妊娠期间COVID-19对产妇结局的影响及其与先兆子痫和妊娠糖尿病的关系已有报道;然而,详细了解产妇积极性的影响,交货方式,和围产期做法对胎儿和新生儿的结局是迫切需要的。
评估COVID-19对胎儿和新生儿结局的影响以及分娩方式的作用,母乳喂养,和早期新生儿护理实践对母婴传播风险的影响。
在这项于2020年3月至2021年3月进行的队列研究中,涉及18个国家的43个机构,2无与伦比,连续的,未暴露的妇女在每个被感染的妇女被确认后立即同时登记,在怀孕或分娩的任何阶段,并在同样的水平上小心,以尽量减少偏见。对妇女和新生儿进行随访直至出院。妊娠COVID-19由实验室确认和/或放射学肺部检查结果或≥2种预定义的COVID-19症状确定。结局指标是新生儿和围产期发病率和死亡率的指标,新生儿阳性及其与分娩方式的相关性,母乳喂养,和医院新生儿护理实践。
共纳入586例诊断为COVID-19的女性所生新生儿和1535例未诊断为COVID-19的女性所生新生儿。诊断为COVID-19的女性剖宫产率更高(52.8%vs无COVID-19诊断的38.5%,P<0.01)和妊娠相关并发症,如妊娠高血压疾病和胎儿窘迫(均P<.001),没有COVID-19诊断的女性。产妇诊断COVID-19的早产率增加(P≤.001),新生儿体重降低(P≤.001),长度,出生时的头围。在患有COVID-19诊断的母亲中,子宫内暴露的长度与新生儿测试阳性的风险显着相关(比值比,4.5;95%置信区间,子宫内暴露时间>14天的2.2-9.4)。在患有COVID-19诊断的母亲所生的新生儿中,通过剖宫产分娩是COVID-19检测呈阳性的危险因素(比值比,2.4;95%置信区间,1.2-4.7),即使考虑了产妇状况的严重程度,并且经过多变量逻辑分析。在诊断为COVID-19的女性所生的新生儿亚组中,当新生儿也测试呈阳性时,结果恶化,随着新生儿重症监护室入院率的提高,发烧,胃肠道和呼吸道症状,和死亡,即使在调整了早产之后。患有COVID-19诊断和医院新生儿护理实践的母亲母乳喂养,包括立即的皮肤接触和房间,与新生儿阳性风险增加无关。
在这项跨国队列研究中,妊娠期间COVID-19与孕产妇和新生儿并发症增加有关。剖宫产与新生儿COVID-19诊断显著相关。如果产科和健康状况允许,阴道分娩应被视为最安全的分娩方式。母亲对孩子的皮肤接触,入住,和直接母乳喂养不是新生儿COVID-19诊断的危险因素,因此,在诊断为COVID-19的女性中,可以继续采用既定的最佳做法。
The effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed.
To evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission.
In this cohort
study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices.
A total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2-9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity.
In this multinational cohort
study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.