University of Maryland School of Medicine, Baltimore, MD (Mses DuBose and Tembunde).
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris).
Am J Obstet Gynecol MFM. 2023 Oct;5(10):101077. doi: 10.1016/j.ajogmf.2023.101077. Epub 2023 Jul 1.
Among pregnant people, COVID-19 can lead to adverse outcomes, but the specific pregnancy outcomes that are affected by the disease are unclear. In addition, the effect of the severity of COVID-19 on pregnancy outcomes has not been clearly identified.
This study aimed to evaluate the associations between COVID-19 with and without viral pneumonia and cesarean delivery, preterm delivery, preeclampsia, and stillbirth.
We conducted a retrospective cohort study (April 2020-May 2021) of deliveries between 20 and 42 weeks of gestation from US hospitals in the Premier Healthcare Database. The primary outcomes were cesarean delivery, preterm delivery, preeclampsia, and stillbirth. We used a viral pneumonia diagnosis (International Classification of Diseases -Tenth-Clinical Modification codes J12.8 and J12.9) to categorize patients by severity of COVID-19. Pregnancies were categorized into 3 groups: NOCOVID (no COVID-19), COVID (COVID-19 without viral pneumonia), and PNA (COVID-19 with viral pneumonia). Groups were balanced for risk factors by propensity-score matching.
A total of 814,649 deliveries from 853 US hospitals were included (NOCOVID: n=799,132; COVID: n=14,744; PNA: n=773). After propensity-score matching, the risks of cesarean delivery and preeclampsia were similar in the COVID group compared with the NOCOVID group (matched risk ratio, 0.97; 95% confidence interval, 0.94-1.00; and matched risk ratio, 1.02; 95% confidence interval, 0.96-1.07; respectively). The risks of preterm delivery and stillbirth were greater in the COVID group than in the NOCOVID group (matched risk ratio, 1.11; 95% confidence interval, 1.05-1.19; and matched risk ratio, 1.30; 95% confidence interval, 1.01-1.66; respectively). The risks of cesarean delivery, preeclampsia, and preterm delivery were higher in the PNA group than in the COVID group (matched risk ratio, 1.76; 95% confidence interval, 1.53-2.03; matched risk ratio, 1.37; 95% confidence interval, 1.08-1.74; and matched risk ratio, 3.33; 95% confidence interval, 2.56-4.33; respectively). The risk of stillbirth was similar in the PNA and COVID group (matched risk ratio, 1.17; 95% confidence interval, 0.40-3.44).
Within a large national cohort of hospitalized pregnant people, we found that the risk of some adverse delivery outcomes was elevated in people with COVID-19 with and without viral pneumonia, with much higher risks in the group with viral pneumonia.
在孕妇中，COVID-19 可导致不良结局，但具体受疾病影响的妊娠结局尚不清楚。此外，COVID-19 严重程度对妊娠结局的影响也尚未明确。
本研究旨在评估 COVID-19 伴或不伴病毒性肺炎与剖宫产、早产、子痫前期和死胎之间的关联。
我们进行了一项回顾性队列研究（2020 年 4 月至 2021 年 5 月），纳入了美国 Premier Healthcare Database 中 20 周至 42 周妊娠期分娩的数据。主要结局为剖宫产、早产、子痫前期和死胎。我们使用病毒性肺炎诊断（国际疾病分类第十次临床修订版代码 J12.8 和 J12.9）对患者进行严重程度分类。妊娠分为 3 组：NOCOVID（无 COVID-19）、COVID（COVID-19 无病毒性肺炎）和 PNA（COVID-19 伴病毒性肺炎）。通过倾向评分匹配使各组在危险因素方面平衡。
共纳入 853 家美国医院的 814649 例分娩（NOCOVID：n=799132；COVID：n=14744；PNA：n=773）。在进行倾向评分匹配后，COVID 组与 NOCOVID 组的剖宫产和子痫前期风险相似（匹配风险比，0.97；95%置信区间，0.94-1.00；和匹配风险比，1.02；95%置信区间，0.96-1.07）。COVID 组早产和死胎的风险高于 NOCOVID 组（匹配风险比，1.11；95%置信区间，1.05-1.19；和匹配风险比，1.30；95%置信区间，1.01-1.66）。PNA 组的剖宫产、子痫前期和早产风险高于 COVID 组（匹配风险比，1.76；95%置信区间，1.53-2.03；匹配风险比，1.37；95%置信区间，1.08-1.74；和匹配风险比，3.33；95%置信区间，2.56-4.33）。PNA 组和 COVID 组的死胎风险相似（匹配风险比，1.17；95%置信区间，0.40-3.44）。
在一项针对住院孕妇的大型全国队列研究中，我们发现 COVID-19 伴或不伴病毒性肺炎患者的一些不良分娩结局风险升高，其中病毒性肺炎组的风险更高。
