这个顺序,前瞻性荟萃分析(sPMA)旨在确定COVID-19孕妇和产后妇女的不良结局的危险因素,产妇发病率,新生儿死亡率和发病率,不良分娩结局。
从2020年3月开始,我们前瞻性地邀请研究研究者通过专业研究网络加入sPMA。
符合条件的研究包括在确定的集水区内招募至少25例连续妊娠COVID-19病例的研究。
我们纳入了21项参与研究的个体患者数据。数据质量进行了评估,并构建了风险因素和结果的协调变量。重复的案例被删除。使用两阶段荟萃分析,对具有和不具有每个风险因素的不良结局的绝对和相对风险进行比较的汇总估计。
我们收集了来自33个国家和地区的数据,包括21,977例妊娠或产后SARS-CoV-2感染病例。我们发现有合并症的女性(预先存在的糖尿病,高血压,心血管疾病)与没有COVID-19严重程度和妊娠健康结局(胎儿死亡,早产,低出生体重)。患有COVID-19和HIV的参与者进入ICU的可能性增加了1.74倍(95%CI:1.12,2.71)。怀孕前体重不足的孕妇进入ICU的风险更高(RR5.53,95%CI:2.27,13.44),通气(RR9.36,95%CI:3.87,22.63),和妊娠相关死亡(RR14.10,95%CI:2.83,70.36)。孕前肥胖也是严重COVID-19结局的危险因素,包括入住ICU(RR1.81,95%CI:1.26,2.60),通气(RR2.05,95%CI:1.20,3.51),任何重症监护(RR1.89,95%CI:1.28,2.77),和肺炎(RR1.66,95%CI:1.18,2.33)。患有COVID-19的贫血孕妇入住ICU的风险也增加(RR1.63,95%CI:1.25,2.11)和死亡的风险增加(RR2.36,95%CI:1.15,4.81)。
我们发现有糖尿病等合并症的孕妇,高血压,心血管疾病发生严重COVID-19相关结局的风险增加,产妇发病率,和不良分娩结局。我们还确定了几个不太常见的风险因素,包括HIV感染,孕前体重不足,和贫血。尽管孕妇已经被认为是高危人群,应特别优先预防和治疗有这些额外危险因素的孕妇。
This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes.
We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020.
Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area.
We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis.
We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12-2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27-13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87-22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83-70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26-2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20-3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28-2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18-2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25-2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15-4.81).
We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.