Background

SARS-CoV-2 infection during pregnancy is associated with adverse pregnancy outcomes, including fetal death and preterm birth. It is not known whether that risk occurs only during the time of acute infection or whether the risk persists later in pregnancy.

Objective

This study aimed to evaluate whether the risk of SARS-CoV-2 infection during pregnancy persists after an acute maternal illness.

Study Design

A retrospective cohort study of pregnant patients with and without SARS-CoV-2 infection delivering at 17 hospitals in the United States between March 2020 and December 2020. Patients experiencing a SARS-CoV-2–positive test at or before 28 weeks of gestation with a subsequent delivery hospitalization were compared with those without a positive SAR-CoV-2 test at the same hospitals with randomly selected delivery days during the same period. Deliveries occurring at <20 weeks of gestation in both groups were excluded. The study outcomes included fetal or neonatal death, preterm birth at <37 weeks of gestation and <34 weeks of gestation, hypertensive disorders of pregnancy (HDP), any major congenital malformation, and size for gestational age of <5th or <10th percentiles at birth based on published standards. HDP that were collected included HDP and preeclampsia with severe features, both overall and with delivery at <37 weeks of gestation.

Results

Of 2326 patients who tested positive for SARS-CoV-2 during pregnancy and were at least 20 weeks of gestation at delivery from March 2020 to December 2020, 402 patients (delivering 414 fetuses or neonates) were SARS-CoV-2 positive before 28 weeks of gestation and before their admission for delivery; they were compared with 11,705 patients without a positive SARS-CoV-2 test. In adjusted analyses, those with SARS-CoV-2 before 28 weeks of gestation had a subsequent increased risk of fetal or neonatal death (2.9% vs 1.5%; adjusted relative risk, 1.97; 95% confidence interval, 1.01–3.85), preterm birth at <37 weeks of gestation (19.6% vs 13.8%; adjusted relative risk, 1.29; 95% confidence interval, 1.02–1.63), and HDP with delivery at <37 weeks of gestation (7.2% vs 4.1%; adjusted relative risk, 1.74; 95% confidence interval, 1.19–2.55). There was no difference in the rates of preterm birth at <34 weeks of gestation, any major congenital malformation, and size for gestational age of <5th or <10th percentiles. In addition, there was no significant difference in the rate of gestational hypertension overall or preeclampsia with severe features.

Conclusion

There was a modest increase in the risk of adverse pregnancy outcomes after SARS-CoV-2 infection.

中文翻译：

---

孕早期或孕中期 SARS-CoV-2 感染和随后的妊娠结局

背景

怀孕期间感染 SARS-CoV-2 与不良妊娠结局有关，包括胎儿死亡和早产。目前尚不清楚该风险是仅在急性感染期间发生，还是该风险在妊娠后期持续存在。

客观的

本研究旨在评估急性孕产妇疾病后妊娠期间感染 SARS-CoV-2 的风险是否持续存在。

学习规划

一项对 2020 年 3 月至 2020 年 12 月期间在美国 17 家医院分娩的感染和未感染 SARS-CoV-2 的孕妇进行的回顾性队列研究。在妊娠 28 周或之前进行 SARS-CoV-2 阳性检测的患者将随后的分娩住院与在同一医院随机选择分娩日的 SAR-CoV-2 检测未呈阳性的患者进行比较。两组发生在妊娠 20 周以下的分娩均被排除在外。研究结果包括胎儿或新生儿死亡、<37 周妊娠和 <34 周妊娠时的早产、妊娠高血压疾病 (HDP)、任何主要的先天性畸形以及小于第 5 个或 <第 10 个百分位数的胎龄根据公布的标准出生。

结果

在 2020 年 3 月至 2020 年 12 月分娩时至少妊娠 20 周的 2326 名怀孕期间 SARS-CoV-2 检测呈阳性的患者中，有 402 名患者（分娩 414 名胎儿或新生儿）在 28 周前呈 SARS-CoV-2 阳性妊娠期和入院分娩前；他们与 11,705 名没有 SARS-CoV-2 检测呈阳性的患者进行了比较。在调整后的分析中，妊娠 28 周前感染 SARS-CoV-2 的人随后胎儿或新生儿死亡的风险增加（2.9% 对 1.5%；调整后的相对风险为 1.97；95% 置信区间为 1.01-3.85）、早产妊娠 37 周以下出生（19.6% 对 13.8%；调整后的相对风险 1.29；95% 置信区间 1.02–1.63），以及妊娠 37 周以下分娩的 HDP（7.2% 对 4.1%；调整后的相对风险） , 1.74；95% 置信区间，1.19–2.55）。小于 34 周妊娠的早产率、任何主要的先天性畸形以及小于 5% 或 <10% 的胎龄大小的发生率没有差异。此外，妊娠期高血压总体发生率或具有严重特征的先兆子痫发生率无显着差异。

结论

SARS-CoV-2 感染后不良妊娠结局的风险略有增加。