Abstract：
The aim of this study is to review the currently available data, and to explore the association of infection with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants during pregnancy with maternal and perinatal outcomes in the real world. Observational cohort studies were analyzed that described the maternal and perinatal outcomes of infection with different SARS-CoV-2 variants during pregnancy. Random-effects inverse-variance models were used to evaluate the pooled prevalence (PP) and its 95% confidence interval (CI) for maternal and perinatal outcomes. Random effects were used to estimate the pooled odds ratios (OR) and their 95% CI for different outcomes between Delta and pre-Delta periods, and between Omicron and Delta periods. Eighteen studies, involving a total of 133,058 cases of SARS-CoV-2 infection during pregnancy (99,567 cases of SARS-CoV-2 wild type or pre-variant infection and 33,494 cases of SARS-CoV-2 variant infections), were included in this meta-analysis. Among pregnant women with SARS-CoV-2 infections, the PPs for required respiratory support, severe or critical illness, intensive care unit (ICU) admission, maternal death, and preterm birth <37 weeks were, respectively, 27.24% (95%CI, 20.51−33.97%), 24.96% (95%CI, 15.96−33.96%), 11.31% (95%CI, 4.00−18.61%), 4.20% (95%CI, 1.43−6.97%), and 33.85% (95%CI, 21.54−46.17%) in the Delta period, which were higher than those in the pre-Delta period, while the corresponding PPs were, respectively, 10.74% (95%CI, 6.05−15.46%), 11.99% (95%CI, 6.23−17.74%), 4.17% (95%CI, 1.53−6.80%), 0.63% (95%CI, 0.05−1.20%), and 18.58% (95%CI, 9.52−27.65%). The PPs for required respiratory support, severe or critical illness, and ICU admission were, respectively, 2.63% (95%CI, 0.98−4.28%), 1.11% (95%CI, 0.29−1.94%), and 1.83% (95%CI, 0.85−2.81%) in the Omicron period, which were lower than those in the pre-Delta and Delta periods. These results suggest that Omicron infections are associated with less severe maternal and neonatal adverse outcomes, though maternal ICU admission, the need for respiratory support, and preterm birth did also occur with Omicron infections. Since Omicron is currently the predominant strain globally, and has the highest rates of transmission, it is still important to remain vigilant in protecting the vulnerable populations of mothers and infants. In particular, obstetricians and gynecologists should not ignore the adverse risks of maternal ICU admission, respiratory support, and preterm births in pregnant patients with SARS-CoV-2 infections, in order to protect the health of mothers and infants.
摘要：
这项研究的目的是回顾目前可用的数据，并探讨妊娠期间感染不同严重急性呼吸道综合征冠状病毒2(SARS-CoV-2)变异与孕妇和围产期结局的关系。分析了观察性队列研究，描述了怀孕期间感染不同SARS-CoV-2变体的孕产妇和围产期结局。随机效应逆方差模型用于评估孕产妇和围产期结局的合并患病率（PP）及其95％置信区间（CI）。随机效应用于估计Delta和Delta前时期之间不同结果的合并优势比（OR）及其95％CI，在Omicron和Delta周期之间。18项研究,涉及妊娠期SARS-CoV-2感染共133,058例(SARS-CoV-2野生型或前变异型感染99,567例,SARS-CoV-2变异型感染33,494例),纳入本荟萃分析。在感染SARS-CoV-2的孕妇中，所需呼吸支持的PPs，严重或危重的疾病，重症监护病房(ICU)入院,产妇死亡,和早产<37周，分别,27.24%（95CI，20.51-33.97%），24.96%（95CI，15.96-33.96%），11.31%（95CI，4.00-18.61%），4.20%（95CI，1.43-6.97%），和33.85%（95CI，21.54-46.17%）在三角洲时期，高于三角洲前时期的水平，而相应的PP是，分别,10.74%（95CI，6.05-15.46%），11.99%（95CI，6.23-17.74%），4.17%（95CI，1.53-6.80%），0.63%（95CI，0.05-1.20%），和18.58%（95CI，9.52-27.65%）。所需呼吸支持的PP，严重或危重的疾病，进了ICU，分别,2.63%（95CI，0.98-4.28%），1.11%（95CI，0.29-1.94%），奥米周期为1.83%(95CI，0.85-2.81%)，低于三角洲前和三角洲时期的水平。这些结果表明，Omicron感染与较不严重的孕产妇和新生儿不良结局有关，虽然产妇入住ICU,需要呼吸支持，早产也发生在Omicron感染中。由于Omicron目前是全球主要菌株，并且具有最高的传输速率，在保护母亲和婴儿的弱势群体方面保持警惕仍然很重要。特别是,妇产科医生不应忽视孕产妇入住ICU的不良风险,呼吸支持,和妊娠合并SARS-CoV-2感染患者的早产，为了保护母亲和婴儿的健康。
