英格兰和威尔士865654名女性的新冠病毒疾病（COVID-19）诊断、孕期接种疫苗与不良妊娠结局：一项基于人群的队列研究
COVID-19 diagnosis, vaccination during pregnancy, and adverse pregnancy outcomes of 865,654 women in England and Wales: a population-based cohort study.
作者信息
Raffetti Elena, Bolton Thomas, Nolan John, Zuccolo Luisa, Denholm Rachel, Smith Gordon, Akbari Ashley, Harron Katie, Curry Gwenetta, Allara Elias, Lawlor Deborah A, Caputo Massimo, Abbasizanjani Hoda, Chico Tim, Wood Angela M
机构信息
British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
出版信息
Lancet Reg Health Eur. 2024 Aug 22;45:101037. doi: 10.1016/j.lanepe.2024.101037. eCollection 2024 Oct.
BACKGROUND
The extent to which COVID-19 diagnosis and vaccination during pregnancy are associated with risks of common and rare adverse pregnancy outcomes remains uncertain. We compared the incidence of adverse pregnancy outcomes in women with and without COVID-19 diagnosis and vaccination during pregnancy.
METHODS
We studied population-scale linked electronic health records for women with singleton pregnancies in England and Wales from 1 August 2019 to 31 December 2021. This time period was divided at 8th December 2020 into pre-vaccination and vaccination roll-out eras. We calculated adjusted hazard ratios (HRs) for common and rare pregnancy outcomes according to the time since COVID-19 diagnosis and vaccination and by pregnancy trimester and COVID-19 variant.
FINDINGS
Amongst 865,654 pregnant women, we recorded 60,134 (7%) COVID-19 diagnoses and 182,120 (21%) adverse pregnancy outcomes. COVID-19 diagnosis was associated with a higher risk of gestational diabetes (adjusted HR 1.22, 95% CI 1.18-1.26), gestational hypertension (1.16, 1.10-1.22), pre-eclampsia (1.20, 1.12-1.28), preterm birth (1.63, 1.57-1.69, and 1.68, 1.61-1.75 for spontaneous preterm), very preterm birth (2.04, 1.86-2.23), small for gestational age (1.12, 1.07-1.18), thrombotic venous events (1.85, 1.56-2.20) and stillbirth (only within 14-days since COVID-19 diagnosis, 3.39, 2.23-5.15). HRs were more pronounced in the pre-vaccination era, within 14-days since COVID-19 diagnosis, when COVID-19 diagnosis occurred in the 3rd trimester, and in the original variant era. There was no evidence to suggest COVID-19 vaccination during pregnancy was associated with a higher risk of adverse pregnancy outcomes. Instead, dose 1 of COVID-19 vaccine was associated with lower risks of preterm birth (0.90, 0.86-0.95), very preterm birth (0.84, 0.76-0.94), small for gestational age (0.93, 0.88-0.99), and stillbirth (0.67, 0.49-0.92).
INTERPRETATION
Pregnant women with a COVID-19 diagnosis have higher risks of adverse pregnancy outcomes. These findings support recommendations towards high-priority vaccination against COVID-19 in pregnant women.
FUNDING
BHF, ESRC, Forte, HDR-UK, MRC, NIHR and VR.
背景
孕期新冠病毒病（COVID-19）诊断及疫苗接种与常见和罕见不良妊娠结局风险之间的关联程度仍不确定。我们比较了孕期有和没有COVID-19诊断及疫苗接种的女性不良妊娠结局的发生率。
方法
我们研究了2019年8月1日至2021年12月31日在英格兰和威尔士单胎妊娠女性的人口规模关联电子健康记录。该时间段在2020年12月8日分为疫苗接种前和疫苗接种推广阶段。我们根据自COVID-19诊断和疫苗接种后的时间、妊娠 trimester 以及COVID-19变异株，计算了常见和罕见妊娠结局的调整风险比（HRs）。
结果
在865,654名孕妇中，我们记录了60,134例（7%）COVID-19诊断病例和182,120例（21%）不良妊娠结局。COVID-19诊断与妊娠期糖尿病风险较高相关（调整后HR 1.22，95%置信区间1.18 - 1.26）、妊娠期高血压（1.16，1.10 - 1.22）、子痫前期（1.20，1.12 - 1.28）、早产（1.63，1.57 - 1.69，自发早产为1.68，1.61 - 1.75）、极早产（2.04，1.86 - 2.23）、小于胎龄儿（1.12，1.07 - 1.18）、血栓性静脉事件（1.85，1.56 - 2.20）和死产（仅在COVID-19诊断后14天内，3.39，2.23 - 5.15）。HRs在疫苗接种前阶段、COVID-19诊断后14天内、妊娠晚期发生COVID-19诊断时以及原始变异株时期更为明显。没有证据表明孕期接种COVID-19疫苗与不良妊娠结局风险较高相关。相反，COVID-19疫苗第1剂与早产风险较低相关（0.90，0.86 - 0.95）、极早产（0.84，0.76 - 0.94）、小于胎龄儿（0.93，0.88 - 0.99）和死产（0.67，0.49 - 0.92）。
解读
确诊COVID-19的孕妇不良妊娠结局风险较高。这些发现支持对孕妇进行优先接种COVID-19疫苗的建议。
资金来源
英国心脏基金会（BHF）、经济和社会研究委员会（ESRC）、福特基金会（Forte）、英国卫生数据研究中心（HDR-UK）、医学研究委员会（MRC）、国家卫生研究院（NIHR）和韦尔科姆基金会（VR）。
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