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目前关于2019年新型冠状病毒病(COVID-19)引起的肺炎暴发的研究大多数是基于普通人群的信息，患有COVID-19肺炎的孕妇的数据有限。近日柳叶刀发表了一项回顾性研究，该研究探讨了COVID-19在妊娠期的临床特点及COVID-19感染的宫内垂直传播潜力。
这项研究回顾性分析了武汉大学中南医院2020年1月20日至1月31日收治的9例经实验室确诊的COVID-19型肺炎孕妇的临床资料、实验室检查结果及胸部CT扫描结果，即孕妇咽拭子标本中检出新型冠状病毒 (SARS-CoV-2)。通过检测羊水、脐带血和新生儿咽拭子样本中SARS-CoV-2的存在来评估宫内垂直传播的证据。
这项研究中所有9名患者都在妊娠晚期进行了剖腹产手术。有7名患者出现发烧症状，还有咳嗽4名、肌痛3名、喉咙痛2名和身体不适2名。9例患者中有5例出现淋巴细胞减少(<1× 109个/L)。3名患者的转氨酶浓度升高。截至2020年2月4日，没有患者患上严重的COVID-19肺炎或死亡。该研究记录了9例活产。新生儿中未观察到新生儿窒息，所有9名活产婴儿的1分钟Apgar评分为8-9，5分钟Apgar评分为9-10。对6名患者的羊水、脐带血、新生儿喉咙拭子和母乳样本进行了SARS-CoV-2检测，所有样本均为阴性。
该研究认为孕妇COVID-19型肺炎的临床特征与报告的非妊娠成人患者发生COVID-19型肺炎的临床特征相似。这一小部分病例的研究结果表明，目前没有证据表明在妊娠晚期患COVID-19型肺炎的妇女中存在垂直传播引起的宫内感染。
Background: Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical tran *** ission potential of COVID-19 infection.
Methods: Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical tran *** ission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation.
Findings: All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 109 cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8–9 and a 5-min Apgar score of 9–10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus.
Interpretation: The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant *** patients who developed COVID-19 pneumonia. Findings from this *** all group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical tran *** ission in women who develop COVID-19 pneumonia in late pregnancy.
文献参考：
Huijun Chen et al. Clinical characteristics and intrauterine vertical tran *** ission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet, 2020, doi:10.1016/S0140-6736(20)30360-3.
