妊娠不同时期感染新型冠状病毒孕妇临床特征及对妊娠结局的影响

摘要：目的：分析妊娠不同时期感染新型冠状病毒（COVID-19）孕妇的临床特征及妊娠结局差异。方法：纳入 2022 年 12 月至 2023 年 5 月于本院确诊 COVID-19 的单胎妊娠孕妇 202 例，按感染时孕周分为孕早期组（<14 周，109 例）、孕中期组（14~27⁺⁶周，71 例）、孕晚期组（≥28 周，22 例）。收集孕妇一般资料、临床症状、用药行为及妊娠结局。采用 Kruskal-Wallis H 检验、χ² 检验及单因素方差分析进行组间比较，检验水准 α=0.05。结果：202 例孕妇中，孕早期感染 109 例（53.96%），为感染高发阶段。三组发热程度比较，孕早期组中高热（体温 39.1℃~41.0℃）比例最高，差异有统计学意义（H=9.8417，P=0.0073）；咳嗽发生率以孕中晚期组更高（χ²=7.542，P=0.023）；咽痛、身体疼痛发生率三组差异无统计学意义（P>0.05）。202 例中共 9 例未获活产：1 例孕中期死胎，8 例因胎儿发育异常引产（孕早期组 7 例，引产率 6.4%；孕中期组 1 例，引产率 1.4%），胎儿异常引产率组间差异无统计学意义（Fisher 确切概率法，P=0.147）。193 例活产孕妇中，早产率 8.29%（16/193），剖宫产率 39.38%（76/193）；三组早产率、剖宫产率差异均无统计学意义（P>0.05）。结论：孕早期是妊娠期 COVID-19 感染的高发阶段，不同感染时期孕妇的临床症状存在差异：孕早期感染发热程度更重，孕中晚期咳嗽更常见。孕早期感染后因胎儿异常引产比例在数值上高于孕中晚期，但差异未达统计学意义，需扩大样本量进一步验证。在继续妊娠并活产的孕妇中，未发现感染孕周及发热程度对早产、剖宫产率有显著影响。建议对孕早期感染者重点关注发热管理及产前筛查，同时加强遗传咨询，实施分孕期个体化临床管理。

关键词：妊娠；新型冠状病毒；感染时期；临床特征；妊娠结局

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Clinical Characteristics of Pregnant Women Infected with SARS-CoV-2 at Different

Gestational Stages and Their Effects on Pregnancy Outcomes

Abstract：Objectives: To analyze the differences in clinical characteristics and pregnancy outcomes among pregnant women infected with coronavirus disease 2019 (COVID-19) at different gestational stages. Methods: A total of 202 singleton pregnant women diagnosed with COVID-19 in our hospital from December 2022 to May 2023 were enrolled. According to the gestational age at infection, they were divided into the first-trimester group (<14 weeks, 109 cases), second-trimester group (14–27⁺⁶ weeks, 71 cases) and third-trimester group (≥28 weeks, 22 cases). General information, clinical symptoms, medication use and pregnancy outcomes of the participants were collected. Intergroup comparisons were performed using the Kruskal-Wallis H test, chi-square test and one-way analysis of variance, with the test level set at α=0.05. Results: Among the 202 pregnant women, 109 cases (53.96%) were infected in the first trimester, representing the high-incidence period. Comparison of fever severity among the three groups showed that the proportion of high fever (body temperature 39.1 ℃–41.0 ℃) was the highest in the first-trimester group, with statistically significant difference (H=9.8417, P=0.0073). The incidence of cough was higher in the second and third-trimester groups (χ²=7.542, P=0.023). No significant intergroup differences were observed in the incidences of sore throat and myalgia (P>0.05). Among all 202 cases, 9 pregnancies did not result in live birth: 1 stillbirth in the second trimester, and 8 induced abortions due to fetal developmental anomalies (7 cases in the first-trimester group, induced abortion rate 6.4%; 1 case in the second-trimester group, induced abortion rate 1.4%). No statistically significant difference was found in the rate of induced abortion for fetal anomalies among groups (Fisher’s exact test, P=0.147). Among the 193 women with live births, the preterm birth rate was 8.29% (16/193) and the cesarean delivery rate was 39.38% (76/193). There were no significant intergroup differences in preterm birth rate and cesarean delivery rate (P>0.05). Conclusions: The first trimester is the high-incidence stage of COVID-19 infection during pregnancy. Clinical symptoms vary by gestational stage at infection: fever tends to be more severe in women infected in the first trimester, whereas cough is more common in those infected in the second and third trimesters. Although the rate of induced abortion owing to fetal anomalies was numerically higher after first-trimester infection, the difference failed to reach statistical significance, which needs further verification with enlarged sample size. Among women who continued pregnancy and achieved live birth, gestational age at infection and fever severity exerted no significant influence on preterm birth rate or cesarean delivery rate. For patients infected in the first trimester, intensified attention to fever management and prenatal screening is recommended, alongside enhanced genetic counseling and individualized clinical management stratified by gestational period.

Keywords: Pregnancy; Coronavirus disease 2019; Timing of infection; Clinical characteristics; Pregnancy outcomes

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