The study details the risk of preterm birth, severe COVID-19 in pregnant women

Two new US studies confirmed preterm birth in pregnant women and an increased risk of severe COVID-19 disease, but systematic reviews and meta-analyses of maternal and neonatal outcomes show that the new coronavirus is significant for pregnancy. It doesn’t seem to affect you.

Half of virus-positive babies born prematurely

The· the first Both of the two studies were published yesterday Weekly morbidity and mortality reports (((MMWR), Coronavirus-infected 4,442 pregnant women and their 4,527 fetuses and newborns with births and infant outcomes from March 29 to October 14, 16 mother and baby threat monitoring networks (SET) -NET) Monitored under jurisdiction.

Of the 3,912 babies born to COVID-19 pregnant women with known gestational ages, 12.9% were born preterm (37 weeks before gestation), compared to a national estimate of 10.2%. Of the 610 newborns tested for coronavirus, only 2.6% were positive, most of whom were born to women with active infections at birth.

Of the 4,527 fetuses and newborns, 4,495 were born, including 79 sets of twins and 1 set of triplets, and 32 had a miscarriage. Of these, 12 (0.3%) were less than 20 weeks pregnant and 20 (0.4%) were 20 weeks pregnant. ‘More pregnant. Of the 3,486 births (77.6%) whose weight, gestational age, and gender were recorded, 198 (5.7%) had a lower gestational age. Of the 4,495 babies, 9 (0.2%) died in the hospital.

Eight (50%) of the 16 COVID-19-positive babies were preterm and all had undocumented indications, but all required admission to the intensive care unit (ICU). Of the eight full-term infants who tested positive, one was admitted to the ICU because of fever and the need for additional oxygen.

The median maternal age was 28.9 years, with 46.0% being Hispanic or Latino. At least one underlying disorder was found in 1,564 women (45.1%), the most common of which was obesity during pregnancy (35.1%). The majority of female infections (84.4%) were diagnosed in the third semester. Of the 2,691 women (60.6%) whose symptom status is known, 374 (14.0%) do not report symptoms.

The authors state that most infected pregnant women reported so far were infected late in pregnancy and require continuous monitoring to assess the effects of infection in early pregnancy and the long-term outcome of exposed newborns. It was.

Meanwhile, pregnant women should be counseled about the risk of coronavirus infection, they said. “Pregnant women and their families should wear masks, social distance, frequent hand washing, etc. when going out, interacting with others, or if there are people infected with COVID-19 at home, etc. You need to follow the recommended infection prevention measures. “Researchers wrote.

High need for intensive intervention

Second MMWR Survey Updated on June 26th reportA new study detailing the characteristics of 23,434 symptomatological pregnant women aged 15-44 years who were infected with COVID-19 from 22 January to 3 October by the National Notification Disease Monitoring System (NNDSS). A previous study evaluated 8,207 pregnant women.

After adjusting for age, race / ethnicity, and underlying illness, pregnant women in yesterday’s study were significantly more likely to require ICU admission than non-pregnant women (3.9% vs 1.1%; adjusted risk). ratio) [aRR], 3.0), Ventilator (2.9% vs 1.1%; aRR, 2.9), and Extracorporeal Membrane Oxygen (Extracorporeal Oxygen; 0.7% vs 0.3%; aRR, 2.4) and Death (1.5) % Vs 1.2%; aRR, 1.7).

The increased risk of ICU admission was seen in all pregnant women, but was particularly high among Asians (aRR, 6.6) and Native Hawaiians / Pacific Islands (aRR, 3.7). Pregnant Hispanic women are at higher risk of both COVID-19 infection and death than non-pregnant peers, and both pregnant and non-pregnant black women are in the distribution among infected women. There was an unbalanced risk of death.

Pregnant women aged 15 to 24 years were three times more at risk of needing a ventilator than non-pregnant women, while women aged 35 to 44 were 3.6 times more at risk.

Although the absolute risk of serious outcomes in pregnant women is low, the authors found that due to physiological changes in pregnancy, such as increased heart rate and oxygen consumption, and decreased vital capacity, severe COVID-19 disease He said the risk was high. It moves away from cell-mediated immunity and increases the risk of blood clots.

“To reduce the risk of serious illness and death from COVID-19, pregnant women should be counseled on the importance of seeking immediate medical care and preventative measures if they have symptoms. [coronavirus] During all medical encounters, including prenatal care visits, infection should be strongly emphasized for pregnant women and their families, “the researchers said.

Reviews show illnesses that are most often less severe

The· Meta-analysisIncludes 24 studies, including 1,100 pregnancies, published on November 1st Clinical microbiology and infectious diseases According to researchers in Trieste, Italy.

Of all pregnant women in the COVID-19-infected study, 89% had pneumonia, 85% gave birth by caesarean section, and 8% required ICU admission. However, the pooled prevalence of ICU admission and maternal mortality was similar to that reported for non-pregnant women.

Five out of 1,100 women (0.5%) died, three out of 779 fetuses (0.4%) stillborn, and three out of 537 newborns (0.6%) died. There was no cause related to COVID-19. 2% of newborns required ICU care and 4.3% were coronavirus positive.

The average gestational age at birth was 38 weeks. The pooled prevalence of preterm birth is 23%, which is higher than the 5% prevalence of the general obstetric population in Europe. “But it is unclear whether COVID-19 is the direct cause of preterm birth. Viral infections during pregnancy can cause an abnormal response to opportunistic bacterial infections that can lead to preterm birth,” the author said. Is writing.

Of the 54 newborns with data on respiratory symptoms and oxygen support, only one needed additional oxygen in the form of non-invasive ventilation.The onset of coronavirus-related symptoms requiring hospitalization or prolonging hospital stay after childbirth occurred more frequently in prenatal women (525 women). [73%]) Later (462 [22%]).

The authors conclude that although ICU hospitalization and death can occur, COVID-19 infection is not severe in most pregnant women and does not appear to have a substantial effect on pregnancy.

“Although high cesarean delivery rates have been reported, there is no clinical evidence to support this mode of delivery,” the researchers write. “Sure, in most cases the disease does not threaten the mother and is a vertically transmitted infection. [from mother to infant] Not clearly proven. Therefore, COVID-19 should not be considered an indication for selective caesarean section. “