背景:在孕妇中,2019年冠状病毒病(COVID-19)可能导致不良后果,但是受该疾病影响的具体妊娠结局尚不清楚.此外,COVID-19严重程度对妊娠结局的影响尚未明确.
目的:评估COVID-19有无病毒性肺炎与剖宫产的关系,早产,先兆子痫,和死产。
方法:我们在PremierHealthcare数据库中对美国医院妊娠20至42周的分娩进行了回顾性队列研究(2020年4月至2021年5月)。主要结局是剖宫产,早产,先兆子痫,和死产。我们使用病毒性肺炎诊断(ICD-10-CM代码J12.8和J12.9)根据COVID-19的严重程度对患者进行分类。怀孕分为三组,NOCOVID:无COVID-19,COVID:COVID-19无病毒性肺炎,和PNA:COVID-19合并病毒性肺炎。通过倾向评分匹配来平衡各组的风险因素。
结果:纳入了853家美国医院的814,649例分娩(NOCOVID:n=799,132,COVID:n=14,744,PNA:n=773)。在倾向得分匹配后,与NOCOVID组相比,COVID组的剖宫产和先兆子痫风险相似(匹配风险比[mRR]0.97,95%置信区间[CI]0.94~1.00和mRR1.02,95%CI0.96~1.07).与NOCOVID组相比,COVID组早产和死产的风险更大(mRR分别为1.11,95%CI1.05-1.19和mRR1.30,95%CI1.01-1.66)。剖宫产的风险,先兆子痫,与COVID相比,PNA组的早产和早产更高(mRR分别为1.76,95%CI1.53-2.03,mRR1.37,95%CI1.08-1.74和mRR3.33,95%CI2.56-4.33)。PNA组和COVID的死产风险相似(mRR1.17,95%CI0.40-3.44)。
结论:在一个庞大的全国住院孕妇队列中,我们发现,在有或没有病毒性肺炎的COVID-19患者中,某些不良分娩结局的风险升高,病毒性肺炎的风险要高得多。
Among pregnant people, COVID-19 can lead to adverse outcomes, but the specific pregnancy outcomes that are affected by the disease are unclear. In addition, the effect of the severity of COVID-19 on pregnancy outcomes has not been clearly identified.
This study aimed to evaluate the associations between COVID-19 with and without viral pneumonia and cesarean delivery, preterm delivery, preeclampsia, and stillbirth.
We conducted a retrospective cohort study (April 2020-May 2021) of deliveries between 20 and 42 weeks of gestation from US hospitals in the Premier Healthcare Database. The primary outcomes were cesarean delivery, preterm delivery, preeclampsia, and stillbirth. We used a viral pneumonia diagnosis (International Classification of Diseases -Tenth-Clinical Modification codes J12.8 and J12.9) to categorize patients by severity of COVID-19. Pregnancies were categorized into 3 groups: NOCOVID (no COVID-19), COVID (COVID-19 without viral pneumonia), and PNA (COVID-19 with viral pneumonia). Groups were balanced for risk factors by propensity-score matching.
A total of 814,649 deliveries from 853 US hospitals were included (NOCOVID: n=799,132; COVID: n=14,744; PNA: n=773). After propensity-score matching, the risks of cesarean delivery and preeclampsia were similar in the COVID group compared with the NOCOVID group (matched risk ratio, 0.97; 95% confidence interval, 0.94-1.00; and matched risk ratio, 1.02; 95% confidence interval, 0.96-1.07; respectively). The risks of preterm delivery and stillbirth were greater in the COVID group than in the NOCOVID group (matched risk ratio, 1.11; 95% confidence interval, 1.05-1.19; and matched risk ratio, 1.30; 95% confidence interval, 1.01-1.66; respectively). The risks of cesarean delivery, preeclampsia, and preterm delivery were higher in the PNA group than in the COVID group (matched risk ratio, 1.76; 95% confidence interval, 1.53-2.03; matched risk ratio, 1.37; 95% confidence interval, 1.08-1.74; and matched risk ratio, 3.33; 95% confidence interval, 2.56-4.33; respectively). The risk of stillbirth was similar in the PNA and COVID group (matched risk ratio, 1.17; 95% confidence interval, 0.40-3.44).
Within a large national cohort of hospitalized pregnant people, we found that the risk of some adverse delivery outcomes was elevated in people with COVID-19 with and without viral pneumonia, with much higher risks in the group with viral pneumonia.