000112751 001__ 112751
000112751 005__ 20230519145605.0
000112751 0247_ $$2doi$$a10.1016/j.ajog.2021.05.014
000112751 0248_ $$2sideral$$a127845
000112751 037__ $$aART-2021-127845
000112751 041__ $$aeng
000112751 100__ $$aPapageorghiou, Aris T.
000112751 245__ $$aPreeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study
000112751 260__ $$c2021
000112751 5060_ $$aAccess copy available to the general public$$fUnrestricted
000112751 5203_ $$aBackground: It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective: This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design: This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results: We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion: COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.
000112751 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000112751 590__ $$a10.693$$b2021
000112751 592__ $$a2.948$$b2021
000112751 594__ $$a13.2$$b2021
000112751 591__ $$aOBSTETRICS & GYNECOLOGY$$b2 / 85 = 0.024$$c2021$$dQ1$$eT1
000112751 593__ $$aObstetrics and Gynecology$$c2021$$dQ1
000112751 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000112751 700__ $$aDeruelle, Philippe
000112751 700__ $$aGunier, Robert B.
000112751 700__ $$aRauch, Stephen
000112751 700__ $$aGarcía-May, Perla K.
000112751 700__ $$aMhatre, Mohak
000112751 700__ $$aUsman, Mustapha Ado
000112751 700__ $$aAbd-Elsalam, Sherief
000112751 700__ $$aEtuk, Saturday
000112751 700__ $$aSimmons, Lavone E.
000112751 700__ $$aNapolitano, Raffaele
000112751 700__ $$aDeantoni, Sonia
000112751 700__ $$aLiu, Becky
000112751 700__ $$aPrefumo, Federico
000112751 700__ $$aSavasi, Valeria
000112751 700__ $$ado Vale, Marynéa Silva
000112751 700__ $$aBaafi, Eric
000112751 700__ $$aZainab, Ghulam
000112751 700__ $$aNieto, Ricardo
000112751 700__ $$aMaiz, Nerea
000112751 700__ $$aAminu, Muhammad Baffah
000112751 700__ $$aCardona-Perez, Jorge Arturo
000112751 700__ $$aCraik, Rachel
000112751 700__ $$aWinsey, Adele
000112751 700__ $$aTavchioska, Gabriela
000112751 700__ $$aBako, Babagana
000112751 700__ $$0(orcid)0000-0002-0670-5541$$aOros, Daniel
000112751 700__ $$aRego, Albertina
000112751 700__ $$aBenski, Anne Caroline
000112751 700__ $$aHassan-Hanga, Fatimah
000112751 700__ $$aSavorani, Mónica
000112751 700__ $$aGiuliani, Francesca
000112751 700__ $$aSentilhes, Loïc
000112751 700__ $$aRisso, Milagros
000112751 700__ $$aTakahashi, Ken
000112751 700__ $$aVecchiarelli, Carmen
000112751 700__ $$aIkenoue, Satoru
000112751 700__ $$aThiruvengadam, Ramachandran
000112751 700__ $$aSoto Conti, Constanza P.
000112751 700__ $$aFerrazzi, Enrico
000112751 700__ $$aCetin, Irene
000112751 700__ $$aNachinab, Vincent Bizor
000112751 700__ $$aErnawati, Ernawati
000112751 700__ $$aDuro, Eduardo A.
000112751 700__ $$aKholin, Alexey
000112751 700__ $$aFirlit, Michelle L.
000112751 700__ $$aEaster, Sarah Rae
000112751 700__ $$aSichitiu, Joanna
000112751 700__ $$aBowale, Abimbola
000112751 700__ $$aCasale, Roberto
000112751 700__ $$aCerbo, Rosa Maria
000112751 700__ $$aCavoretto, Paolo Ivo
000112751 700__ $$aEskenazi, Brenda
000112751 700__ $$aThornton, Jim G.
000112751 700__ $$aBhutta, Zulfiqar A.
000112751 700__ $$aKennedy, Stephen H.
000112751 700__ $$aVillar, José
000112751 773__ $$g225, 3 (2021), 289.e1-289.e17$$pAm. j. obstet. gynecol.$$tAMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY$$x0002-9378
000112751 8564_ $$s657757$$uhttps://zaguan.unizar.es/record/112751/files/texto_completo.pdf$$yVersión publicada
000112751 8564_ $$s3594432$$uhttps://zaguan.unizar.es/record/112751/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000112751 909CO $$ooai:zaguan.unizar.es:112751$$particulos$$pdriver
000112751 951__ $$a2023-05-18-16:04:04
000112751 980__ $$aARTICLE