Pregnant women admitted to hospital with covid-19 in 10 European countries: individual patient data meta-analysis of population based cohorts in International Obstetric Survey Systems.

BMJ medicine Pub Date : 2024-12-12 eCollection Date: 2024-01-01 DOI:10.1136/bmjmed-2023-000733
Hilde Marie Engjom, Odette de Bruin, Rema Ramakrishnan, Anna J M Aabakke, Outi Äyräs, Catherine Deneux-Tharaux, Serena Donati, Marian Knight, Eva Jonasdottir, Teresia Svanvik, An Vercoutere, Nicola Vousden, Kitty Wm Bloemenkamp
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Abstract

Objectives: To assess the incidence of hospital admissions for covid-19 disease in pregnant women, severity of covid-19 disease, and medical treatment provided to pregnant women with moderate to severe covid-19 during the first 10 months of the pandemic.

Design: Individual patient data meta-analysis of population based cohorts in International Obstetric Survey Systems.

Setting: 10 European countries with national or regional surveillance within the International Obstetric Survey Systems (INOSS) collaboration using aligned definitions and case report forms: Belgium, France (regional), Italy, the Netherlands, Denmark, Finland, Iceland, Norway, Sweden (regional), and the UK. The dominant variant of the SARS-CoV-2 virus was the wild-type variant in all countries during the study period (1 March 2020 to 31 December 2020).

Participants: The source population was 1.7 million women giving birth (maternities) from 1 March 2020 to 31 December 2020; pregnant women were included if they were admitted to hospital and had a positive polymerase chain reaction test for the SARS-CoV-2 virus ≤7 days before hospital admission, during admission, or up to two days after giving birth. We further categorised the hospital admission in two groups; covid-19 admission (hospital admission due to covid-19 or with reported symptoms of covid-19 disease) or non-covid-19 admission (admission to hospital for obstetric healthcare or no symptoms of covid-19 disease).

Main outcome measures: Incidence of hospital admissions for covid-19 per 1000 maternities, frequency of moderate to severe covid-19 disease, and number of women who received specific medical treatment for SARS-CoV-2 infection. Moderate to severe covid-19 disease was defined as maternal death, admission to an intensive care unit, or need for respiratory support.

Results: Among 1.7 million maternities, 9003 women were included in the study: 2350 (26.1%) were admitted to hospital because of covid-19 disease or had symptoms of disease. The pooled incidence of hospital admissions for covid-19 per 1000 maternities was 0.8 (95% confidence interval (CI) 0.5 to 1.2, τ2=0.44), ranging from no hospital admissions in Iceland to 1.7 in France and 1.9 in the UK. 13 women died due to covid-19. Among 2219 women admitted to hospital for covid-19 in countries with complete information on respiratory support, 820 women (39.5%, 95% CI 34.6% to 44.4%, τ2=0.02) had moderate to severe covid-19 disease. At most, 16.8% (95% CI 7.7% to 32.9%, I2=81.8%, τ2=0.7) of women with moderate to severe covid-19 received specific medical treatment for SARS-CoV-2 infection with corticosteroids, although 66.6% (59.4% to 73.2%, I2=50.1, τ2=0.06) were given thromboprophylaxis.

Conclusions: Population based surveillance in 10 European countries during the first 10 months of the covid-19 pandemic showed variations in the risk of hospital admissions for covid-19 in pregnant women. This finding indicates that national public health policies likely had a substantial and previously unrecognised role in protecting pregnant women. Few pregnant women with moderate to severe covid-19 were given specific medical treatment for SARS-CoV-2 disease, even when there were no or minor safety concerns. Lessons for future pandemics include the importance of rapid, robust surveillance systems for maternal and perinatal health, and of including use for pregnant women early in the development and testing of medicines and vaccines for public health emergencies.

10个欧洲国家因covid-19入院的孕妇:国际产科调查系统中基于人口的队列的个体患者数据荟萃分析
目的:评估在大流行的前10个月期间,孕妇因covid-19疾病住院的发生率、covid-19疾病的严重程度以及为患有中度至重度covid-19的孕妇提供的医疗服务。设计:对国际产科调查系统中基于人群的队列进行个体患者数据荟萃分析。环境:在国际产科调查系统(INOSS)合作下使用统一定义和病例报告表格开展国家或区域监测的10个欧洲国家:比利时、法国(区域)、意大利、荷兰、丹麦、芬兰、冰岛、挪威、瑞典(区域)和英国。在研究期间(2020年3月1日至2020年12月31日),所有国家的主要SARS-CoV-2病毒变体为野生型变体。参与者:源人口为2020年3月1日至2020年12月31日期间分娩的170万妇女;如果孕妇入院并在入院前≤7天、入院期间或分娩后2天内SARS-CoV-2病毒聚合酶链反应试验呈阳性,则纳入孕妇。我们进一步将住院患者分为两组;COVID-19住院(因COVID-19或报告有COVID-19疾病症状入院)或非COVID-19住院(住院接受产科保健或无COVID-19疾病症状)。主要结局指标:每1000名产妇因covid-19住院的发生率、中至重度covid-19疾病的发生频率,以及因SARS-CoV-2感染而接受特定医疗治疗的妇女人数。中度至重度covid-19疾病被定义为孕产妇死亡、入住重症监护病房或需要呼吸支持。结果:在170万名产妇中,有9003名妇女被纳入研究:2350名(26.1%)因covid-19疾病或有疾病症状而住院。每1000名产妇因covid-19住院的总发生率为0.8(95%置信区间(CI) 0.5至1.2,τ2=0.44),范围从冰岛的零住院到法国的1.7和英国的1.9。13名妇女死于covid-19。在呼吸支持信息完整的国家中,因covid-19住院的2219名妇女中,有820名妇女(39.5%,95% CI 34.6%至44.4%,τ2=0.02)患有中度至重度covid-19疾病。最多16.8% (95% CI 7.7% ~ 32.9%, I2=81.8%, τ2=0.7)的中重度covid-19女性接受了糖皮质激素治疗,尽管66.6% (59.4% ~ 73.2%,I2=50.1, τ2=0.06)的女性接受了血栓预防治疗。结论:在covid-19大流行的前10个月,在10个欧洲国家进行的基于人群的监测显示,孕妇因covid-19住院的风险存在差异。这一发现表明,国家公共卫生政策可能在保护孕妇方面发挥了巨大的、以前未被认识到的作用。患有中至重度covid-19的孕妇很少接受针对SARS-CoV-2疾病的特定医疗治疗,即使没有或只有轻微的安全问题。对未来大流行的教训包括建立快速、强有力的孕产妇和围产期健康监测系统的重要性,以及在开发和测试用于突发公共卫生事件的药物和疫苗的早期阶段将孕妇纳入其中的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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