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妊娠期covid-19的临床表现、危险因素以及母婴围产期结局分析
作者:小柯机器人 发布时间:2020/9/8 21:25:07

英国伯明翰大学Shakila Thangaratinam团队分析了妊娠期covid-19的临床表现、危险因素和母婴围产期结局。2020年9月1日,该研究发表在《英国医学杂志》上。

为了确定疑似或确诊covid-19的孕妇和刚怀孕女性的临床表现、危险因素以及孕产妇和围产期结局,研究组进行了一项生活系统回顾和荟萃分析。

研究组在Medline、Embase、Cochrane数据库、世卫组织COVID-19数据库、中国知网(CNKI)、万方数据库、以及预印本服务器等大型数据库中检索2019年12月1日至2020年6月26日的文献,筛选出报告疑似或确诊covid-19的孕妇和新近怀孕女性的发病率、临床表现(症状、实验室和放射学表现)、危险因素以及孕产妇和围产期结局的队列研究。

研究组共纳入77项研究。总体而言,共有10%疑似或确诊covid-19的孕妇和新近怀孕女性住院治疗。妊娠期covid-19最常见的临床表现为发热(40%)和咳嗽(39%)。与未怀孕的育龄女性相比,患有covid-19的孕妇和新近怀孕女性发烧和肌痛的发生率较低,但被收入重症监护病房和进行有创通气的风险更高。

共有73名孕妇(0.1%)全因死亡。高龄产妇、高体重指数、慢性高血压以及糖尿病史均与孕期重症covid-19显著相关。先前存在的产科并发症是被收入重症监护室和有创通气的危险因素。covid-19孕妇的自发早产率为6%,显著高于未患covid-19的孕妇。与未患covid-19的母亲相比,covid-19母亲分娩的新生儿中有四分之一被送入新生儿病房,入院风险显著增加。

总之,与未怀孕的育龄女性相比,孕妇和新近怀孕女性不太可能出现与covid-19相关的发热和肌痛症状,但更可能需要接受重症监护治疗。先前存在的共病、高龄产妇和高体重指数似乎是导致重症covid-19的危险因素。covid-19孕妇的早产率高于未患病的孕妇。

附:英文原文

Title: Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

Author: John Allotey, Elena Stallings, Mercedes Bonet, Magnus Yap, Shaunak Chatterjee, Tania Kew, Luke Debenham, Anna Clavé Llavall, Anushka Dixit, Dengyi Zhou, Rishab Balaji, Siang Ing Lee, Xiu Qiu, Mingyang Yuan, Dyuti Coomar, Madelon van Wely, Elizabeth van Leeuwen, Elena Kostova, Heinke Kunst, Asma Khalil, Simon Tiberi, Vanessa Brizuela, Nathalie Broutet, Edna Kara, Caron Rahn Kim, Anna Thorson, Olufemi T Oladapo, Lynne Mofenson, Javier Zamora, Shakila Thangaratinam, for PregCOV- Living Systematic Review Consortium

Issue&Volume: 2020/09/01

Abstract:

Objective To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19).

Design Living systematic review and meta-analysis.

Data sources Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 26 June 2020, along with preprint servers, social media, and reference lists.

Study selection Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19.

Data extraction At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly.

Results 77 studies were included. Overall, 10% (95% confidence interval 7% to14%; 28 studies, 11432 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (39%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to report symptoms of fever (odds ratio 0.43, 95% confidence interval 0.22 to 0.85; I2=74%; 5 studies; 80521 women) and myalgia (0.48, 0.45 to 0.51; I2=0%; 3 studies; 80409 women) and were more likely to need admission to an intensive care unit (1.62, 1.33 to 1.96; I2=0%) and invasive ventilation (1.88, 1.36 to 2.60; I2=0%; 4 studies, 91606 women). 73 pregnant women (0.1%, 26 studies, 11580 women) with confirmed covid-19 died from any cause. Increased maternal age (1.78, 1.25 to 2.55; I2=9%; 4 studies; 1058 women), high body mass index (2.38, 1.67 to 3.39; I2=0%; 3 studies; 877 women), chronic hypertension (2.0, 1.14 to 3.48; I2=0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 1.31 to 4.80; I2=12%; 2 studies; 858 women) were associated with severe covid-19 in pregnancy. Pre-existing maternal comorbidity was a risk factor for admission to an intensive care unit (4.21, 1.06 to 16.72; I2=0%; 2 studies; 320 women) and invasive ventilation (4.48, 1.40 to 14.37; I2=0%; 2 studies; 313 women). Spontaneous preterm birth rate was 6% (95% confidence interval 3% to 9%; I2=55%; 10 studies; 870 women) in women with covid-19. The odds of any preterm birth (3.01, 95% confidence interval 1.16 to 7.85; I2=1%; 2 studies; 339 women) was high in pregnant women with covid-19 compared with those without the disease. A quarter of all neonates born to mothers with covid-19 were admitted to the neonatal unit (25%) and were at increased risk of admission (odds ratio 3.13, 95% confidence interval 2.05 to 4.78, I2=not estimable; 1 study, 1121 neonates) than those born to mothers without covid-19.

Conclusion Pregnant and recently pregnant women are less likely to manifest covid-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and are potentially more likely to need intensive care treatment for covid-19. Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe covid-19. Preterm birth rates are high in pregnant women with covid-19 than in pregnant women without the disease.

DOI: 10.1136/bmj.m3320

Source: https://www.bmj.com/content/370/bmj.m3320

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj