Funk Anna, Stephenson Nikki, McNeil Deborah A, Kuret Verena, Castillo Eliana, Parmar Radhmilla, Nerenberg Kara A, Teare Gary, Klein Kristin, Metcalfe Amy
Departments of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.
Paediatr Perinat Epidemiol. 2024 Sep;38(7):583-593. doi: 10.1111/ppe.13105. Epub 2024 Jul 25.
Results of population-level studies examining the effect of the COVID-19 pandemic on the risks of perinatal death have varied considerably.
To explore trends in the risk of perinatal death among pregnancies beginning prior to and during the pandemic using a pregnancy cohort approach.
This secondary analysis included data from singleton pregnancies ≥20 weeks' gestation in Alberta, Canada, beginning between 5 March 2017 and 4 March 2021. Perinatal death (i.e. stillbirth or neonatal death) was the primary outcome considered. The risk of this outcome was calculated for pregnancies with varying gestational overlap with the pandemic (i.e. none, 0-20 weeks, entire pregnancy). Interrupted time series analysis was used to further determine temporal trends in the outcome by time period of interest.
There were 190,853 pregnancies during the analysis period. Overall, the risk of perinatal death decreased with increasing levels of pandemic exposure; this outcome was experienced in 1.0% (95% confidence interval [CI] 0.9, 1.0), 0.9% (95% CI 0.8, 1.1) and 0.8% (95% CI 0.7, 0.9) of pregnancies with no overlap, partial overlap and complete pandemic overlap respectively. Pregnancies beginning during the pandemic that had high antepartum risk scores less frequently led to perinatal death compared to those beginning prior; 3.3% (95% CI 2.7, 3.9) versus 5.7% (95% CI 5.0, 6.5) respectively. Interrupted time-series analysis revealed a decreasing temporal trend in perinatal death for pregnancies beginning ≤40 weeks prior to the start of the COVID-19 pandemic (i.e. with pandemic exposure), with no trend for pregnancies beginning >40 weeks pre-pandemic (i.e. no pandemic exposure).
We observed a decrease in perinatal death for pregnancies overlapping with the COVID-19 pandemic in Alberta, particularly among those at high risk of these outcomes. Specific pandemic control measures and government response programmes in our setting may have contributed to this finding.
关于新冠疫情对围产期死亡风险影响的人群水平研究结果差异很大。
采用妊娠队列研究方法，探讨疫情之前及期间开始的妊娠中围产期死亡风险的趋势。
这项二次分析纳入了加拿大艾伯塔省2017年3月5日至2021年3月4日期间妊娠≥20周的单胎妊娠数据。围产期死亡（即死产或新生儿死亡）是主要研究结局。计算了与疫情有不同孕周重叠情况（即无重叠、0至20周重叠、整个孕期重叠）的妊娠发生该结局的风险。采用中断时间序列分析进一步确定感兴趣时间段内该结局的时间趋势。
分析期间共有190,853例妊娠。总体而言，围产期死亡风险随着疫情暴露程度的增加而降低；无重叠、部分重叠和完全重叠的妊娠中，该结局的发生率分别为1.0%（95%置信区间[CI]0.9, 1.0）、0.9%（95%CI 0.8, 1.1）和0.8%（95%CI 0.7, 0.9）。与疫情之前开始的妊娠相比，疫情期间开始且产前风险评分高的妊娠导致围产期死亡的情况较少见；分别为3.3%（95%CI 2.7, 3.9）和5.7%（95%CI 5.0, 6.5）。中断时间序列分析显示，在新冠疫情开始前≤40周开始的妊娠（即有疫情暴露）中，围产期死亡呈下降的时间趋势，而在疫情前>40周开始的妊娠（即无疫情暴露）中无此趋势。
我们观察到艾伯塔省与新冠疫情重叠的妊娠中围产期死亡有所减少，尤其是在那些发生这些结局风险高的妊娠中。我们地区的特定疫情防控措施和政府应对计划可能促成了这一结果。
