JAMA:新冠确实增加围产期不良事件风险
创作:Epi汪 审核:Epi汪 2022年02月18日
  • 纳入14104名孕产妇数据,其中2352名孕妇感染了新冠病毒,关注的主要结局是孕产妇死亡、妊娠期高血压疾病、产后出血及其他严重疾病;
  • 感染者女性发生主要结局的风险增高(13.4% vs 9.2%);
  • 共发生5例孕产妇死亡病例,均属于新冠阳性组;
  • 但感染组孕妇的剖宫产率并没有显著增加(34.7% vs 32.4%);
  • 进一步分析发现,新冠症状中等/严重的孕妇发生主要结局以及剖宫产的风险均增加,但轻症或无症状感染者发生这些结局的风险无统计学差异。
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Epi汪
新冠疫情流行的2年时间里,有多篇流行病学研究讨论了新冠病毒对孕妇妊娠结局的影响。近期,发表在《JAMA》上的一篇研究通过对1万余名孕产妇数据的分析,进一步明确了感染新冠病毒可能增加孕产妇不良妊娠结局的风险。
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JAMA [IF:157.335]

Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications

SARS-CoV-2感染与严重的孕产妇发病率和产科并发症死亡率的关系

10.1001/jama.2022.1190

2022-02-07, Article

Abstract & Authors:展开

Abstract:收起
Importance : It remains unknown whether SARS-CoV-2 infection specifically increases the risk of serious obstetric morbidity.
Objective : To evaluate the association of SARS-CoV-2 infection with serious maternal morbidity or mortality from common obstetric complications.
Design, Setting, and Participants : Retrospective cohort study of 14 104 pregnant and postpartum patients delivered between March 1, 2020, and December 31, 2020 (with final follow-up to February 11, 2021), at 17 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Gestational Research Assessments of COVID-19 (GRAVID) Study. All patients with SARS-CoV-2 were included and compared with those without a positive SARS-CoV-2 test result who delivered on randomly selected dates over the same period.
Exposures : SARS-CoV-2 infection was based on a positive nucleic acid or antigen test result. Secondary analyses further stratified those with SARS-CoV-2 infection by disease severity.
Main Outcomes and Measures: The primary outcome was a composite of maternal death or serious morbidity related to hypertensive disorders of pregnancy, postpartum hemorrhage, or infection other than SARS-CoV-2. The main secondary outcome was cesarean birth.
Results : Of the 14 104 included patients (mean age, 29.7 years), 2352 patients had SARS-CoV-2 infection and 11 752 did not have a positive SARS-CoV-2 test result. Compared with those without a positive SARS-CoV-2 test result, SARS-CoV-2 infection was significantly associated with the primary outcome (13.4% vs 9.2%; difference, 4.2% [95% CI, 2.8%-5.6%]; adjusted relative risk [aRR], 1.41 [95% CI, 1.23-1.61]). All 5 maternal deaths were in the SARS-CoV-2 group. SARS-CoV-2 infection was not significantly associated with cesarean birth (34.7% vs 32.4%; aRR, 1.05 [95% CI, 0.99-1.11]). Compared with those without a positive SARS-CoV-2 test result, moderate or higher COVID-19 severity (n = 586) was significantly associated with the primary outcome (26.1% vs 9.2%; difference, 16.9% [95% CI, 13.3%-20.4%]; aRR, 2.06 [95% CI, 1.73-2.46]) and the major secondary outcome of cesarean birth (45.4% vs 32.4%; difference, 12.8% [95% CI, 8.7%-16.8%]; aRR, 1.17 [95% CI, 1.07-1.28]), but mild or asymptomatic infection (n = 1766) was not significantly associated with the primary outcome (9.2% vs 9.2%; difference, 0% [95% CI, −1.4% to 1.4%]; aRR, 1.11 [95% CI, 0.94-1.32]) or cesarean birth (31.2% vs 32.4%; difference, −1.4% [95% CI, −3.6% to 0.8%]; aRR, 1.00 [95% CI, 0.93-1.07]).
Conclusions and Relevance: Among pregnant and postpartum individuals at 17 US hospitals, SARS-CoV-2 infection was associated with an increased risk for a composite outcome of maternal mortality or serious morbidity from obstetric complications.

First Authors:
Torri D Metz

Correspondence Authors:
Torri D Metz

All Authors:
Torri D Metz,Rebecca G Clifton,Brenna L Hughes,Grecio J Sandoval,William A Grobman,George R Saade,Tracy A Manuck,Monica Longo,Amber Sowles,Kelly Clark,Hyagriv N Simhan,Dwight J Rouse,Hector Mendez-Figueroa,Cynthia Gyamfi-Bannerman,Jennifer L Bailit,Maged M Costantine,Harish M Sehdev,Alan T N Tita,George A Macones,National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network

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