Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis

被引：63

作者：

Smith, Emily R. ^{[1
]}

Oakley, Erin ^{[1
]}

Grandner, Gargi Wable ^{[1
]}

Rukundo, Gordon ^{[2
]}

Farooq, Fouzia ^{[1
]}

Ferguson, Kacey ^{[1
]}

Baumann, Sasha ^{[1
]}

Waldorf, Kristina Maria Adams ^{[3
,4
]}

Afshar, Yalda ^{[5
]}

Ahlberg, Mia ^{[6
]}

Ahmadzia, Homa ^{[7
]}

Akelo, Victor ^{[8
]}

Aldrovandi, Grace ^{[9
]}

Bevilacqua, Elisa ^{[10
]}

Bracero, Nabal ^{[11
,12
]}

Brandt, Justin S. ^{[13
]}

Broutet, Natalie ^{[14
]}

Carrillo, Jorge ^{[15
]}

Conry, Jeanne ^{[16
]}

Cosmi, Erich ^{[17
]}

Crispi, Fatima ^{[18
,19
]}

Crovetto, Francesca ^{[18
,19
]}

Gil, Maria del Mar ^{[20
,21
]}

Delgado-Lopez, Camille ^{[22
]}

Divakar, Hema ^{[23
]}

Driscoll, Amanda J. ^{[24
]}

Favre, Guillaume ^{[25
]}

Buhigas, Irene Fernandez ^{[20
,21
]}

Flaherman, Valerie ^{[26
]}

Gale, Christopher ^{[27
]}

Godwin, Christine L. ^{[14
]}

Gottlieb, Sami ^{[14
]}

Gratacos, Eduard ^{[18
,19
]}

He, Siran ^{[1
]}

Hernandez, Olivia ^{[28
,29
]}

Jones, Stephanie ^{[30
,31
]}

Joshi, Sheetal ^{[23
]}

Kalafat, Erkan ^{[32
]}

Khagayi, Sammy ^{[33
]}

Knight, Marian ^{[34
]}

Kotloff, Karen L. ^{[24
]}

Lanzone, Antonio ^{[10
,35
]}

Longo, Valentina Laurita ^{[10
,35
]}

Le Doare, Kirsty ^{[2
,36
,37
,38
]}

Lees, Christoph ^{[39
]}

Litman, Ethan ^{[7
]}

Lokken, Erica M. ^{[3
,4
]}

Madhi, Shabir A. ^{[30
,31
]}

Magee, Laura A. ^{[40
,41
]}

Martinez-Portilla, Raigam Jafet ^{[42
]}

机构：

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

[2] Makerere Univ Johns Hopkins Univ Res Collaborat, PeriCOVID PREPARE Uganda Team, Kampala, Uganda

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

[4] Univ Washington, Dept Global Hlth, Seattle, WA USA

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

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

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

[8] Ctr Dis Control & Prevent, Kisumu, Kenya

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

[10] Fdn Policlin Univ Agostino Gemelli, Ist Ricovero & Cura Carattere Sci, Dept Women & Child Hlth, Women Hlth Area, Rome, Italy

[11] Univ Puerto Rico, Dept Obstet & Gynecol, Sch Med, San Juan, PR USA

[12] Puerto Rico Obstet & Gynecol PROGyn, San Juan, PR USA

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

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

[15] Univ Desarrollo, Fac Med Clin Alemana, Dept Obstet & Ginecol, Clin Alemana Santiago, Santiago, Chile

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

[17] Univ Padua, Dept Womens & Childrens Hlth, Obstet & Gynecol Clin, Padua, Italy

[18] Univ Barcelona, Hosp St Joan Deu Barcelona, BCNatal, Barcelona Ctr Maternal Fetal & Neonatal Med, Barcelona, Spain

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

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

[21] Univ Francisco Vitoria, Sch Med, Madrid, Spain

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

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

[24] Univ Maryland, Ctr Vaccine Dev & Global Hlth, Sch Med, Baltimore, MD USA

[25] Lausanne Univ Hosp, Dept Femme Mere Enfant, Maternofetal & Obstet Res Unit, Lausanne, Switzerland

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

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

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

[29] RedSalud Clin, Santiago, Chile

[30] Univ Witwatersrand, South African Med Res Council, Vaccines & Infect Dis Analyt Res Unit, Johannesburg, South Africa

[31] Univ Witwatersrand, Dept Sci & Technol, South African Res Chair Initiat Vaccine Preventab, Fac Hlth Sci,Natl Res Fdn, Johannesburg, South Africa

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

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

[34] Univ Oxford, Nuffield Dept Populat Hlth, Natl Perinatal Epidemiol Unit, Oxford, England

[35] Univ Cattolica Sacro Cuore, Rome, Italy

[36] MRC, Uganda Virus Res Inst, Entebbe, Uganda

[37] London Sch Hyg & Trop Med, Uganda Res Unit, Entebbe, Uganda

[38] St Georges Univ London, Paediat Infect Dis Res Grp, London, England

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

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

[41] Kings Coll Hosp London, Inst Women & Childrens Hlth, London, England

[42] Natl Inst Perinatol, Clin Res Branch, Mexico City, DF, Mexico

[43] Univ Utah Hlth, Div Maternal Fetal Med, Salt Lake City, UT USA

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

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

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

[47] George Inst Global Hlth, London, England

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

[49] Univ Pittsburgh, Grad Sch Publ Hlth, Ctr Global Hlth, Pittsburgh, PA USA

[50] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Med, Cape Town, South Africa

来源：

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY | 2023年 / 228卷 / 02期

基金：

比尔及梅琳达.盖茨基金会;

关键词：

COVID-2019; maternal mortality; neonatal mortality; pneumonia; pregnancy; preterm birth; SARS-CoV-2; small-for-gestational-age; MIDDLE-INCOME COUNTRIES; MATERNAL HEMOGLOBIN; DATA-COLLECTION; CASE-DEFINITION; PRETERM BIRTH; STILLBIRTH; UNDERWEIGHT; POPULATION; GUIDELINES; INFECTION;

D O I：

10.1016/j.ajog.2022.08.038

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

OBJECTIVE: This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. DATA SOURCES: We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. STUDY ELIGIBILITY CRITERIA: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. METHODS: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. RESULTS: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or post-partum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12-2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27-13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87-22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83-70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26-2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20-3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28-2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18-2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25-2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15-4.81). CONCLUSION: We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.

引用

页码：161 / 177

页数：17

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