背景:关于严重急性呼吸道综合征冠状病毒2(SARS-CoV-2)感染和妊娠结局的现有数据主要是指妇女在妊娠晚期或接近分娩时感染感染。关于妊娠早期SARS-CoV-2感染与其结果之间的关联的信息有限。
方法:我们旨在系统地回顾产妇,妊娠早期SARS-CoV-2感染后的胎儿和新生儿结局,定义为<20周妊娠(PROSPERO注册2020CRD42020177673)。在PubMed中进行了搜索,Medline,EMBASE,2020年1月至2023年4月的Scopus数据库和2019年12月至2023年4月的WHO2019年冠状病毒病出版物数据库(COVID-19)。关于妊娠早期COVID-19的队列和病例对照研究报告了孕产妇数据,胎儿,并纳入新生儿结局.病例报告和研究报告仅暴露于SARS-CoV-2或未根据胎龄分层结局被排除。数据一式两份提取。在适当的时候进行荟萃分析,使用R元(R版本4.0.5)。
结果:共18项研究,12个回顾性和6个前瞻性,包括在这篇评论中,报告了10147名在怀孕早期感染SARS-CoV-2阳性妇女,9533名新生儿,和180882名SARS-CoV-2阴性女性。根据纽卡斯尔-渥太华质量评估量表,这些研究具有低到中度的偏倚风险。研究显示出显著的临床和方法学异质性。只能对结果流产率进行荟萃分析,合并随机效应比值比为1.44(95%置信区间0.96-2.18),在感染SARS-CoV-2的妇女中,流产没有统计学差异。个别研究报告死产发生率增加,妊娠早期受COVID-19影响的母亲所生的新生儿低出生体重和早产;然而,这些结果在所有研究中并不一致.
结论:在对现有证据的全面系统评价中,我们发现妊娠早期(妊娠20周前)SARS-CoV-2感染与胎儿之间没有统计学上显著的不良关联,新生儿,或产妇结局。然而,有44%的流产率增加令人担忧,需要更多样本量的进一步研究来证实或反驳我们的发现.
BACKGROUND: Available data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and pregnancy outcomes mostly refer to women contracting the infection during advanced pregnancy or close to delivery. There is limited information on the association between SARS-CoV-2 infection in early pregnancy and outcomes thereof.
METHODS: We aimed to systematically review the maternal, fetal and neonatal outcomes following SARS-CoV-2 infection in early pregnancy, defined as <20 weeks of gestation (PROSPERO Registration 2020 CRD42020177673). Searches were carried out in PubMed, Medline, EMBASE, and Scopus databases from January 2020 until April 2023 and the WHO database of publications on coronavirus disease 2019 (COVID-19) from December 2019 to April 2023. Cohort and case-control studies on COVID-19 occurring in early pregnancy that reported data on maternal, fetal, and neonatal outcomes were included. Case reports and studies reporting only exposure to SARS-CoV-2 or not stratifying outcomes based on gestational age were excluded. Data were extracted in duplicate. Meta-analyses were conducted when appropriate, using R meta (R version 4.0.5).
RESULTS: A total of 18 studies, 12 retrospective and six prospective, were included in this review, reporting on 10 147 SARS-CoV-2-positive women infected in early pregnancy, 9533 neonates, and 180 882 SARS-CoV-2 negative women. The studies had low to moderate risk of bias according to the Newcastle-Ottawa quality assessment Scale. The studies showed significant clinical and methodological heterogeneity. A meta-analysis could be performed only on the outcome miscarriage rate, with a pooled random effect odds ratio of 1.44 (95% confidence interval 0.96-2.18), showing no statistical difference in miscarriage in SARS-CoV-2-infected women. Individual studies reported increased incidences of stillbirth, low birthweight and preterm birth among neonates born to mothers affected by COVID-19 in early pregnancy; however, these results were not consistent among all studies.
CONCLUSIONS: In this comprehensive systematic review of available evidence, we identified no statistically significant adverse association between SARS-CoV-2 infection in early pregnancy (before 20 weeks of gestation) and fetal, neonatal, or maternal outcomes. However, a 44% increase in miscarriage rate is concerning and further studies of larger sample size are needed to confirm or refute our findings.