Bruno Ann M, Zang Chengxi, Xu Zhengxing, Wang Fei, Weiner Mark G, Guthe Nick, Fitzgerald Megan, Kaushal Rainu, Carton Thomas W, Metz Torri D
Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA.
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
EClinicalMedicine. 2024 May 24;73:102654. doi: 10.1016/j.eclinm.2024.102654. eCollection 2024 Jul.
Little is known about post-acute sequelae of SARS-CoV-2 infection (PASC) after acquiring SARS-CoV-2 infection during pregnancy. We aimed to evaluate the association between acquiring SARS-CoV-2 during pregnancy compared with acquiring SARS-CoV-2 outside of pregnancy and the development of PASC.
This retrospective cohort study from the Researching COVID to Enhance Recovery (RECOVER) Initiative Patient-Centred Clinical Research Network (PCORnet) used electronic health record (EHR) data from 19 U.S. health systems. Females aged 18-49 years with lab-confirmed SARS-CoV-2 infection from March 2020 through June 2022 were included. Validated algorithms were used to identify pregnancies with a delivery at >20 weeks' gestation. The primary outcome was PASC, as previously defined by computable phenotype in the adult non-pregnant PCORnet EHR dataset, identified 30-180 days post-SARS-CoV-2 infection. Secondary outcomes were the 24 component diagnoses contributing to the PASC phenotype definition. Univariable comparisons were made for baseline characteristics between individuals with SARS-CoV-2 infection acquired during pregnancy compared with outside of pregnancy. Using inverse probability of treatment weighting to adjust for baseline differences, the association between SARS-CoV-2 infection acquired during pregnancy and the selected outcomes was modelled. The incident risk is reported as the adjusted hazard ratio (aHR) with 95% confidence intervals.
In total, 83,915 females with SARS-CoV-2 infection acquired outside of pregnancy and 5397 females with SARS-CoV-2 infection acquired during pregnancy were included in analysis. Non-pregnant females with SARS-CoV-2 infection were more likely to be older and have comorbid health conditions. SARS-CoV-2 infection acquired in pregnancy as compared with acquired outside of pregnancy was associated with a lower incidence of PASC (25.5% vs 33.9%; aHR 0.85, 95% CI 0.80-0.91). SARS-CoV-2 infection acquired in pregnant females was associated with increased risk for some PASC component diagnoses including abnormal heartbeat (aHR 1.67, 95% CI 1.43-1.94), abdominal pain (aHR 1.34, 95% CI 1.16-1.55), and thromboembolism (aHR 1.88, 95% CI 1.17-3.04), but decreased risk for other diagnoses including malaise (aHR 0.35, 95% CI 0.27-0.47), pharyngitis (aHR 0.36, 95% CI 0.26-0.48) and cognitive problems (aHR 0.39, 95% CI 0.27-0.56).
SARS-CoV-2 infection acquired during pregnancy was associated with lower risk of development of PASC at 30-180 days after incident SARS-CoV-2 infection in this nationally representative sample. These findings may be used to counsel pregnant and pregnant capable individuals, and direct future prospective study.
National Institutes of Health (NIH) Other Transaction Agreement (OTA) OT2HL16184.
关于孕期感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后的急性后遗症（PASC），人们了解甚少。我们旨在评估孕期感染SARS-CoV-2与非孕期感染SARS-CoV-2及PASC发生之间的关联。
这项来自“研究COVID以促进康复（RECOVER）倡议”患者中心临床研究网络（PCORnet）的回顾性队列研究，使用了来自美国19个医疗系统的电子健康记录（EHR）数据。纳入了2020年3月至2022年6月期间实验室确诊SARS-CoV-2感染的18至49岁女性。使用经过验证的算法识别妊娠20周以上分娩的孕妇。主要结局是PASC，如成人非妊娠PCORnet EHR数据集中先前通过可计算表型定义的，在SARS-CoV-2感染后30至180天确定。次要结局是构成PASC表型定义的24项组成诊断。对孕期感染SARS-CoV-2的个体与非孕期感染SARS-CoV-2的个体的基线特征进行单变量比较。使用治疗权重逆概率来调整基线差异，对孕期感染SARS-CoV-2与选定结局之间的关联进行建模。将发病风险报告为调整后的风险比（aHR）及95%置信区间。
总共83915例非孕期感染SARS-CoV-2的女性和5397例孕期感染SARS-CoV-2的女性纳入分析。非孕期感染SARS-CoV-2的女性更可能年龄较大且有合并健康问题。与非孕期感染相比，孕期感染SARS-CoV-2与PASC发生率较低相关（25.5%对33.9%；aHR 0.85，95%CI 0.80 - 0.91）。孕期感染SARS-CoV-2的女性与某些PASC组成诊断的风险增加相关，包括心跳异常（aHR 1.67，95%CI 1.43 - 1.94）、腹痛（aHR 1.34，95%CI 1.16 - 1.55）和血栓栓塞（aHR 1.88，95%CI 1.17 - 3.04），但与其他诊断的风险降低相关，包括不适（aHR 0.35，95%CI 0.27 - （此处原文有误，应为0.47））、咽炎（aHR 0.36，95%CI 0.26 - 0.48）和认知问题（aHR 0.39，95%CI 0.27 - 0.56）。
在这个具有全国代表性的样本中，孕期感染SARS-CoV-2与SARS-CoV-2感染后30至180天发生PASC的风险较低相关。这些发现可用于为孕妇和有怀孕能力的个体提供咨询，并指导未来的前瞻性研究。
美国国立卫生研究院（NIH）其他交易协议（OTA）OT2HL16184。
