Will novel coronavirus pneumonia affect pregnancy?

Does novel coronavirus pneumonia affect pregnancy? Novel coronavirus pneumonia (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)

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As of August 20, 2020, Spain had more than 249000 confirmed cases and more than 2700 deaths

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According to the spread of the disease, Spain has developed a pregnancy screening program and designed a database to record the information of sars-cov-2 infection during pregnancy

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81% of SARS cov-2 infected patients had no complications or mild conditions, but some patients would develop serious diseases related to cytokine mediated inflammation; A similar situation exists among pregnant women

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Previous studies have shown that inflammatory mediators related to sars-cov-2 infection are related to poor perinatal outcomes

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Will sars-cov-2 infection have an adverse effect on pregnancy? Today, Xiaobian is reading an article published in BMCPregnancyandChildbirth on April 1, 2021, entitled “SARS-CoV-2 infection and preterm delivery: a prospective study of multivariate analysis”, which aims to assess whether SARS-CoV-2 infection is related to incidence rate of Obstetrics during pregnancy

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01 patient screening and acceptance criteria this multicenter prospective study detected covid-19 in pregnant women in delivery wards of 45 hospitals

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Polymerase chain reaction (PCR) positive patients were sars-cov-2 infected (divided into mild, mild to moderate, severe pneumonia and septic shock), and PCR negative patients were uninfected

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Positive pregnant women and negative pregnant women were followed up to 6 weeks postpartum, and neonatal events were recorded to 14 days postpartum

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The known confounding variables were adjusted for multivariate logistic regression analysis to determine the adjusted odds ratio (AOR) and 95% confidence interval (95% CI) of the relationship between sars-cov-2 infection and obstetric outcome

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Main outcome measures: preterm birth, premature rupture of membranes and admission to neonatal intensive care unit

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The baseline characteristics of patients included 1009 pregnant women, 246 in the infected group and 763 in the uninfected group

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Among the pregnant women in the infection group, 88.6% were asymptomatic and 11.4% were symptomatic

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Among asymptomatic pregnant women, 20.2% had previous symptoms and 79.8% were completely asymptomatic; Among symptomatic pregnant women, 85.7% were mild (the most common were cough [33.3%] and loss of smell [20.8%], followed by fatigue / discomfort, fever and dyspnea), 7.1% were mild to moderate and 7.1% were severe

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There were no cases of septic shock or maternal death among infected pregnant women

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There was no significant difference in demographic characteristics, complications and obstetric history between the infected group and the uninfected group

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The proportion of pregnant women in Latin America in the infected group was significantly higher than that in the uninfected group (P < 0.001); Or = 2.85, 95% CI: 1.96 – 4.15), and there were significantly fewer white Europeans (P < 0.001, or = 0.49, 95% CI: 0.36 – 0.67)

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Results compared with the uninfected group, the number of pregnant women who delivered less than 37 weeks in the infected group increased significantly (6.7% vs 13.8%, AOR, 2.12, 95% CI 1.32-3.36, P = 0.002)

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Sars-cov-2 infection increased the incidence of preterm birth

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Compared with the uninfected group, iatrogenic preterm birth was significantly more in the infected group (4.9% vs 1.3%, P = 0.001), and the incidence of spontaneous preterm birth was similar (6.1% vs 4.7%)

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The risk of full-term premature rupture of membranes (PROM, 15.8% vs 9.8%, aor1.70, 95% CI 1.11-2.57, P = 0.013) and premature rupture of membranes (PPROM, 45% vs 2.0%, aor2.26, 95% CI 0.99-4.98, P = 0.045) was significantly higher in the infected group than in the uninfected group

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There was fetal intrauterine death in the study, and the incidence in the infected group was significantly higher than that in the uninfected group (1.2% vs 0.1%, P = 0.047)

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Compared with the uninfected group, the incidence of admission to neonatal intensive care unit in the infected group was significantly higher (2.4% vs 9.3%, aor4.62, 95% CI 2.43-8.94, P < 0.001)

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Premature delivery and respiratory distress are the main reasons for admission to neonatal intensive care unit, but they are not caused by neonatal sars-cov-2 infection

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04 advantages and limitations this study is one of the first multicenter prospective studies to analyze the relationship between sars-cov-2 infection and preterm birth, and puts forward the future research direction for the relationship between sars-cov-2 infection and premature rupture of membranes

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The biggest limitation of the study is that it is impossible to compare infected and uninfected people from the beginning, there is no serological test for pregnant women who are negative by PCR, and there is a lack of a complete cohort screened from the analysis

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Summary: SARS-CoV-2 infection is related to obstetric morbidity in general

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The incidence rate of premature delivery, full-term premature rupture of membranes and neonatal intensive care unit in pregnant women is significantly higher

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This result is worthy of evaluating causality in further research..

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