Abstract
Objective: The primary aim of this article was to describe SARS-CoV-2 infection among pregnant women during the wild-type and Alpha-variant periods in Italy. The secondary aim was to compare the impact of the virus variants on the severity of maternal and perinatal outcomes.
Design: National population-based prospective cohort study.
Setting: A total of 315 Italian maternity hospitals.
Sample: A cohort of 3306 women with SARS-CoV-2 infection confirmed within 7 days of hospital admission.
Methods: Cases were prospectively reported by trained clinicians for each participating maternity unit. Data were described by univariate and multivariate analyses.
Main outcome measures: COVID-19 pneumonia, ventilatory support, intensive care unit (ICU) admission, mode of delivery, preterm birth, stillbirth, and maternal and neonatal mortality.
Results: We found that 64.3% of the cohort was asymptomatic, 12.8% developed COVID-19 pneumonia and 3.3% required ventilatory support and/or ICU admission. Maternal age of 30-34 years (OR 1.43, 95% CI 1.09-1.87) and ≥35 years (OR 1.62, 95% CI 1.23-2.13), citizenship of countries with high migration pressure (OR 1.75, 95% CI 1.36-2.25), previous comorbidities (OR 1.49, 95% CI 1.13-1.98) and obesity (OR 1.72, 95% CI 1.29-2.27) were all associated with a higher occurrence of pneumonia. The preterm birth rate was 11.1%. In comparison with the pre-pandemic period, stillbirths and maternal and neonatal deaths remained stable. The need for ventilatory support and/or ICU admission among women with pneumonia increased during the Alpha-variant period compared with the wild-type period (OR 3.24, 95% CI 1.99-5.28).
Conclusions: Our results are consistent with a low risk of severe COVID-19 disease among pregnant women and with rare adverse perinatal outcomes. During the Alpha-variant period there was a significant increase of severe COVID-19 illness. Further research is needed to describe the impact of different SARS-CoV-2 viral strains on maternal and perinatal outcomes.
Keywords: COVID-19 pneumonia; Cohort studies; Italy; SARS-CoV-2; pregnancy.
【저자키워드】 SARS-CoV-2, COVID-19 pneumonia, Italy, Cohort studies, pregnancy., 【초록키워드】 COVID-19, COVID-19 pneumonia, intensive care, Pneumonia, SARS-COV-2 infection, obesity, severity, intensive care unit, Comorbidity, risk, outcome, Italy, prospective cohort study, Cohort studies, ICU, hospitals, COVID-19 disease, pregnant women, outcomes, Cohort, Maternal, Pregnancy, Preterm birth, Stillbirth, Migration, Asymptomatic, Research, ICU admission, death, age, Hospital admission, virus variants, women, Admission, severe COVID-19 disease, strain, Neonatal, ventilatory support, Birth rate, Neonatal Mortality, 95% CI, clinician, mode, significant increase, COVID-19 illness, wild-type, multivariate analyses, severe COVID-19 illness, maternal age, citizenship, country, Italian, SARS-CoV-2 viral, Occurrence, described, reported, remained, required, virus variant, 【제목키워드】 COVID-19 severity, population-based cohort, viral strain, National, hospitalised,