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Pregnancy and COVID-19: past, present and future

김의혁|김영근
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2023.05|Obstetrics & Gynecology Science|제66권 제3호|pp. 149-160|DOI https://doi.org/10.5468/ogs.23001

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COVID-19PregnancyRisk factorsSevere acute respiratory syndrome coronavirus 2Vertical infection transmission
주제분류산부인과학

초록

Current evidence suggests that severe acute respiratory syndrome coronavirus 2 infection is associated with anincreased incidence of adverse severe maternal and perinatal outcomes. However, vertical transmission is rare. Themanagement of pregnant women with coronavirus disease 2019 (COVID-19) is similar to that of non-pregnantwomen, and effective treatments, including antiviral therapy, dexamethasone, and prophylactic anticoagulationshould not be withheld during pregnancy. During the early COVID-19 pandemic period, the management of pregnant women was often delayed until thepolymerase chain reaction (PCR) results came out or due to close contact, even among those without symptoms. Outof concern for the spread of infection, cesarean sections were performed instead of vaginal birth, since infection couldhave led to an increase in maternal and neonatal morbidities. Additionally, if the maternal PCR test was positive, theneonate was quarantined, and despite infectivity decreasing 10 days after symptom onset. It is necessary to ease thestrict measures of infection control in the field of obstetrics. The presence or absence of maternal COVID-19 symptoms should be identified to stratify the risk, and vaginaldelivery can be attempted in asymptomatic women with low infectivity. With more women being vaccinated safetydata about vaccination is rapidly accumulating and no concerns have been detected. Globally, COVID-19 vaccinesare recommended even during pregnancy. In order to prepare for future pandemics, it is necessary to apply lessonslearned from this pandemic. Policymakers and healthcare leaders must determine efficient and effective strategies forpreserving safe maternal care, even during an ongoing global emergency.

Abstract

Current evidence suggests that severe acute respiratory syndrome coronavirus 2 infection is associated with anincreased incidence of adverse severe maternal and perinatal outcomes. However, vertical transmission is rare. Themanagement of pregnant women with coronavirus disease 2019 (COVID-19) is similar to that of non-pregnantwomen, and effective treatments, including antiviral therapy, dexamethasone, and prophylactic anticoagulationshould not be withheld during pregnancy. During the early COVID-19 pandemic period, the management of pregnant women was often delayed until thepolymerase chain reaction (PCR) results came out or due to close contact, even among those without symptoms. Outof concern for the spread of infection, cesarean sections were performed instead of vaginal birth, since infection couldhave led to an increase in maternal and neonatal morbidities. Additionally, if the maternal PCR test was positive, theneonate was quarantined, and despite infectivity decreasing 10 days after symptom onset. It is necessary to ease thestrict measures of infection control in the field of obstetrics. The presence or absence of maternal COVID-19 symptoms should be identified to stratify the risk, and vaginaldelivery can be attempted in asymptomatic women with low infectivity. With more women being vaccinated safetydata about vaccination is rapidly accumulating and no concerns have been detected. Globally, COVID-19 vaccinesare recommended even during pregnancy. In order to prepare for future pandemics, it is necessary to apply lessonslearned from this pandemic. Policymakers and healthcare leaders must determine efficient and effective strategies forpreserving safe maternal care, even during an ongoing global emergency.

참고문헌 (92)

  1. Wiersinga WJ, "Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019(COVID-19) : a review", JAMA, 324, pp.782~793 (2020)
  2. Kourtis AP, "Pregnancy and infection", N Engl J Med, 370, pp.2211~2218 (2014)
  3. Robinson DP, "Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis", Horm Behav, 62, pp.263~271 (2012)
  4. Pazos M, "The influence of pregnancy on systemic immunity", Immunol Res, 54, pp.254~261 (2012)
  5. Badr DA, "Severe acute respiratory syndrome coronavirus 2 and pregnancy outcomes according to gestational age at time of infection", Emerg Infect Dis, 27, pp.2535~2543 (2021)
  6. Metz TD, "Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019(COVID-19)", Obstet Gynecol, 137, pp.571~580 (2021)
  7. Vousden N, "The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020 : a national cohort study using the UK Obstetric Surveillance System(UKOSS)", PLoS One, 16, pp.e0251123~ (2021)
  8. LoMauro A, "Respiratory physiology of pregnancy : physiology masterclass", Breathe(Sheff), 11, pp.297~301 (2015)
  9. Liu D, "Pregnancy and perinatal outcomes of women with coronavirus disease(COVID-19)pneumonia : a preliminary analysis", AJR Am J Roentgenol, 215, pp.127~132 (2020)
  10. Callaghan WM, "Pregnancyrelated mortality resulting from influenza in the United States during the 2009-2010 pandemic", Obstet Gynecol, 126, pp.486~490 (2015)
  11. Rogers VL, "Presentation of seasonal influenza a in pregnancy : 2003-2004 influenza season", Obstet Gynecol, 115, pp.924~929 (2010)
  12. Guan WJ, "Clinical characteristics of coronavirus disease 2019 in China", N Engl J Med, 382, pp.1708~1720 (2020)
  13. Vintzileos WS, "Screening all pregnant women admitted to labor and delivery for the virus responsible for coronavirus disease 2019", Am J Obstet Gynecol, 223, pp.284~286 (2020)
  14. Jamieson DJ, "An update on COVID-19and pregnancy", Am J Obstet Gynecol, 226, pp.177~186 (2022)
  15. Hantoushzadeh S, "Maternal death due to COVID-19", Am J Obstet Gynecol, 223, pp.109~ (2020)
  16. Panagiotakopoulos L, "SARS-CoV-2 infection among hospitalized pregnant women : reasons for admission and pregnancy characteristics-eight U. S. health care centers, March 1-May 30, 2020", MMWR Morb Mortal Wkly Rep, 69, pp.1355~1359 (2020)
  17. Lokken EM, "Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State", Am J Obstet Gynecol, 223, pp.911~ (2020)
  18. Knight M, "Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARSCoV-2 infection in UK : national population based cohort study", BMJ, 369, pp.m2107~ (2020)
  19. "WHO coronavirus (COVID-19) dashboard 2020" (2023)[URL]
  20. Oran DP, "Prevalence of asymptomatic SARSCoV-2 infection : a narrative review", Ann Intern Med, 173, pp.362~367 (2020)
  21. Buitrago-Garcia D, "Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections : a living systematic review and meta-analysis", PLoS Med, 17, pp.e1003346~ (2020)
  22. 이여진, "한국의 임산부에서 실험실에서 확인된 SARS-CoV-2 감염에 따른 임상 양상 및 산모와 신생아의 결과", 한국모자보건학회지, 26(2), pp.104~111 (2022), 한국모자보건학회
  23. Shook LL, "SARS-CoV-2 placentitis associated with B. 1. 617. 2(Delta)variant and fetal distress or demise", J Infect Dis, 225, pp.754~758 (2022)
  24. Lokken EM, "Disease severity, pregnancy outcomes, and maternal deaths among pregnant patients with severe acute respiratory syndrome coronavirus 2 infection in Washington State", Am J Obstet Gynecol, 225, pp.77~ (2021)
  25. Zambrano LD, "Update : characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status-United States, January 22-October 3, 2020", MMWR Morb Mortal Wkly Rep, 69, pp.1641~1647 (2020)
  26. Magnus MC, "Pregnancy and risk of COVID-19 : a Norwegian registry-linkage study", BJOG, 129, pp.101~109 (2022)
  27. McClymont E, "Association of SARS-CoV-2 infection during pregnancy with maternal and perinatal outcomes", JAMA, 327, pp.1983~1991 (2022)
  28. Golan Y, "COVID-19 mRNA vaccination in lactation : assessment of adverse events and vaccine related antibodies in mother-infant dyads", Front Immunol, 12, pp.777103~ (2021)
  29. Jacoby VL, "Risk of pregnancy loss before 20 weeks’ gestation in study participants with COVID-19", Am J Obstet Gynecol, 225, pp.456~457 (2021)
  30. Galang RR, "Risk factors for illness severity among pregnant women with confirmed severe acute respiratory syndrome coronavirus 2 infectionsurveillance for emerging threats to mothers and babies network, 22 state, local, and territorial health departments, 29 March 2020-5 March 2021", Clin Infect Dis, 73, pp.S17~23 (2021)
  31. Allotey J, "Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019in pregnancy : living systematic review and meta-analysis", BMJ, 370, pp.m3320~ (2020)
  32. Wei SQ, "The impact of COVID-19 on pregnancy outcomes : a systematic review and meta-analysis", CMAJ, 193, pp.E540~8 (2021)
  33. Di Mascio D, "Outcome of coronavirus spectrum infections(SARS, MERS, COVID-19)during pregnancy : a systematic review and meta-analysis", Am J Obstet Gynecol MFM, 2, pp.100107~ (2020)
  34. Marchand G, "Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to June 3, 2021", AJOG Glob Rep, 2, pp.100049~ (2022)
  35. Mullins E, "Pregnancy and neonatal outcomes of COVID-19 : coreporting of common outcomes from PANCOVID and AAP-SONPM registries", Ultrasound Obstet Gynecol, 57, pp.573~581 (2021)
  36. Jering KS, "Clinical characteristics and outcomes of hospitalized women giving birth with and without COVID-19", JAMA Intern Med, 181, pp.714~717 (2021)
  37. Woodworth KR, "Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy-SET-NET, 16 jurisdictions, March 29-October 14, 2020", MMWR Morb Mortal Wkly Rep, 69, pp.1635~1640 (2020)
  38. "Vital statistics rapid release births: provisional data for 2018" (2018)[URL]
  39. Katz D, "The society for obstetric anesthesia and perinatology coronavirus disease 2019 registry : an analysis of outcomes among pregnant women delivering during the initial severe acute respiratory syndrome coronavirus-2 outbreak in the United States", Anesth Analg, 133, pp.462~473 (2021)
  40. Pierce-Williams RAM, "Clinical course of severe and critical coronavirus disease 2019 in hospitalized pregnancies : a United States cohort study", Am J Obstet Gynecol MFM, 2, pp.100134~ (2020)
  41. Smith LH, "Timing and severity of COVID-19during pregnancy and risk of preterm birth in the international registry of coronavirus exposure in pregnancy", BMC Pregnancy Childbirth, 22, pp.775~ (2022)
  42. Shah PS, "Preterm birth and stillbirth rates during the COVID-19 pandemic : a population-based cohort study", CMAJ, 193, pp.E1164~72 (2021)
  43. Chmielewska B, "Effects of the COVID-19 pandemic on maternal and perinatal outcomes : a systematic review and meta-analysis", Lancet Glob Health, 9, pp.e759~72 (2021)
  44. Been JV, "Impact of COVID-19 mitigation measures on the incidence of preterm birth : a national quasi-experimental study", Lancet Public Health, 5, pp.e604~11 (2020)
  45. Harvey EM, "Association of preterm birth rate with COVID-19 statewide stay-at-home orders in tennessee", JAMA Pediatr, 175, pp.635~637 (2021)
  46. Villar J, "Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection : the INTERCOVID multinational cohort study", JAMA Pediatr, 175, pp.817~826 (2021)
  47. Allotey J, "SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission : living systematic review and meta-analysis", BMJ, 376, pp.e067696~ (2022)
  48. Kirtsman M, "Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection", CMAJ, 192, pp.E647~50 (2020)
  49. Vivanti AJ, "Transplacental transmission of SARSCoV-2 infection", Nat Commun, 11, pp.3572~ (2020)
  50. Jeganathan K, "Vertical transmission of SARSCoV-2 : a systematic review", Obstet Med, 15, pp.91~98 (2022)
  51. "The evolving epidemiologic and clinical picture of SARS-CoV-2 and COVID-19 disease in children and young people" (2020)[URL]
  52. Edlow AG, "Assessment of maternal and neonatal SARSCoV-2 viral load, transplacental antibody transfer, and placental pathology in pregnancies during the COVID-19pandemic", JAMA Netw Open, 3, pp.e2030455~ (2020)
  53. Wang W, "Detection of SARS-CoV-2 in different types of clinical specimens", JAMA, 323, pp.1843~1844 (2020)
  54. Wong YP, "The effects of COVID-19on placenta and pregnancy : what do we know so far?", Diagnostics(Basel), 11, pp.94~ (2021)
  55. Chambers C, "Evaluation for SARS-CoV-2 in breast milk from 18 infected women", JAMA, 324, pp.1347~1348 (2020)
  56. Salvatore CM, "Neonatal management and outcomes during the COVID-19 pandemic : an observation cohort study", Lancet Child Adolesc Health, 4, pp.721~727 (2020)
  57. "COVID-19 FAQs for obstetrician-gynecologists, obstetrics" (2020)[URL]
  58. "Evaluation and management considerations for neonates at risk for COVID-19" (2020)[URL]
  59. Vousden N, "Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes : data from the UK obstetric surveillance system national cohort", MedRxiv, 2021, pp.21261000~ (2021)
  60. "Coronavirus disease 2019(COVID-19) treatment guidelines" (2022)[URL]
  61. "COVID-19 vaccination considerations for obstetric-gynecologic care. Practice advisory 2020" (2022)[URL]
  62. James JL, "The regulation of trophoblast differentiation by oxygen in the first trimester of pregnancy", Hum Reprod Update, 12, pp.137~144 (2006)
  63. Jensen GM, "The effect of high altitude and other risk factors on birthweight : independent or interactive effects?", Am J Public Health, 87, pp.1003~1007 (1997)
  64. Tapanainen PJ, "Maternal hypoxia as a model for intrauterine growth retardation : effects on insulin-like growth factors and their binding proteins", Pediatr Res, 36, pp.152~158 (1994)
  65. Shanes ED, "Placental pathology in COVID-19", Am J Clin Pathol, 154, pp.23~32 (2020)
  66. Glynn SM, "SARS-CoV-2 and placental pathology : malperfusion patterns are dependent on timing of infection during pregnancy", Am J Surg Pathol, 46, pp.51~57 (2022)
  67. Dashraath P, "Coronavirus disease 2019(COVID-19)pandemic and pregnancy", Am J Obstet Gynecol, 222, pp.521~531 (2020)
  68. DeSisto CL, "Risk for stillbirth among women with and without COVID-19 at delivery hospitalization-united states, March 2020-September 2021", MMWR Morb Mortal Wkly Rep, 70, pp.1640~1645 (2021)
  69. Srivastava K, "Covid-19 : why has India had a spike in stillbirths?", BMJ, 374, pp.n2133~ (2021)
  70. Hernández-Díaz S, "First trimester COVID-19 and the risk of major congenital malformations-International registry of coronavirus exposure in pregnancy", Birth Defects Res, 114, pp.906~914 (2022)
  71. Kachikis A, "Short-term reactions among pregnant and lactating individuals in the first wave of the COVID-19vaccine rollout", JAMA Netw Open, 4, pp.e2121310~ (2021)
  72. Perl SH, "SARS-CoV-2-specific antibodies in breast milk after COVID-19 vaccination of breastfeeding women", JAMA, 325, pp.2013~2014 (2021)
  73. Young BE, "Association of human milk antibody induction, persistence, and neutralizing capacity with SARS-CoV-2 infection vs mRNA vaccination", JAMA Pediatr, 176, pp.159~168 (2022)
  74. Goldshtein I, "Association between BNT162b2vaccination and incidence of SARS-CoV-2 infection in pregnant women", JAMA, 326, pp.728~735 (2021)
  75. Eid J, "Decreased severity of COVID-19in vaccinated pregnant individuals during predominance of different SARS-CoV-2 variants", Am J Reprod Immunol, 88, pp.e13596~ (2022)
  76. Kim H, "Impact of vaccination and the omicron variant on COVID-19 severity in pregnant women", Am J Infect Control, 51, pp.351~353 (2023)
  77. Prabhu M, "Antibody response to coronavirus disease 2019(COVID-19)messenger RNA vaccination in pregnant women and transplacental passage into cord blood", Obstet Gynecol, 138, pp.278~280 (2021)
  78. Zauche LH, "Receipt of mRNA Covid-19 vaccines and risk of spontaneous abortion", N Engl J Med, 385, pp.1533~1535 (2021)
  79. Kharbanda EO, "Spontaneous abortion following COVID-19 vaccination during pregnancy", JAMA, 326, pp.1629~1631 (2021)
  80. Lipkind HS, "Receipt of COVID-19vaccine during pregnancy and preterm or small-forgestational-age at birth-eight integrated health care organizations, United States, December 15, 2020-July 22, 2021", MMWR Morb Mortal Wkly Rep, 71, pp.26~30 (2022)
  81. Sadarangani M, "Safety of COVID-19vaccines in pregnancy : a Canadian National Vaccine Safety(CANVAS)Network cohort study", Lancet Infect Dis, 22, pp.1553~1564 (2022)
  82. 안기훈, "COVID-19 and vaccination during pregnancy: a systematic analysis using Korea National Health Insurance claims data", Obstetrics & Gynecology Science, 65(6), pp.487~501 (2022), 대한산부인과학회[DOI]
  83. Magnus MC, "Covid-19 vaccination during pregnancy and first-trimester miscarriage", N Engl J Med, 385, pp.2008~2010 (2021)
  84. Ruderman RS, "Association of COVID-19 vaccination during early pregnancy with risk of congenital fetal anomalies", JAMA Pediatr, 176, pp.717~719 (2022)
  85. "Maternal immunization" (2022)[URL]
  86. Rottenstreich A, "The effect of gestational age at BNT162b2 mRNA vaccination on maternal and neonatal severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)antibody levels", Clin Infect Dis, 75, pp.e603~10 (2022)
  87. Yang YJ, "Association of gestational age at coronavirus disease 2019(COVID-19)vaccination, history of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection, and a vaccine booster dose with maternal and umbilical cord antibody levels at delivery", Obstet Gynecol, 139, pp.373~380 (2022)
  88. Martínez-Perez O, "Association between mode of delivery among pregnant women with COVID-19 and maternal and neonatal outcomes in Spain", JAMA, 324, pp.296~299 (2020)
  89. Liu S, "Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term", CMAJ, 176, pp.455~460 (2007)
  90. Rottenstreich A, "Efficient maternofetal transplacental transfer of anti-severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)spike antibodies after antenatal SARS-CoV-2 BNT162b2 messenger RNA vaccination", Clin Infect Dis, 73, pp.1909~1912 (2021)
  91. Shimabukuro TT, "Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons", N Engl J Med, 384, pp.2273~2282 (2021)
  92. Phillips N, "The coronavirus is here to stay-here’s what that means", Nature, 590, pp.382~384 (2021)

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