76.7%）未接种疫苗，且无人接种三剂。
结论
大多数新冠重症女性未接种疫苗，因SARS-CoV-2入院的孕妇疫苗接种率较低。持续采取行动优先并倡导孕妇接种疫苗至关重要。迫切需要更好地了解药物治疗使用率持续较低的情况。
试验注册
ISRCTN 40092247。
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