2014年至2016年在西非爆发的埃博拉病毒病(EVD)破坏了当地的卫生系统,并造成数千人死亡。扎伊尔埃博拉病毒暴发的历史报告表明,怀孕与严重疾病和死亡风险增加有关。死亡率从74%到100%。总的来说,文献报道了111例妊娠合并EVD患者,孕产妇总死亡率为86%。最近爆发的妊娠特定数据包括四项小型描述性队列研究和五项病例报告。尽管存在报告偏差和样本量小等限制,这些研究表明,孕妇的死亡率可能低于以前的报道,13名受感染妇女中有5人(39%)死亡。孕妇的最佳治疗方法,孕妇和非孕妇之间的EVD病程差异,是尚未系统地解决的重大科学差距。埃博拉病毒可能在子宫内从母亲传播给婴儿,在交付期间,或在出生后接触母体体液,包括母乳。EVD对发育中的胎儿几乎普遍致命,和有限的胎儿尸检数据阻止了对出生缺陷风险的推断。有关分娩方式和其他产科干预措施的决定应个体化。世卫组织建议密切监测后来怀孕的幸存者,但不建议在后续交付时加强预防措施。尽管埃博拉病毒的性传播已被记录在案,幸存者的分娩结局尚未公布,这对于就妊娠结局向妇女提供适当的咨询,以及为医疗服务提供者提供分娩预防措施非常重要.出生缺陷研究109:353-362,2017.©2017Wiley期刊,Inc.
The 2014 to 2016 Ebola virus disease (EVD) outbreak in West Africa devastated local health systems and caused thousands of deaths. Historical reports from Zaire ebolavirus outbreaks suggested pregnancy was associated with an increased risk of severe illness and death, with mortality rates from 74 to 100%. In total, 111 cases of pregnant patients with EVD are reported in the literature, with an aggregate maternal mortality of 86%. Pregnancy-specific data published from the recent outbreak include four small descriptive cohort studies and five case reports. Despite limitations including reporting bias and small sample size, these studies suggest mortality in pregnant women may be lower than previously reported, with five of 13 (39%) infected women dying. Optimal treatments for pregnant women, and differences in EVD course between pregnant women and nonpregnant individuals, are major scientific gaps that have not yet been systematically addressed. Ebola virus may be transmitted from mother to baby in utero, during delivery, or through contact with maternal body fluids after birth including breast milk. EVD is almost universally fatal to the developing fetus, and limited fetal autopsy data prevent inferences on risk of birth defects. Decisions about delivery mode and other obstetric interventions should be individualized. WHO recommends close monitoring of survivors who later become pregnant, but does not recommend enhanced precautions at subsequent delivery. Although sexual transmission of Ebola virus has been documented, birth outcomes among survivors have not been published and will be important to appropriately counsel women on pregnancy outcomes and inform delivery precautions for healthcare providers. Birth Defects Research 109:353-362, 2017. © 2017 Wiley Periodicals, Inc.