University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
Division of Maternal-Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2196364. doi: 10.1080/14767058.2023.2196364.
This retrospective, single-center case series was designed to characterize the effects of perinatal COVID-19 diagnosis on obstetric and neonatal outcomes in a predominantly high-risk, urban Black population.: Data were collected retrospective chart review on all COVID-19-positive obstetric patients and their neonates who presented to the University of Chicago Medical Center between March 2020 and November 2020, before the availability of the COVID-19 vaccine. Patient demographics, delivery outcomes, COVID-19 symptoms, treatment, and outcomes were analyzed. A total of 56 COVID-19-positive obstetric patients were included in the study, of which four were lost to follow-up before delivery. The median age of patients was 27 years (IQR 23, 32), with 73.2% publicly insured and 66.1% Black. Patients had a median body mass index (BMI) of 31.6 kg/m (IQR 25.9, 35.5). 3.6% of patients had chronic hypertension, 12.5% had diabetes, and 16.1% had asthma. Perinatal complications were common. Twenty-six patients (50.0%) had a diagnosis of a hypertensive disorder of pregnancy (HDP). 28.8% had gestational hypertension, and 21.2% had preeclampsia (with and without severe features). The rate of maternal ICU admission was 3.6%. Furthermore, 23.5% of patients delivered preterm (<37 weeks gestation), and 50.9% of infants were admitted to the Neonatal Intensive Care Unit (NICU). In our study of a predominantly Black, publicly-insured, unvaccinated group of COVID-19-positive pregnant patients, we found high rates of hypertensive disorders of pregnancy, preterm delivery, and NICU admission compared to rates reported in existing literature before widespread vaccine availability. Our findings suggest that SARS-CoV-2 infection during pregnancy, irrespective of maternal disease severity, may exacerbate existing obstetric health disparities by disproportionately impacting Black, publicly insured patients. Larger comparative studies are needed to better characterize possible racial and socioeconomic disparities in obstetric outcomes in the setting of SARS-CoV-2 infection during pregnancy. These studies should examine the pathophysiology of SARS-CoV-2 infection during pregnancy, as well as potential associations between adverse perinatal outcomes and disparities in access to care, COVID-19 vaccination, and other social determinants of health amongst more vulnerable populations infected with SARS-CoV-2 during pregnancy.
本回顾性单中心病例系列研究旨在描述在以高危、城市黑人为主的人群中，围产期 COVID-19 诊断对产科和新生儿结局的影响。：数据来自 2020 年 3 月至 2020 年 11 月期间在芝加哥大学医学中心就诊的所有 COVID-19 阳性产科患者及其新生儿的回顾性图表审查，当时 COVID-19 疫苗尚未问世。分析了患者的人口统计学特征、分娩结局、COVID-19 症状、治疗和结局。本研究共纳入 56 例 COVID-19 阳性产科患者，其中 4 例在分娩前失访。患者的中位年龄为 27 岁（IQR 23，32），73.2%有公共保险，66.1%是黑人。患者的中位体重指数（BMI）为 31.6kg/m（IQR 25.9，35.5）。3.6%的患者患有慢性高血压，12.5%患有糖尿病，16.1%患有哮喘。围产期并发症很常见。26 名患者（50.0%）诊断为妊娠高血压疾病（HDP）。28.8%为妊娠期高血压，21.2%为子痫前期（有或无严重特征）。产妇 ICU 入住率为 3.6%。此外，23.5%的患者早产（<37 周妊娠），50.9%的婴儿入住新生儿重症监护病房（NICU）。在我们对一个以黑人为主、有公共保险、未接种疫苗的 COVID-19 阳性孕妇群体的研究中，我们发现与现有文献中广泛疫苗可用之前报告的比率相比，妊娠高血压疾病、早产和 NICU 入院的比率较高。我们的研究结果表明，妊娠期间感染 SARS-CoV-2，无论母体疾病严重程度如何，都可能通过不成比例地影响黑人、有公共保险的患者，加剧现有的产科健康差异。需要更大规模的比较研究来更好地描述妊娠期间感染 SARS-CoV-2 时产科结局中可能存在的种族和社会经济差异。这些研究应检查妊娠期间 SARS-CoV-2 感染的病理生理学，以及不良围产期结局与获得护理、COVID-19 疫苗接种以及妊娠期间感染 SARS-CoV-2 的弱势群体中其他健康决定因素之间的潜在关联。
