Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Department of Maternal-Fetal Medicine, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California.
Am J Perinatol. 2024 Nov;41(15):2109-2118. doi: 10.1055/a-2298-4826. Epub 2024 Apr 3.
Recent studies have reported associations between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy and adverse perinatal outcomes but the extent to which these associations vary by race/ethnicity remains uncertain. Therefore, we examined how the association between prenatal SARS-CoV-2 infection and adverse perinatal outcomes may be modified by race/ethnicity.
A retrospective cohort study was performed using data on 67,986 pregnant women extracted from the Kaiser Permanente Southern California electronic health records between April 6, 2020, and December 31, 2021. Upon admission to labor and delivery, all women were routinely tested for coronavirus disease 2019 (COVID-19) using real-time reverse-transcriptase polymerase chain reaction test. Adjusted odds ratios (aORs) were used to estimate associations.
During the study period, COVID-19 was diagnosed in 4,960 (7%) of singleton pregnancies, with the highest rates observed among Hispanics (9.4%) and non-Hispanic Blacks (6.2%). Compared with non-Hispanic Whites, Hispanics (aOR: 1.12, 95% CI: 1.03, 1.21) with SARS-CoV-2 infection had the highest odds of a pregnancy associated with nonreassuring fetal heart rate tracing. Neonates of all races/ethnicities, except for non-Hispanic Blacks, showed significantly increased odds of SARS-CoV-2 infection, with the highest risk observed among Asians/Pacific Islanders (aOR: 10.88, 95% CI: 1.33, 89.04). Non-Hispanic White mothers who tested positive were admitted to intensive care unit (ICU) at a higher rate at delivery and within 7 days of delivery (aOR: 34.77, 95% CI: 11.3, 107.04; aOR: 26.48, 95% CI: 9.55, 73.46, respectively). Hispanics were also at a significantly higher odds of admission to ICU (aOR: 4.62, 95% CI: 2.69, 7.94; aOR: 4.42, 95% CI: 2.58, 7.56, respectively). Non-Hispanic Black, Hispanic, and Asian/Pacific Islander mothers who tested positive for SARS-CoV-2 prenatally, were at increased risk for preeclampsia/eclampsia, and preterm birth as compared to non-Hispanic White mothers.
The findings highlight racial/ethnic disparities in the association between SARS-CoV-2 infection and adverse perinatal outcomes. The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders. We also observed a remarkably high risk of ICU admission for non-Hispanic White mothers infected with SARS-CoV-2.
· Race/ethnicity influences perinatal outcomes in pregnancies impacted by SARS-CoV-2.. · The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders.. · White mothers had a notably high risk of ICU admission at delivery following SARS-CoV-2 infection..
最近的研究报告了严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）在妊娠期间感染与围产期不良结局之间的关联，但这些关联在多大程度上因种族/民族而异仍不确定。因此，我们研究了产前 SARS-CoV-2 感染与不良围产期结局之间的关联可能会因种族/民族而发生怎样的变化。
使用 2020 年 4 月 6 日至 2021 年 12 月 31 日从凯撒永久南加州电子健康记录中提取的 67986 名孕妇的数据，进行了一项回顾性队列研究。所有女性在分娩时都常规接受实时逆转录聚合酶链反应（RT-PCR）检测冠状病毒病 2019（COVID-19）。使用调整后的优势比（aOR）来估计关联。
在研究期间，67986 名单胎妊娠中诊断出 4960 例（7%）COVID-19，其中西班牙裔（9.4%）和非西班牙裔黑人（6.2%）的发病率最高。与非西班牙裔白人相比，感染 SARS-CoV-2 的西班牙裔（aOR：1.12，95%CI：1.03，1.21）最有可能出现与胎儿心率描记不令人满意相关的妊娠。所有种族/民族的新生儿，除了非西班牙裔黑人外，感染 SARS-CoV-2 的几率均显著增加，其中亚洲/太平洋岛民的风险最高（aOR：10.88，95%CI：1.33，89.04）。检测呈阳性的非西班牙裔白人母亲在分娩时和分娩后 7 天内更有可能入住重症监护病房（ICU）（aOR：34.77，95%CI：11.3，107.04；aOR：26.48，95%CI：9.55，73.46）。西班牙裔也明显更有可能入住 ICU（aOR：4.62，95%CI：2.69，7.94；aOR：4.42，95%CI：2.58，7.56）。与非西班牙裔白人母亲相比，检测呈阳性的非西班牙裔黑人、西班牙裔和亚洲/太平洋岛民母亲患子痫前期/子痫和早产的风险增加。
研究结果强调了 SARS-CoV-2 感染与不良围产期结局之间的关联存在种族/民族差异。亚洲/太平洋岛民新生儿 SARS-CoV-2 感染的风险最高。我们还观察到，感染 SARS-CoV-2 的非西班牙裔白人母亲入住 ICU 的风险显著增加。
·种族/民族影响 SARS-CoV-2 感染妊娠的围产期结局。·亚洲/太平洋岛民新生儿 SARS-CoV-2 感染的风险最高。·感染 SARS-CoV-2 的非西班牙裔白人母亲在分娩时入住 ICU 的风险明显增加。
