Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis

被引：109

作者：

Smith, Emily R. ^{[1
]}

Oakley, Erin ^{[1
]}

Grandner, Gargi Wable ^{[1
]}

Ferguson, Kacey ^{[1
]}

Farooq, Fouzia ^{[1
]}

Afshar, Yalda ^{[2
]}

Ahlberg, Mia ^{[3
]}

Ahmadzia, Homa ^{[4
]}

Akelo, Victor ^{[5
]}

Aldrovandi, Grace ^{[6
]}

Barr, Beth A. Tippett ^{[5
]}

Bevilacqua, Elisa ^{[7
]}

Brandt, Justin S. ^{[8
]}

Broutet, Nathalie ^{[9
]}

Buhigas, Irene Fernandez ^{[10
]}

Carrillo, Jorge ^{[11
]}

Clifton, Rebecca ^{[12
]}

Conry, Jeanne ^{[13
]}

Cosmi, Erich ^{[14
]}

Crispi, Fatima ^{[15
,16
]}

Crovetto, Francesca ^{[15
,16
]}

Delgado-Lopez, Camille ^{[17
]}

Divakar, Hema ^{[18
]}

Driscoll, Amanda J. ^{[19
]}

Favre, Guillaume ^{[20
]}

Flaherman, Valerie J. ^{[21
]}

Gale, Chris ^{[22
]}

Gil, Maria M. ^{[10
]}

Gottlieb, Sami L. ^{[9
]}

Gratacos, Eduard ^{[15
,16
]}

Hernandez, Olivia ^{[23
,24
]}

Jones, Stephanie ^{[25
]}

Kalafat, Erkan ^{[26
]}

Khagayi, Sammy ^{[27
]}

Knight, Marian ^{[28
]}

Kotloff, Karen ^{[29
]}

Lanzone, Antonio ^{[7
]}

Le Doare, Kirsty ^{[30
,31
,32
]}

Lees, Christoph ^{[33
]}

Litman, Ethan ^{[4
]}

Lokken, Erica M. ^{[34
]}

Laurita Longo, Valentina ^{[35
,36
]}

Madhi, Shabir A. ^{[25
]}

Magee, Laura A. ^{[37
]}

Martinez-Portilla, Raigam Jafet ^{[38
]}

McClure, Elizabeth M. ^{[39
]}

Metz, Tori D. ^{[40
,41
]}

Miller, Emily S. ^{[42
]}

Money, Deborah ^{[43
]}

Moungmaithong, Sakita ^{[44
]}

机构：

[1] George Washington Univ, Milken Inst, Sch Publ Hlth, Dept Global Hlth, Washington, DC 20052 USA

[2] Univ Calif Los Angeles, Div Maternal Fetal Med, Los Angeles, CA USA

[3] Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden

[4] George Washington Univ, Sch Med & Hlth Sci, Div Maternal Fetal Med, Washington, DC USA

[5] US Ctr Dis Control & Prevent, Off Director, Kisumu, Kenya

[6] Univ Calif Los Angeles, Dept Pediat, Los Angeles, CA USA

[7] IRCCS, Fdn Policlin Univ Agostino Gemelli, Dept Women & Child Hlth, Women Hlth Area, Rome, Italy

[8] Rutgers Robert Wood Johnson Med Sch, Dept Obstet Gynecol & Reprod Sci, Div Maternal Fetal Med, New Brunswick, NJ USA

[9] WHO, Dept Sexual & Reprod Hlth & Res, Geneva, Switzerland

[10] Hosp Univ Torrejon, Dept Obstet & Gynecol, Madrid, Spain

[11] Puerto Rico Dept Hlth, Dept Obstet & Ginecol, Fac Med Clin Alemana, Santiago, Chile

[12] George Washington Univ, Milken Inst, Biostat Ctr, Sch Publ Hlth, Rockville, MD USA

[13] Int Federat Gynecol & Obstet, London, England

[14] Univ Padua, Dept Womens & Childrens Hlth, Padua, Italy

[15] Univ Barcelona, Hosp Sant Joan Deu, Barcelona Ctr Maternal Fetal & Neonatal Med, Dept Maternal Fetal Med,BCNatal, Barcelona, Spain

[16] Univ Barcelona, Hosp Clin, Barcelona, Spain

[17] Puerto Rico Dept Hlth, Surveillance Emerging Threats Mothers & Babies, San Juan, PR USA

[18] Asian Res & Training Inst Skill Transfer ARTIST, Bengaluru, India

[19] Univ Maryland, Ctr Vaccine Dev, Sch Med, Baltimore, MD USA

[20] Lausanne Univ Hosp, Dept Femme Mere Enfant, Materno Fetal & Obstet Res Unit, Lausanne, Switzerland

[21] Univ Calif San Francisco, Dept Pediat, San Francisco, CA USA

[22] Imperial Coll London, Sch Publ Hlth, Fac Med, Neonatal Med, London, England

[23] Hosp Clin Felix Bulnes, Gynecol & Obstet, Santiago, Chile

[24] RedSalud Clin, Santiago, Chile

[25] Univ Witwatersrand, South African Med Res Council, Fac Hlth Sci, Vaccines & Infect Dis Analyt Res Unit, Johannesburg, South Africa

[26] Koc Univ, Sch Med, Dept Obstet & Gynecol, Istanbul, Turkiye

[27] Kenya Govt Med Res Ctr, Ctr Global Hlth Res, Kisumu, Kenya

[28] Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England

[29] Univ Maryland, Sch Med, Dept Pediat, Baltimore, MD USA

[30] Uganda Virus Inst, Entebbe, Uganda

[31] London Sch Hyg & Trop Med, Entebbe, Uganda

[32] St Georges Univ London, Pediat Infect Dis Res Grp, London, England

[33] Imperial Coll London, Dept Metab Digest & Reprod, London, England

[34] Univ Washington, Sch Med, Dept Obstet & Gynecol, Seattle, WA USA

[35] Univ Cattolica Sacro Cuore, Inst Obstet, Rome, Italy

[36] Univ Cattolica Sacro Cuore, Gynecol Clin, Rome, Italy

[37] Kings Coll London, Sch Life Course & Populat Sci, Dept Women & Childrens Hlth, London, England

[38] Natl Inst Perinatol, Clin Res Div, Mexico City, Mexico

[39] RTI Int, Res Triangle Pk, NC USA

[40] Univ Utah, Hlth Sci Ctr, Dept Obstet, Salt Lake City, UT USA

[41] Univ Utah, Hlth Sci Ctr, Dept Gynecol, Salt Lake City, UT USA

[42] Northwestern Univ, Feinberg Sch Med, Dept Obstet & Gynecol, Div Maternal Fetal Med, Chicago, IL USA

[43] Univ British Columbia, Dept Obstet & Gynecol, Vancouver, BC, Canada

[44] Chinese Univ Hong Kong, Dept Obstet & Gynecol, Hong Kong, Peoples R China

[45] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA

[46] Kisumu Cty Dept Hlth, Kisumu, Kenya

[47] Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland

[48] NIH, Pediat Growth & Nutr Branch, Bethesda, MD USA

[49] Univ Pontificia Bolivariana, Medellin, Antioquia, Colombia

[50] Aga Khan Univ, Ctr Excellence Women & Child Hlth, Nairobi, Kenya

来源：

BMJ GLOBAL HEALTH | 2023年 / 8卷 / 01期

基金：

比尔及梅琳达.盖茨基金会;

关键词：

COVID-19; Maternal health; Epidemiology; DATA-COLLECTION; CASE-DEFINITION; GUIDELINES; COVID-19;

D O I：

10.1136/bmjgh-2022-009495

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

IntroductionDespite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. MethodsWe screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. ResultsWe screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. ConclusionsThis analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

引用

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