尽管妊娠期间与SARS-CoV-2感染相关的严重疾病和不良妊娠结局的风险增加已得到充分描述,感染与严重孕产妇发病率之间的关系尚未得到很好的表征.
本研究旨在评估妊娠期间与SARS-CoV-2感染相关的严重孕产妇发病风险。
这是一项多中心回顾性队列研究,对所有在2020年3月1日至2021年3月1日期间在纽约卫生系统进行SARS-CoV-2测试并分娩的怀孕患者进行了研究。排除检测结果缺失的患者。严重孕产妇发病率的主要结果,来自美国妇产科医师学会和母胎医学学会的诊断和并发症的例子清单,在以下两组之间进行了比较:在怀孕期间SARS-CoV-2检测阳性的患者和检测阴性的患者。次要结局包括严重产妇发病率亚组。多变量逻辑回归被用来调整潜在的混杂因素,如产妇人口统计学,邻里社会经济地位,医院位置,和妊娠相关并发症。进行了亚分析,以确定严重产科出血和高血压相关或神经系统发病率的风险是否根据SARS-CoV-2感染的时间而有所不同,在分娩住院时SARS-CoV-2检测呈阳性的人之间(即,活动性感染)和那些在怀孕期间测试为阳性但在分娩住院时测试为阴性的人(即,已解决的感染)。
在22,483名患者中,1653(7.4%)的SARS-CoV-2感染呈阳性。SARS-CoV-2感染的患者更常见的是黑人,多种族,西班牙裔,非英语,使用医疗补助保险,是多胎的,来自社会经济地位较低的社区。与未感染的患者相比,SARS-CoV-2感染的患者发生严重孕产妇发病率的风险增加(9.3vs6.5%;调整后的比值比,1.52;95%置信区间,1.21-1.88)。SARS-CoV-2感染的患者发生严重产科出血的风险也增加(1.1%vs0.5%;调整后的比值比,1.78;95%置信区间,1.04-2.88),肺部发病率(2.0%vs0.5%;调整后比值比,3.90;95%置信区间,2.52-5.89),和重症监护病房入院(1.8%对0.5%;调整后的赔率比,3.29;95%置信区间,2.09-5.04)与没有感染的人相比。两组之间高血压相关或神经系统疾病的风险相似。与没有感染的人相比,SARS-CoV-2感染的时间(无论是在分娩时活跃还是缓解)与严重产科出血或高血压相关或神经系统疾病的风险无关。
妊娠期间SARS-CoV-2感染与严重孕产妇发病率的风险增加有关。严重的产科出血,肺发病率,和重症监护室入院。这些数据强调了在照顾SARS-CoV-2感染患者时需要产科准备,持续的公共卫生努力旨在将感染风险降至最低,并支持将这一选定人群纳入研究性治疗和疫苗试验。
Although the increased risk for severe illness and adverse pregnancy outcomes associated with SARS-CoV-2 infection during pregnancy is well described, the association of infection with severe maternal morbidity has not been well characterized.
This study aimed to evaluate the risk for severe maternal morbidity associated with SARS-CoV-2 infection during pregnancy.
This was a multicenter retrospective cohort study of all pregnant patients who had a SARS-CoV-2 test done and who delivered in a New York health system between March 1, 2020 and March 1, 2021. Patients with missing test results were excluded. The primary outcome of severe maternal morbidity, derived from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine example list of diagnoses and complications, was compared between the following 2 groups: patients who tested positive for SARS-CoV-2 during pregnancy and patients who tested negative. Secondary outcomes included subgroups of severe maternal morbidity. Multivariable logistic regression was used to adjust for potential confounders such as maternal demographics, neighborhood socioeconomic status, hospital location, and pregnancy-related complications. A subanalysis was performed to determine if the risk for severe obstetrical hemorrhage and hypertension-associated or neurologic morbidity differed based on the timing of SARS-CoV-2 infection between those who tested positive for SARS-CoV-2 at their delivery hospitalization (ie, active infection) and those who tested positive during pregnancy but negative at their delivery hospitalization (ie, resolved infection).
Of the 22,483 patients included, 1653 (7.4%) tested positive for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were more commonly Black, multiracial, Hispanic, non-English speaking, used Medicaid insurance, were multiparous, and from neighborhoods with a lower socioeconomic status. Patients with SARS-CoV-2 infection were at an increased risk for severe maternal morbidity when compared with those without infection (9.3 vs 6.5%; adjusted odds ratio, 1.52; 95% confidence interval, 1.21-1.88). Patients with SARS-CoV-2 infection were also at an increased risk for severe obstetrical hemorrhage (1.1% vs 0.5%; adjusted odds ratio, 1.78; 95% confidence interval, 1.04-2.88), pulmonary morbidity (2.0% vs 0.5%; adjusted odds ratio, 3.90; 95% confidence interval, 2.52-5.89), and intensive care unit admission (1.8% vs 0.5%; adjusted odds ratio, 3.29; 95% confidence interval, 2.09-5.04) when compared with those without infection. The risk for hypertension-associated or neurologic morbidity was similar between the 2 groups. The timing of SARS-CoV-2 infection (whether active or resolved at time of delivery) was not associated with the risk for severe obstetrical hemorrhage or hypertension-associated or neurologic morbidity when compared with those without infection.
SARS-CoV-2 infection during pregnancy was associated with an increased risk for severe maternal morbidity, severe obstetrical hemorrhage, pulmonary morbidity, and intensive care unit admission. These data highlight the need for obstetrical unit preparedness in caring for patients with SARS-CoV-2 infection, continued public health efforts aimed at minimizing the risk for infection, and support in including this select population in investigational therapy and vaccine trials.