在新冠母婴结局（COMBO）队列中，孕产妇感染新冠病毒的孕期对新生儿大小有不同的预测作用。

Trimester of maternal SARS-CoV-2 infection differentially predicts newborn size in the COVID-19 Mother Baby Outcomes (COMBO) cohort.

作者信息

Kyle Margaret H, Nichols Presley, Coskun Lerzan, Fifer William, Finch Amara, Firestein Morgan R, Gallagher Dympna, Gyamfi-Bannerman Cynthia, Marsh Rachel, Mollicone Isabelle, Monk Catherine, Mourad Mirella, Baidal Jennifer Woo, Oberfield Sharon, Stockwell Melissa S, Fennoy Ilene, Dumitriu Dani

机构信息

Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, USA.

Division of Developmental Neuroscience, Department of Psychiatry, Columbia University Irving Medical Center, New York, USA.

出版信息

Pediatr Res. 2025 May 31. doi: 10.1038/s41390-025-03909-1.

DOI:10.1038/s41390-025-03909-1

PMID:40450140

Abstract

BACKGROUND

In-utero exposures affect the developing fetus differentially and may manifest as growth and body size differences. We examined associations between maternal SARS-CoV-2 infection and newborn body size at a large medical center in New York City.

METHODS

Between 3/22/2020 and 10/31/2020, birth outcomes for 544 newborns exposed to SARS-CoV-2 in utero and 3325 unexposed newborns were collected through retrospective chart review as part of the COVID-19 Mother Baby Outcomes (COMBO) Initiative. Data were also abstracted for 560 newborns born in February 2020 as a pre-pandemic comparison group. Growth outcomes at 6-10 weeks of life were available for a subset of 865 newborns followed in our hospital system.

RESULTS

Newborns exposed to SARS-CoV-2 during the first trimester had significantly smaller birth weight, length, head circumference (HC) and earlier gestational age (GA) at birth than unexposed or second-to-third trimester exposed newborns. Mediation analysis found that GA mediated the relationship between first trimester SARS-CoV-2 exposure and body size at birth.

CONCLUSION

Maternal SARS-CoV-2 infection during the first trimester is associated with smaller body size at birth and this association is largely mediated by earlier GA. Size differences at birth can predict later adverse cardiometabolic and neurodevelopmental outcomes, warranting prospective analysis in this cohort.

IMPACT

Using data obtained through universal SARS-CoV-2 testing at a large, urban medical center, maternal SARS-CoV-2 infection during pregnancy was associated with newborn size. Previous literature shows that SARS-CoV-2 does not tend to cause severe respiratory disease in infants and that vertical transmission to the fetus is unlikely. However, maternal SARS-CoV-2 infection during pregnancy is associated with increased occurrence of pre-term delivery. This study contributes to the literature by showing that timing of maternal SARS-CoV-2 infection, specifically during the first trimester of pregnancy, predicts smaller newborn body size and that this relationship is mediated by earlier gestational age (GA) at birth.

摘要

背景

子宫内暴露对发育中的胎儿有不同影响，可能表现为生长和体型差异。我们在纽约市的一家大型医疗中心研究了孕产妇感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）与新生儿体型之间的关联。

方法

作为2019冠状病毒病母婴结局（COMBO）倡议的一部分，通过回顾性病历审查收集了2020年3月22日至2020年10月31日期间544例子宫内暴露于SARS-CoV-2的新生儿和3325例未暴露新生儿的出生结局。还提取了2020年2月出生的560例新生儿的数据作为疫情前的对照组。在我们的医院系统中，对865例新生儿的亚组进行了6至10周龄时的生长结局评估。

结果

与未暴露或在孕中期至晚期暴露的新生儿相比，在孕早期暴露于SARS-CoV-2的新生儿出生体重、身长、头围（HC）显著更小，出生时孕周更早。中介分析发现孕周介导了孕早期SARS-CoV-2暴露与出生时体型之间的关系。

结论

孕早期孕产妇感染SARS-CoV-2与出生时体型较小有关，这种关联很大程度上由更早的孕周介导。出生时的体型差异可预测后期不良的心脏代谢和神经发育结局，因此有必要对该队列进行前瞻性分析。

影响

利用在一家大型城市医疗中心通过普遍的SARS-CoV-2检测获得的数据，孕期孕产妇感染SARS-CoV-2与新生儿体型有关。先前的文献表明，SARS-CoV-2不太可能导致婴儿严重呼吸道疾病，也不太可能垂直传播给胎儿。然而，孕期孕产妇感染SARS-CoV-2与早产发生率增加有关。本研究通过表明孕产妇感染SARS-CoV-2的时间，特别是在妊娠早期，可预测新生儿体型较小，且这种关系由出生时更早的孕周介导，为该文献做出了贡献。