SARS-CoV-2/COVID-19 与妊娠的产妇和新生儿结局:与人类免疫缺陷病毒/获得性免疫缺陷综合症的相似之处与对比。

Medical research archives Pub Date : 2024-04-01 Epub Date: 2024-04-29 DOI:10.18103/mra.v12i4.5205
Dan Li, Jing Zhang, Xiaofen Zhang, Yifan Chang, Sten H Vermund
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引用次数: 0

摘要

综述目的:我们的综述旨在比较和对比人类免疫缺陷病毒/获得性免疫缺陷综合症和 SARS-CoV-2/COVID-19 对孕产妇和新生儿预后的影响。过去几十年来,我们在人类免疫缺陷病毒/获得性免疫缺陷综合症的预防和治疗方面取得了重大进展。借鉴以往公共卫生危机的经验证据,可以为应对当前和未来的流行病提供宝贵的启示。因此,有必要对人类免疫缺陷病毒/获得性免疫缺陷综合症和 SARS-CoV-2/COVID-19 之间的相似之处和不同之处进行比较分析。这项研究工作是一项开创性的、全方位的研究,旨在辨别和理解 SARS-CoV-2 和人类免疫缺陷病毒各自对妊娠的影响的相似之处和不同之处:根据目前的证据,没有迹象表明怀孕会增加妇女感染人类免疫缺陷病毒或 SARS-CoV-2 的可能性。然而,怀孕状态与疾病的恶化和进展有关联。人类免疫缺陷病毒和 SARS-CoV-2 都会增加孕产妇死亡的风险和一些产科并发症,包括早产和先兆子痫。虽然人类免疫缺陷病毒的垂直传播已得到证实,但对 SARS-CoV-2 的垂直传播仍然缺乏全面的了解,这就强调了进一步调查的必要性。初步数据表明,在采取适当的预防干预措施和进行普遍筛查的情况下,SARS-CoV-2 的垂直传播率较低。对于病毒载量高或抗逆转录病毒疗法(ART)依从性差的人类免疫缺陷病毒感染妇女,剖宫产可降低母婴传播的风险。然而,对于坚持抗逆转录病毒疗法的人类免疫缺陷病毒感染妇女或患有 COVID-19 的妇女来说,它并不能提供额外的保护。人类免疫缺陷病毒和 SARS-CoV-2 与新生儿并发症有关,如死胎、出生体重不足和新生儿重症监护室(ICU)住院。对孕妇和新生儿进行普遍检测是预防人类免疫缺陷病毒和 SARS-CoV-2 传播和并发症的有效策略。人类免疫缺陷病毒的控制主要依靠预防垂直传播和孕期及产后用药,而安全行为和疫苗已被证明能有效预防 SARS-CoV-2 垂直传播。摘要:本综述旨在比较和对比人类免疫缺陷病毒和 SARS-CoV-2 对妊娠结局、垂直传播、分娩方式、新生儿结局和临床管理的影响。SARS-CoV-2 和人类免疫缺陷病毒都与严重的产科相关并发症有关,因此密切的临床监测和准备工作至关重要。将 SARS-CoV-2/COVID-19 管理与生殖健康服务相结合,对于确保孕产妇和新生儿的预后至关重要。尽管人类免疫缺陷病毒/获得性免疫缺陷综合症与 SARS-CoV-2 对孕产妇和新生儿预后的影响有所不同,但我们的综述不仅首次为这一主题的知识现状及其临床影响奠定了基础,而且还为未来的研究方向提供了新的见解。利用人类免疫缺陷病毒/获得性免疫缺陷综合症的研究有助于了解 SARS-CoV-2 对妊娠的影响。这两种感染都会给孕妇及其胎儿带来风险,导致孕产妇死亡率和并发症增加。找出共同的模式和风险因素可以改善对 SARS-CoV-2 孕妇的临床管理。虽然直接进行观察研究进行比较可能不可行,但与人类免疫缺陷病毒进行比较则是一种符合道德规范且切实可行的方法。不过,仍有必要对 SARS-CoV-2 进行专门研究,以收集有关孕产妇和胎儿结局的详细数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Maternal and Newborn Outcomes of SARS-CoV-2/COVID-19 and Pregnancy: Parallels and Contrasts with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome.

Purpose of review: Our review aims to compare and contrast Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2/COVID-19's impact on maternal and neonatal outcomes. We have made significant progress in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome prevention and treatment over the last few decades. Drawing on empirical evidence with past public health crises can offer valuable insights into dealing with current and future pandemics. Therefore, it is imperative to conduct a comparative analysis of the resemblances and disparities existing between Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2/COVID-19.This research endeavor represents a pioneering and all-encompassing examination, aiming to discern and comprehend the parallels and contrasts in the respective impacts of SARS-CoV-2 and Human Immunodeficiency Virus on pregnancy.

Recent findings: Based on the current evidence, there is no indication that pregnancy increases women's susceptibility to acquiring Human Immunodeficiency Virus or SARS-CoV-2. Nevertheless, the state of being pregnant was correlated with the worsening of diseases and their progression. Both Human Immunodeficiency Virus and SARS-CoV-2 pose increased risks of maternal mortality and several obstetric complications, including premature birth and pre-eclampsia. While the vertical transmission of Human Immunodeficiency Virus is well-established, a comprehensive understanding of the vertical transmission of SARS-CoV-2 remains elusive, emphasizing the need for further investigations. Initial data suggest low SARS-CoV-2 vertical transmission rates in the setting of proper preventative interventions and universal screening. A cesarean delivery could reduce the risk of mother-to-child transmission in Human Immunodeficiency Virus-infected women with high viral loads or poor adherence to antiretroviral therapy (ART). However, it did not offer additional protection for Human Immunodeficiency Virus-infected women who adhered to Adherence to Antiretroviral Therapy or those with COVID-19. Human Immunodeficiency Virus and SARS-CoV-2 were linked to neonatal complications such as stillbirth, low birth weight, and neonatal intensive care unit (ICU) admissions. The universal testing of both pregnant patients and neonates is an effective strategy to prevent the spread and complications of both Human Immunodeficiency Virus and SARS-CoV-2. Human Immunodeficiency Virus control largely relies on preventing vertical transmission and medications during pregnancy and postpartum, whereas safety behaviors and vaccines have proven effective in preventing SARS-CoV-2 vertical transmissions.

Summary: This review aims to compare and contrast the impact of Human Immunodeficiency Virus and SARS-CoV-2 on pregnancy outcomes, vertical transmissions, delivery modalities, neonatal outcomes, and clinical management. SARS-CoV-2 and Human Immunodeficiency Virus were associated with significant obstetric-related complications, making close clinical monitoring and preparation essential. Integration of SARS-CoV-2/COVID-19 management with reproductive health services is crucial to ensuring maternal and neonatal outcomes. Our review is not only the first to establish a groundwork for the current state of knowledge and its clinical implications on this topic, but it also sheds new insights for future research directions.Comparing Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome and SARS-CoV-2 in terms of their impact on maternal and neonatal outcomes provides valuable insights despite their differences. Leveraging Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome research can help understand SARS-CoV-2 effects on pregnancy. Both infections pose risks to pregnant individuals and their fetuses, leading to increased maternal mortality and complications. Identifying common patterns and risk factors can improve clinical management for pregnant individuals with SARS-CoV-2. While a direct observational study for this comparison may not be feasible, comparing with Human Immunodeficiency Virus offers an ethical and practical approach. However, specific studies on SARS-CoV-2 are still necessary to gather detailed data on maternal and fetal outcomes.

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