意大利一项全国性前瞻性基于人群的队列研究：住院孕妇中的 SARS-CoV-2 感染及不同病毒株对 COVID-19 严重程度的影响。
SARS-CoV-2 infection among hospitalised pregnant women and impact of different viral strains on COVID-19 severity in Italy: a national prospective population-based cohort study.
机构信息
National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy.
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
出版信息
BJOG. 2022 Jan;129(2):221-231. doi: 10.1111/1471-0528.16980. Epub 2021 Nov 20.
OBJECTIVE
The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes.
DESIGN
National population-based prospective cohort study.
SETTING
A total of 315 Italian maternity hospitals.
SAMPLE
A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission.
METHODS
Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses.
MAIN OUTCOME MEASURES
COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality.
RESULTS
We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28).
CONCLUSIONS
Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes.
目的
本文的主要目的是描述意大利野生型和阿尔法变异株时期孕妇的 SARS-CoV-2 感染情况。次要目的是比较病毒变异对母婴结局严重程度的影响。
设计
全国性前瞻性队列研究。
设置
315 家意大利产科医院。
样本
3306 名在入院后 7 天内确诊 SARS-CoV-2 感染的妇女队列。
方法
由培训有素的临床医生为每个参与的产科单位前瞻性报告病例。数据通过单变量和多变量分析进行描述。
主要观察指标
COVID-19 肺炎、通气支持、重症监护病房（ICU）入院、分娩方式、早产、死产以及母婴死亡率。
结果
我们发现，该队列中 64.3%的患者无症状，12.8%的患者发生 COVID-19 肺炎，3.3%的患者需要通气支持和/或 ICU 入院。产妇年龄 30-34 岁（OR 1.43，95%CI 1.09-1.87）和≥35 岁（OR 1.62，95%CI 1.23-2.13）、高移民压力国家的公民身份（OR 1.75，95%CI 1.36-2.25）、既往合并症（OR 1.49，95%CI 1.13-1.98）和肥胖（OR 1.72，95%CI 1.29-2.27）均与肺炎发生率增加相关。早产率为 11.1%。与大流行前相比，死产和母婴死亡保持稳定。与野生型相比，肺炎患者在阿尔法变异株时期需要通气支持和/或 ICU 入院的比例增加（OR 3.24，95%CI 1.99-5.28）。
结论
我们的结果表明孕妇患严重 COVID-19 疾病的风险较低，围产期不良结局罕见。在阿尔法变异株时期，严重 COVID-19 疾病显著增加。需要进一步研究来描述不同 SARS-CoV-2 病毒株对母婴结局的影响。
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