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中国循证儿科杂志

中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (1): 32-36.

• COVID-19特稿·论著 • 上一篇    下一篇

冠状病毒感染孕产妇及其分娩新生儿临床结局的系统综述

王来栓1,胡晓静2,王瑞3,钱天阳1,肖甜甜1,张崇凡3,周文浩1   

  1. 作者单位国家儿童医学中心 复旦大学附属儿科医院1 新生儿科，2 护理部，3 临床实践指南制作评价中心上海，201102
  • 收稿日期:2020-03-31 修回日期:2020-03-31 出版日期:2020-02-25 发布日期:2020-03-16
  • 通讯作者: 张崇凡，周文浩
  • 基金资助:
     

Clinical outcomes in pregnant women with coronavirus infection and their neonates: A systematic review

 WANG Lai-shuan1, HU Xiao-jing2, WANG Rui3, QIAN Tian-yang1, XIAO Tian-tian1, ZHANG Chong-fan3, ZHOU Wen-hao1   

  1.  National Children's Medical Center, Children's Hospital of Fudan University: 1 Department of Neonatology, 2 Nursing Department, 3 Center for Clinical Practice Guideline Development and Evaluation, Shanghai 201102, China
  • Received:2020-03-31 Revised:2020-03-31 Online:2020-02-25 Published:2020-03-16
  • Contact: ZHANG Chong-fan, ZHOU Wen-hao
  • Supported by:
     

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摘要： 目的比较严重急性呼吸综合征冠状病毒1(SARS-CoV-1)、中东呼吸综合征病毒（MERS-CoV）及严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染孕妇的妊娠结局及对新生儿的影响，为指导SARS-CoV-2感染的防治提供证据。方法纳入核酸检测确诊冠状病毒（SARS、MERS和 COVID-19）感染的孕产妇分娩的新生儿，系统检索SARS、MERS和COVID-19孕妇的妊娠结局及新生儿文献，在Pubmed、中国生物医学文献数据库（CBM）和中国知网数据库（CNKI）检索，并在WHO COVID-19文献数据库和纳入文献的参考文献中进行补充检索，检索起止时间：2000年1月1日至2020年3月9日。分别通过阅读摘要和全文进行文献筛选，排除诊断试剂、分子诊断等方面文献。文献提取和评价均得到临床指南制作和评价中心专业人员的培训和审核，并对文献行偏倚风险评价。结果共纳入42例确诊冠状病毒感染的孕产妇和36例活产新生儿。其中SARS-CoV-1感染孕产妇13例，死亡3例 (23%)，存活10例中4例在孕早期发生自然流产 (40%)，其余6例分娩活产新生儿6例 (早产4例，足月2例)，均未发生SARS-CoV-1感染；确诊MERS-CoV感染孕产妇2例，存活2例共分娩活产新生儿2例（早产、足月各1例）， 均未发生MERS-CoV感染；确诊SARS-CoV-2感染孕产妇27例，无产妇死亡病例，分娩活产新生儿28例 (双胞胎1例)，咽拭子SARS-CoV-2核酸检测阳性新生儿3例，1例重型病例（先天性房间隔缺损）、2例轻型病例，生后新生儿与家人均有密切接触史，无证据显示胎盘垂直传播，均未行亲自母乳喂养，均治愈出院。结论文献报道不够充分的SARS-CoV-1和MERS-CoV感染孕产妇及其新生儿流行病学和临床特征，对SARS-CoV-2感染孕产妇及其新生儿感染预防、诊断和治疗仍有一定的参考价值。尽管文献存在高偏倚风险，但SARS-CoV-2感染晚期孕产妇及其新生儿出院时的结局是好的。

 

Abstract: Objective To compare the pregnancy outcomes of pregnant women infected with SARS-CoV-1, MERS-CoV and SARS-CoV-2 and their impacts on newborns so as to provide evidence to guide the prevention and treatment of COVID-19. MethodsNeonates delivered by pregnant women diagnosed with coronavirus (SARS-CoV-1, MERS-CoV and SARS-CoV-2) infections through nucleic acid tests were included. Literature on pregnant women with SARS, MERS and COVID-19 and their neonates was searched in the database of PubMed, CBM and CNKI from January 1st, 2000 to March 9th, 2020 and a supplementary search was performed in the WHO COVID-19 literature database and references of the included literature. The literature was screened by reading the abstract and the full text according the eligibility criteria. Literature evaluation and data extraction were instructed and reviewed by professionals from Center for Clinical Guideline Development and Evaluation in Children's Hospital of Fudan University. ResultsA total of 42 pregnant women diagnosed with coronavirus infections and 36 live births were included for statistical analysis. There were 13 cases of SARS-CoV-1 infected pregnant women. Among them, 3 died (23%) and 4 of 10 surviving cases had a spontaneous abortion in the first trimester (40%), and the remaining 6 cases gave birth to 6 neonates (4 premature and 2 full-term) without SARS-CoV-1 infection. Two pregnant women were diagnosed with MERS-CoV infection. Both of them survived and 2 live-born neonates were born (1 premature and 1 full-term) without MERS-CoV infection. There were 27 confirmed cases of pregnant women with SARS-CoV-2 infection without deaths and 28 live births (1 twins) were delivered. Three of the newborns were tested positive for the nucleic acid test of SARS-CoV-2 through nasopharyngeal swabs with one severe case with congenital atrial septum defect and two mild cases. Close contact between mother and baby or family members after birth existed and no evidence of vertical placental transmission was found. There was no breastfeeding. All were cured and discharged. ConclusionThough the epidemiological and clinical characteristics of pregnant women infected by SARS-CoV-1 and MERS-CoV and their newborns were insufficiently reported in the literature, it was still of certain reference value for the prevention, diagnosis and treatment of SARS-CoV-2 infection in this population. Despite the high risk of bias in the literature, the outcomes of pregnant women with SARS-CoV-2 infection and their newborns at discharge were good.

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