Impact of the COVID-19 pandemic, SARS-CoV-2 infection and social determinants of health on pregnancy complications, birth outcomes and post-pregnancy maternal cardiovascular and mortality outcomes

COVID-19 大流行、SARS-CoV-2 感染和健康社会决定因素对妊娠并发症、出生结局以及孕后孕产妇心血管和死亡率结局的影响

• 批准号: 10598574
• 负责人: KELLY J HUNT
• 金额: $ 49.47万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10598574
• 关键词: 2019-nCoV; Admission activity; African American; Birth; COVID-19; COVID-19 diagnosis; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 test; Cardiovascular Diseases; Cardiovascular system; Caring; Censuses; Clinic; Coronary heart disease; Data; Data Set; Diabetes Mellitus; Disparity; Economics; Embolism; Emergency department visit; Ethnic Origin; Event; Extracorporeal Membrane Oxygenation; Functional disorder; Health; Health Policy; Healthcare; Hispanic; Hospitalization; Hypertension; Incidence; Infant; Infant Mortality; Infection; Intensive Care Units; Interruption; Job loss; Left; Link; Live Birth; Longitudinal cohort; Maternal Mortality; Measures; Mechanical ventilation; Medicaid; Medical; Minority Groups; Morbidity - disease rate; Mothers; Myocardial Infarction; Obesity; Outcome; Population; Population Study; Populations at Risk; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnant Women; Premature Birth; Prevalence; Prevention; Public Health; Race; Records; Reporting; Risk; Risk Factors; SARS-CoV-2 infection; SARS-CoV-2 positive; Small for Gestational Age Infant; Social Distance; Social Work; South Carolina; Stroke; Testing; Time Series Analysis; Transportation; United States; Vascular Diseases; Ventricular; Woman; Women' s Health; adverse birth outcomes; cardiovascular risk factor; clinical care; clinical practice; cohort; comorbidity; coronavirus pandemic; ethnic difference; ethnic disparity; follow-up; health care availability; health care service; health difference; health disparity; health inequalities; human old age (65+); improved; indexing; infant morbidity; infant morbidity/mortality; infant outcome; maternal diabetes; maternal morbidity; maternal obesity; maternal outcome; maternal risk; mortality; novel; outcome disparities; pandemic coronavirus; pandemic disease; population based; post pregnancy; pre-pandemic; pregnant; prepregnancy; prepregnancy obesity; racial difference; racial disparity; severe maternal morbidity; social; social determinants; social disparities; social health determinants; social vulnerability; ventilation

PROJECT SUMMARY Nationally, South Carolina (SC) ranks among the worst for poor pregnancy outcomes and high maternal and infant mortality rates, with vast racial/ethnic disparities present. Infection with the novel SARS-CoV-2 during pregnancy has been associated with pregnancy complications and poor infant and maternal outcomes including mortality. Moreover, the effect of social determinants and inequities in healthcare received and health outcomes have been heightened by the COVID-19 pandemic caused by SARS-CoV-2. Cardiovascular risk factors during pregnancy (e.g., obesity, diabetes, and hypertension) and pregnancy complications such as pre-eclampsia are common, can result in morbidity and mortality for the mother and the baby, and are well-known risk factors for maternal cardiovascular and vascular disease short and long-term. Infection with SARS-CoV-2 during pregnancy has also been related to complications (e.g., intensive care unit (ICU) admission, invasive ventilation, myocardial infarction, embolism). Less information is available regarding the impact of the COVID-19 pandemic or specifically SARS-CoV-2 infection on maternal and infant morbidity and mortality. The objective of our study is to understand the impact of both the COVID-19 pandemic and infection with SARS-CoV-2 on the risk of maternal and infant morbidity and mortality including pregnancy complications (e.g., pre-eclampsia, ICU admissions, mechanical ventilation), adverse birth outcomes (e.g., preterm birth, small for gestational age), and maternal cardiovascular events (e.g., coronary heart disease, stroke, embolism) during and post-pregnancy. Data from statewide administrative datasets (e.g., hospitalizations, vital records, Medicaid, positive COVID-19 tests) will be linked to create a diverse, longitudinal cohort of women who gave birth between 2018-2021 with at least one year of follow-up through 2022. Approximately 45,000 live birth pregnancies take place in SC each year for a total of ~180,000 deliveries anticipated over the 4-year study period. As of June 1, 2021, 2600 pregnant women in SC were diagnosed with COVID-19. The proposed project aims to evaluate the impact of the COVID-19 pandemic (Aim 1) and the impact of SARS-CoV-2 infection (Aim 2) at the population level in SC on (1) pregnancy complications, adverse birth outcomes, maternal cardiovascular events, and maternal and infant mortality; (2) maternal one-year post pregnancy cardiovascular and mortality outcomes; and (3) to examine differences by race/ethnicity, social vulnerability, distance to main medical facility, and pre-pregnancy obesity and diabetes. This study will be among the first to evaluate the COVID-19 pandemic and SARS-CoV-2 infection during pregnancy in relation to maternal and infant morbidity and mortality in a population-based study. Determining the impact of the COVID-19 pandemic and SARS-CoV-2 infection on infant and maternal morbidity and mortality and the extent of social and racial-ethnic differences is critical to improving pregnancy outcomes and health disparities in the U.S. Findings are expected to inform clinical care of pregnant women and public health policy.

项目概要 在全国范围内，南卡罗来纳州 (SC) 是妊娠结局最差、孕产妇死亡率最高的地区之一。 婴儿死亡率，存在巨大的种族/民族差异。期间感染新型 SARS-CoV-2 怀孕与妊娠并发症以及婴儿和产妇结局不佳有关，包括 死亡。此外，社会决定因素和不平等对接受的医疗保健和健康结果的影响 SARS-CoV-2 引起的 COVID-19 大流行加剧了这种情况。期间心血管危险因素 妊娠（例如肥胖、糖尿病和高血压）和妊娠并发症（例如先兆子痫） 常见，可导致母亲和婴儿发病和死亡，并且是众所周知的危险因素 母亲心血管和血管疾病的短期和长期。怀孕期间感染 SARS-CoV-2 也与并发症有关（例如，入住重症监护病房 (ICU)、有创通气、心肌梗塞 梗塞、栓塞）。关于 COVID-19 大流行的影响的信息较少，或者 特别是 SARS-CoV-2 感染对孕产妇和婴儿发病率和死亡率的影响。我们研究的目的是 了解 COVID-19 大流行和 SARS-CoV-2 感染对孕产妇风险的影响 婴儿发病率和死亡率，包括妊娠并发症（例如先兆子痫、入住 ICU、 机械通气）、不良分娩结局（例如早产、小于胎龄）和产妇 怀孕期间和怀孕后的心血管事件（例如冠心病、中风、栓塞）。数据来自 全州范围内的行政数据集（例如住院情况、重要记录、医疗补助、COVID-19 阳性检测）将 建立一个多样化的纵向队列，该队列的女性在 2018 年至 2021 年期间生育过至少一名女性 随访年至 2022 年。每年，南卡罗莱纳州约有 45,000 例活产妊娠 在 4 年研究期间预计总共约有 180,000 次分娩。截至2021年6月1日，已有2600名孕妇 SC 被诊断患有 COVID-19。拟议项目旨在评估 COVID-19 的影响 大流行（目标 1）以及 SARS-CoV-2 感染（目标 2）在南卡罗来纳州人口层面对 (1) 妊娠的影响 并发症、不良分娩结局、孕产妇心血管事件以及孕产妇和婴儿死亡率； (2) 孕产妇怀孕一年后的心血管和死亡率结果； (3) 通过以下方式检查差异 种族/民族、社会脆弱性、距主要医疗设施的距离以及孕前肥胖和糖尿病。 这项研究将是首批评估 COVID-19 大流行和 SARS-CoV-2 感染的研究之一 在一项基于人口的研究中，妊娠与孕产妇和婴儿发病率和死亡率的关系。确定 COVID-19 大流行和 SARS-CoV-2 感染对婴儿和孕产妇发病率和死亡率的影响 社会和种族差异的程度对于改善妊娠结局和健康至关重要 美国的差异预计调查结果将为孕妇的临床护理和公共卫生政策提供信息。