This document aims to provide guidance to healthcare professionals who care for pregnant women during the COVID-19 pandemic. It is not intended to replace existing clinical guidelines, but to act as a supplement with additional advice on how to implement standard practice during this time. The advice in this document is provided as a resource for UK healthcare professionals based on a combination of available evidence, good practice and expert consensus opinion.
這份文件的目的，是希望在Covid-19疫情期間，提給照顧孕產婦的醫事人員一一些指引。這並不是要取代既有的臨床指引，而是當成額外的補充，以能對於疫情期間如何執行標準常規，另外提出一些建議。這份文件裡的建議，依據於現有的證據、良好的措施、以及專家的共識意見，希望能作為醫事人員的資源。
需要優先考量以下幾點：
- The reduction of transmission of SARS-CoV-2 to pregnant women, their family members and healthcare workers.
降低傳染SARS-CoV-2 給孕婦、孕婦家人以及醫事人員的機率。
- The provision of safe, personalised and woman-centred care during pregnancy, birth and the early postnatal period, during the COVID-19 pandemic.
Covid-19大流行期間，為懷孕、生產以及產後的婦女，提供安全、個人化、以婦女為中心的健康照護。
- The provision of safe, personalised and woman-centred care to pregnant and postnatal women with suspected or confirmed COVID-19.
為疑似染疫或已確診婦女，提供安全、個人化及以婦女為中心的健康照護。
This is very much an evolving situation requiring this guidance to be a living document that is under regular review and updated as new information and evidence emerges. Updated advice and information will be published in the Coronavirus (COVID-19), pregnancy and women’s health section of the Royal College of Obstetricians and Gynaecologists (RCOG) website.
疫情不斷變動，我們必須將這份指引作為一份動態文件，定期檢視，並隨著新的資料與證據來予以更新。更新後的建議和訊息，將會公佈在皇家婦產科醫學會（Royal College of Obstetrics and Gynecology, RCOG）的「Covid-19、懷孕、與婦女健康」網站頁面。
Information for pregnant women and their families is available in question and answer format, with accompanying videos in some cases, on the RCOG and Royal College of Midwives (RCM) COVID-19 hubs.
「給懷孕婦女與家人」網站頁面，則是以問答形式提供資訊，部分案例還以影片供民眾參考。這列於皇家婦產科醫學會以及皇家助產師學會(Royal College of Midwives, RCM)有關疫情的網站資訊中。
1.1 證據的識別與評估
This guidance has been developed by a multidisciplinary group using the best available evidence retrieved by weekly literature reviews undertaken by a member of the RCOG Library team.Owing to the relatively recent emergence of COVID-19 and the rapidly evolving nature of the pandemic, there is a lack of high-quality evidence.
這份文件是由一個涵括多領域的小組，運用英國皇家婦產科醫學會的圖書資源小組，每週進行文獻回顧所得到現有的最佳證據而制訂出來的。由於新出現的Covid-19瞬息萬變，因此欠缺高品質的證據。
Using a conventional grading system for guideline development, such as SIGN, many of the studies would be classed as level 3 or 4 (non-analytical studies, e.g. case series/reports), with a few studies being classed as level 2 (systematic reviews of cohort studies). Much of the advice based on this evidence would therefore be graded D, and in some cases, graded as good practice points based on expert opinion. Furthermore, where randomised trials have been undertaken, such as to investigate therapeutic interventions in severe COVID-19, most of the trial participants were not pregnant. Healthcare providers, women and their families are advised to be aware of the low-quality evidence on which the advice is given when using this guidance to assist decision making.
舉SIGN的例子來說，使用傳統的分級系統進行指南制定時，許多研究會被分類為3或4級（非分析研究，例如案例系列/報告），少數研究被歸類為 2 級（追蹤性研究的系統性回顧）。因此，許多奠基於這些證據的建議會被評比為D，且在有些狀況，會基於專家意見，而列為良好的措施。此外，許多隨機分派的試驗，例如研究醫療介入Covid-19重症患者的成效， 大多數的受試者都不是處於懷孕狀態。 建議醫療人員、婦女及其家人想運用本指南裡的建議做出醫療決定時，要注意這些證據品質並不高。
For a more detailed description of the methods used to develop this guidance please see Appendix III.
如果想知道更多建立此指引的詳細方法，請參見附錄三。
1.2 流行病學
SARS-CoV-2 is the strain of coronavirus which causes COVID-19. It was first identified in Wuhan City, China, towards the end of 2019. Other human coronavirus (HCoV) infections include HCoV 229E, NL63, OC43 and HKU1, which usually cause mild to moderate upper respiratory tract illnesses, like the common cold, Middle East Respiratory Syndrome (MERS- CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).
SARS-CoV-2 是導致 Covid-19 的冠狀病毒株，它於2019年底首次在中國武漢市被發現。其他人類冠狀病毒 (HCoV) 感染包括 HCoV 229E、NL63、OC43 和 HKU1，它們通常會導致輕度至中度上呼吸道疾病，如普通感冒、中東呼吸綜合症 (MERS-CoV) 和嚴重急性呼吸道症候群 (SARS-ＣoV).
The diagnosis of COVID-19 can be made based on symptoms and known exposure, or simply from a positive test for SARS-CoV-2 even in the absence of any symptoms. COVID-19 can therefore be symptomatic or asymptomatic.
診斷Covid-19， 可以根據症狀，以及已知感染源，或者即使沒有任何症狀，也可以僅根據對 SARS-CoV-2 的陽性檢測做出診斷。 因此，Covid-19 可以是有症狀或無症狀的。
The World Health Organization (WHO) publishes a weekly international situation report with an additional Situation Dashboard to provide information for individual countries. The total number of confirmed cases in the UK is published by the Department of Health and Social Care (DHSC), and is available in a visual dashboard.
世界衛生組織（WHO）每週發布國際形勢報告，並附有現況儀表板，提供各個國家的訊息。英國的確診病例總數，由衛生和社會照護部 (Department of Health and Social Care, DHSC) 發布，並公布在視覺化的儀表板上。
For the most up-to-date advice please refer to health protection agency websites: for England, Wales, Scotland and Northern Ireland. Public Health England (PHE) and Public Health Scotland (PHS) have been cited throughout this document; specific guidance from the other areas of the UK will be updated as they become available.
有關最新建議，請參閱各個不同地區（ 英格蘭、威爾斯、蘇格蘭和北愛爾蘭）的健康保護機構網站。本文件通篇引用了英格蘭公共衛生 (Public Health England) 和蘇格蘭公共衛生 (Public Health Scotland)的資訊； 而英國其他地區特定的指南，如果有更新的話，也會放上。
1.3 傳播
Most global cases of COVID-19 have evidence of human-to-human transmission. This virus can be readily isolated from respiratory droplets or secretions, faeces and fomites (objects). Transmission of the virus is known to occur most often through close contact with an infected person or from contaminated surfaces.
全球大多數 Covid-19 病例都有人傳人的證據。這種病毒很容易從呼吸道飛沫或分泌物、糞便和污染物（物體）中分離出來。 我們已知病毒最常透過與感染者密切接觸或從受污染的表面傳播。
With regard to vertical transmission (transmission from woman to her baby antenatally or intrapartum), evidence now suggests that if vertical transmission does occur, it is uncommon. If it does occur, it appears to not be affected by mode of birth, delayed cord clamping, skin-to-skin contact, method of feeding or whether the woman and baby stay together (rooming in).
關於垂直傳播（從婦女在產前或產時傳染給嬰兒），現在有證據表示，假使確實發生垂直感染，這種情況也並不常見。 如果確實發生，垂直感染似乎不受出生方式、延遲夾臍、肌膚接觸、餵養方式或母嬰是否在一起（同房）的影響。
1.4 對抗Covid-19的疫苗
The first vaccine against COVID-19 was approved for use in the UK on the 2 December 2020, after a review by the Medicines and Healthcare products Regulatory Agency (MHRA). Since then, other vaccines have been approved and a national vaccination programme is underway. None of the vaccines have undergone specific clinical trials in pregnant women.
經過英國藥品和保健品監管局 (Medicine and Healthcare products Regulatory Agency, MHRA) 的審查，首支針對 Covid-19 的疫苗於 2020 年 12 月 2 日獲准在英國使用。 從那時起，其他疫苗也獲批准，國家疫苗接種計劃也正在進行中。 沒有任何一種疫苗特定針對孕婦進行臨床試驗。
The Joint Committee on Vaccination and Immunisation (JCVI) published updated advice on the 30 December 2020 and confirmed the available data do not indicate any safety concerns or harm to pregnancy, and vaccination in pregnancy should be considered where the risk of exposure to SARS-CoV-2 infection is high or cannot be avoided. Furthermore, the JCVI stated that vaccination should be considered where the woman has an underlying condition that puts her at very high risk of serious complications of COVID-19. Similar advice was issued for breastfeeding women.
疫苗接種與免疫聯合委員會 (Joint Committee on Vaccination and Immunization, JCVI) 於 2020 年 12 月 30 日發布了最新建議，確認現有的數據並沒有顯示接種疫苗對懷孕有任何的安全疑慮，或造成傷害。如果感染SARS-CoV-2 的暴露風險很高，或是難以避免，則應考慮在懷孕期間接種疫苗。 此外，JCVI 表示，如果女性有潛在狀況，使得她有很高機率在染疫後會產生 Covid-19 的嚴重併發症，則應考慮接種疫苗 。類似的建議也適用於哺乳期婦女。
Updated information for women and healthcare professionals on vaccination during pregnancy or while breastfeeding is available on the RCOG website.
有關懷孕期或哺乳期接種疫苗的最新訊息，都會公佈在 RCOG 網站上，提供給婦女與醫事人員參考。
1.5 Covid-19對孕婦的影響
Pregnant women do not appear more likely to contract the infection than the general population.
對照一般人口來說，孕婦染疫的機率似乎沒有比較高。
1.5.1 染疫孕婦的症狀
The majority of pregnant women who are infected with SARS-CoV-2 will be asymptomatic: the PregCOV-19 Living Systematic Review reporting on universal screening in pregnancy found an estimated 74% (95% CI 51–93) of women were asymptomatic, while another study from the USA reported that 86% of women who were admitted in labour and who tested positive for SARS-CoV-2 were asymptomatic.
大多數感染 SARS-CoV-2 的孕婦會是無症狀的。一份針對懷孕婦女持續更新的系統性回顧（PregCOV-19 Living Systematic Review ），發現普篩懷孕婦女中，有74%（95% CI 51-93）的婦女沒有症狀。而來自美國的另一項研究報告指出，86% 被收治入院且確診的產婦沒有任何症狀。
Most symptomatic women experience only mild or moderate cold/flu-like symptoms. The PregCOV-19 systematic review has so far included over 64 000 pregnant women worldwide with suspected or confirmed COVID-19 (reported prior to 29 November 2020). In this review, the most common symptoms of COVID-19 in pregnant women were cough (41%) and fever (40%). Less frequent symptoms were dyspnoea (21%), myalgia (19%), loss of sense of taste (14%) and diarrhoea (8%). Pregnant women with COVID-19 were less likely to have fever or myalgia than non-pregnant women of the same age. The PRIORITY (Pregnancy CoRonavirus Outcomes RegIsTry) study, an ongoing prospective cohort study of pregnant women from the United States, found the most prevalent first symptoms in infected women were cough (20%), sore throat (16%), myalgia (12%) and fever (12%). In this group of 594 symptomatic women, one-quarter had persistent symptoms 8 or more weeks after onset.
大多數有症狀的女性僅出現類似輕度或中度感冒/流感症狀。這篇針對孕婦的系統性回顧（PregCOV-19 Living Systematic Review） 涵括全球超過 64000 名疑似或確診 Covid-19 的孕婦（ 2020 年 11 月 29 日之前報告）。 在這篇系統性回顧論文中，染疫孕婦最常見的症狀有咳嗽 (41%) 和發燒 (40%)。 較少見的症狀是呼吸困難 (21%)、肌肉痠痛 (19%)、味覺喪失 (14%) 和腹瀉 (8%)。染疫的孕婦比同齡的非孕婦，較少出現發燒或肌肉痠痛。PRIORITY（Pregnancy Coronavirus Outcomes Registry，新冠病毒懷孕婦女結果登錄制）是一項持續性針對美國孕婦的前瞻性世代研究（prospective cohort study），它發現染疫婦女最常見的首發症狀是咳嗽（ 20%)、喉嚨痛 (16%)、肌肉痠痛 (12%) 和發燒 (12%)。 在這組 594 名有症狀的女性中，有1/4的女性在發病 8 週或更長時間後仍持續有症狀。
At present, it is unclear whether pregnancy will impact on the proportion of women who develop prolonged signs and symptoms after an acute SARS-CoV-2 infection, (so-called ‘long COVID’ or post COVID-19 condition). NICE has produced a rapid guideline outlining the care of individuals who develop long-term effects of COVID-19.
目前，尚不清楚懷孕是否會影響女性在罹患重症後出現長期的後遺症和症狀（所謂的「長期 Covid」或 Covid-19 後病症）的比例。 NICE （National Institute of Health and Care Excellence）制訂了一份快速指引，概述了針對產生長期後遺症的照護方式。
1.5.2 重症孕婦
主要發現：
More than two-thirds of pregnant women with COVID-19 are asymptomatic.
超過2/3的染疫孕婦是無症狀的。
Compared to non-pregnant women with COVID-19, pregnant women with COVID-19:
比起沒有染疫的婦女，染疫孕婦：
- have higher rates of intensive care unit (ICU) admission; this may reflect a lower threshold for admission to ICU, rather than more severe disease.
收治在加護病房的比率較高， 這可能反映了孕婦入住加護病房的門檻較低而不是因為重症的關係。
- are not at increased risk of death from COVID-19, according to the largest systematic review.
根據大規模的系統性資料檢視，染疫孕婦的死亡風險並沒有比一般染疫婦女更高。
- were however found in more recent data from the USA and Mexico to have a slightly higher risk of death in these specific national healthcare settings.
然而，根據美國和墨西哥最新的數據顯示，在這些國家特定的醫療體制下，染疫孕婦的死亡率有些微偏高。
Compared to pregnant women without COVID-19, pregnant women with symptomatic COVID-19 requiring hospitalisation have overall worse maternal outcomes, including an increased risk of death, although that risk remains very low (the UK maternal mortality rate from COVID-19 is 2.2 per 100 000 maternities).
整體而言，與沒有染疫的孕婦相比，有症狀且需要住院的孕婦，其結果狀況差，包括死亡風險增加，儘管這種風險仍然很低。（英國因Covid-19而造成的孕產婦死亡率為，每10萬人有2.2位）。
1.5.2.1 孕婦罹患重症的頻率
COVID-19 ranges from asymptomatic infection, through to mild disease (no evidence of pneumonia or hypoxia), moderate disease (viral pneumonia), severe disease (severe pneumonia, e.g. with SpO2 below 90% on room air) and critical disease (Acute Respiratory Distress Syndrome [ARDS], sepsis, septic shock, or complications such pulmonary embolism or acute coronary syndrome).
Covid-19 的症狀範圍從無症狀到輕度症況（沒有肺炎或缺氧的徵狀）、中度症狀（病毒性肺炎）、重度症狀（重度肺炎，例如室內空氣中 SpO2 低於 90%）和危急症狀（急性呼吸窘迫症候群 [Accurate Respiratory Distress Syndrome]、敗血症、感染性休克或肺部併發症、 栓塞或急性冠狀動脈綜合症）。
Severe illness, such as that requiring ICU admission, is relatively uncommon in women of reproductive age, but can occur. During the initial wave of the pandemic, there were case reports and case series of women with severe COVID-19 infection at the time of birth who have required ventilation and extracorporeal membrane oxygenation (ECMO), and of maternal death. In the PregCOV-19 Living Systematic Review Consortium analysis, 73/11 580 women with confirmed COVID-19 were recorded as having died of any cause, and 16/1935 women required ECMO. A large US study published in January 2021 compared outcomes for pregnant women with and without COVID-19 from April–November 2020, drawing the information retrospectively from a database that covers about 20% of the American population. Data was available for 406 446 women hospitalised for childbirth, 6380 (1.6%) of whom had COVID-19. In-hospital maternal death was rare, but rates were significantly higher for women with COVID-19 (141 deaths per 100 000 women, 95% CI 65–268) than for women without COVID-19 (5 deaths per 100 000 women, 95% CI 3.1–7.7).
症狀危急（例如需要入住加護病房）的狀況在育齡婦女中相對少見，但也可能會發生。 在第一波大流行中，有一些案例報告與病例系列，呈現嚴重染疫孕婦，在生產時刻需要使用呼吸器、葉克膜，以及死亡的情況。在PregCOV-19 Living Systematic Review Consortium 分析中， 73/11,580 名染疫婦女的死因為被記錄為「死於任何原因』，16/1935 名女性需要葉克膜。2021 年 1 月有一篇發表，從涵蓋美國約 20% 人口的大型資料庫中，以回溯性的資料，比較了 2020 年 4 月至 11 月期間染疫和未染疫的孕婦，顯示406,446名在醫院生產的婦女中，有6380位 (佔全部孕婦的1.6%) 染疫。 院內孕產婦死亡很少見，但染疫孕婦的死亡率（每 10 萬名婦女有141 人死亡，95%信賴區間為 65-268）明顯高於沒有染疫的孕婦（每 10 萬名婦女死亡 5 人，95 % CI 3.1–7.7）。
A preprint (not yet peer reviewed) was released on 9 January 2021 with the results from two large COVID-19 in pregnancy registries. The PAN-COVID registry recorded suspected or confirmed COVID-19 at any stage in pregnancy (in the UK and ten other countries), and the AAP SONPM registry recorded maternal COVID-19 around the time of birth (from 14 days before to 3 days after birth). Maternal mortality was uncommon in both registries: it occurred in 3 of 651 (0.46%) of women with confirmed COVID-19 in the PAN-COVID registry, and in 5 of 2398 women with COVID-19 (0.21%) in the AAP SONPM registry. For the UK data (PAN-COVID), the mortality rate is likely inflated by under-reporting of women with asymptomatic or mild COVID-19 in pregnancy. The authors of this study have postulated that only 10% of maternal COVID-19 infections were detected as cases, and the true infection fatality rate would therefore be ten times lower (i.e. 0.046%, which is close to the estimate of 0.03% for men and women aged 15–44 years in the UK REACT2 study). Nonetheless, these maternal mortality rates are higher than previously recorded maternal mortality rates in these populations. For example, the maternal deaths from the AAP SONPM registry equate to a perinatal maternal mortality rate of 167 per 100 000 (for women who have COVID-19 around the time of birth), compared with a pre-COVID rate of 17.3 per 100 000 in the USA. Moreover, COVID-19 was listed as the cause of death for all the maternal deaths in these registries where cause of death of was known.
一篇尚未經過同行審查的預印本，於 2021 年 1 月 9 日公布，兩個大型染疫懷孕登錄資料庫的結果。 PAN-COVID 登錄了疑似或已確診的懷孕者（英國和其他十個國家）， AAP SONPM 則登錄了生產前 14 天至生產後 3 天的染疫孕產婦。這兩個登錄資料庫裡的產婦死亡率並不常見。在PAN-COVID 登錄制的紀錄中，產婦死亡率是0.46%（3位死亡/651位染疫孕婦），在 AAP SONPM的登錄制則是0.21%（5位死亡/2398位染疫孕婦 )。英國的數據 (PAN-COVID) 顯示，孕婦死亡率有可能高估，因為無症狀或輕度症狀的孕產婦，並沒有被記錄下來。本研究的作者群假設，只有 10% 的染疫孕婦被檢測而成為病例，因此真正的感染死亡率會低十倍（即 0.046%，這個數據接近英國 REACT2 研究中 15-44 歲男性和女性的 0.03% 估計值）。儘管如此，這些染疫的孕產婦死亡率，仍高於先前記錄的孕產婦死亡率。 例如，AAP SONPM 登錄制的孕產婦死亡，相當於每十萬人中 167人的周產期死亡率（生產前後染疫的女性），而在疫情發生前，美國孕婦死亡率為每 10 萬人中 17.3 人。 此外，Covid-19已被列爲孕產婦死亡的已知原因。
The UK Obstetric Surveillance System (UKOSS) published its first report on pregnant women admitted to hospital with confirmed COVID-19 in the UK on 8 June 2020, and an updated report was made available as a preprint on 5 January 2021. This second report covers the period from 1 March 2020 to 31 August 2020. During that time, 1148 hospitalised women had COVID-19 in pregnancy. Most (63%) of women were symptomatic with COVID-19; however, this includes many women from the initial wave of the pandemic, when testing was only performed for symptomatic individuals. As testing for SARS-CoV-2 has become more routinely offered on admission to labour ward, the proportion of asymptomatic women is likely to have increased. Of the 1148 hospitalised pregnant women, 63 (5%) required critical care. During this time, eight women with symptomatic COVID-19 died in hospital. Two of the deaths were not related to COVID-19, and six deaths were, giving a maternal mortality rate of 2.2 hospitalised women per 100 000 maternities (95% CI 0.9–4.3).
英國產科監測系統 (UKOSS) 於 2020 年 6 月 8 日發布了關於在英國因染疫而入院的孕婦的第一份報告，並於 2021 年 1 月 5 日以預印本的形式提供了一份最新報告。第二份報告涵蓋了 2020 年 3 月 1 日至 2020 年 8 月 31 日期間。在此期間，1148 名住院婦女在懷孕期間感染了 Covid-19。大多數 (63%) 女性出現 Covid-19 症狀；然而，這包含大流行初期僅對有症狀的女性進行檢測。由於 SARS-CoV-2的檢測在進入產房前越來越成為常規後，被診斷為無症狀女性的比例可能因此而增加。在 1148 名住院孕婦中，63 名 (5%) 需要重症照護。在此期間，8 名有症狀的婦女在醫院死亡。其中 2 人與 Covid-19 無關，其他6人則被納進每 10 萬名產婦中有 2.2 名住院婦女的死亡率中（95% 信賴區間為0.9 –4.3）。
Severe illness appears to be more common in later pregnancy. In the UKOSS study, most women were hospitalised in the third trimester or peripartum (bearing in mind that admission at term to give birth will contribute to this distribution). Symptomatic COVID-19 was principally diagnosed in the third trimester: 83% of symptomatic women were diagnosed at or beyond 28 weeks, with 52% diagnosed at or beyond 37 weeks.The reason for hospital admission was known for a subset of pregnant women in the UKOSS study. For asymptomatic women, the reason for admission was principally to give birth (68%). For symptomatic women, the reasons for admission were roughly a third for symptomatic COVID-19, a third to give birth, and a third for other reasons.
重症似乎在懷孕後期更常見。在 UKOSS 研究中，多數孕婦都在第三孕期或週產期被收治入院（(bearing in mind that admission at term to give birth will contribute to this distribution）。 Covid-19 主要在第三孕期被診斷出來：83% 有症狀的孕婦是在 28 週或之後被診斷出來，52% 在 37 週或之後被診斷出來。 在UKOSS的研究裡，無症狀孕婦入院的原因是為了生產（68%）。 有症狀的女性入院原因大約有三分之一是因為有Covid-19的症狀，三分之一是為了生產，三分之一則是其他原因。
The UK Intensive Care National Audit and Research Centre (ICNARC) has released two reports of patients admitted to ICU with COVID-19. The first report covers the start of 2020 up until 31 August 2020. During that time, a total of 70 women who were either currently or recently (within 6 weeks) pregnant had been admitted to intensive care, representing 8.9% of all the 785 pregnant and non-pregnant women admitted aged 16–49 years. The second ICNARC report covers the period from 1 September 2020–early January 2021. During that period, a further 142 women who were either currently or recently (within 6 weeks) pregnant were admitted to intensive care, corresponding to 12% of the 1184 women admitted aged 16–49 years. For context, the conception rate in the UK in 2018 was 75.4 per 1000 women aged 15–44 years, suggesting that the percentage of women pregnant at any one time in the UK is less than 7.5%. It is important to note that the threshold for admitting a pregnant woman to ICU is likely to be lower than for a non-pregnant woman: a higher rate of ICU admission for pregnant women does not therefore necessarily mean a higher burden of severe disease.
英國重症照護國家審計與研究中心 (ICNARC) 發布了兩份關於因 Covid-19 入住 加護病房的患者報告。第一份報告涵蓋 2020 年初至 2020 年 8 月 31 日止。在這段期間內785名16~49歲懷孕與未懷孕的婦女中，有 70 名正在懷孕或最近（6 週內）懷孕的婦女，住入加護病房，佔了 全部住進加護病房婦女的8.9% 。第二份 ICNARC 報告則涵蓋了 2020 年 9 月 1 日至 2021 年 1 月上旬，在這段期間內1184位16~49歲懷孕與未懷孕的婦女中，有 142名（佔12% ）正在懷孕或最近（6 週內）懷孕的婦女被收治在加護病房。就報告看起來，英國 2018 年的受孕率為每 1000 名 15-44 歲女性中有75.4 人，這說明英國任何時間點的懷孕女性，比例都低於 7.5% 。 值得注意的是，孕婦入住加護病房的門檻可能低於非孕婦：因此，孕婦入住加護病房的比率較高並不一定意味著承受著較嚴重的症狀。
The MBRRACE-UK consortium published a rapid report on maternal deaths in the UK between March and May 2020. During that period, nine women died during pregnancy or in the immediate postpartum period (up to 6 weeks postnatal), and one woman died during the extended postpartum period (up to 1 year). Of these ten women, seven died of COVID-19, in one the cause of death was undetermined but was considered to be probably related to COVID-19, and two died of unrelated causes. It is, at this time, unclear whether the pandemic will result in a statistically significant impact on the overall rate of maternal death in the UK. Key lessons from the report of these deaths have been incorporated into this guidance.
MBRRACE-UK （以查核和保密調查來降低全英母嬰風險，Mothers and Babies: Reducing Risks Through Audits and Confidential Enquires across the UK) 這個組織，發布了一份關於英國孕產婦死亡的快速報告。 在2020 年 3 月至 5 月期間，9 名婦女在懷孕期間或產後（產後 6 週）死亡，1 名婦女在產後 1 年內死亡。 這 10 名女性中，有 7 名死於 Covid-19，其中一名死因尚未確定，但被認為可能與 Covid-19 相關，另外兩名死因與Covid-19無關。 目前尚不清楚Covid-19大流行是否對英國孕產婦的總死亡率產生統計上的顯著影響，但這些死亡案例的重要經驗已納入本指引。
1.5.2.2 懷孕與非懷孕的的重症資料比對
It was not clear earlier in the pandemic whether pregnancy itself was a risk factor for severe illness from COVID-19. There is now growing evidence that pregnant women may be at increased risk of severe illness from COVID-19 compared with non-pregnant women, particularly in the third trimester. The most consistent signal of increased severity of COVID-19 in pregnancy is an increase in ICU admissions for pregnant women. However, ICU admission rates must be interpreted with caution, as the threshold for ICU admission for a pregnant woman may be lower than for a non-pregnant woman. Moreover, there is currently no robust data from the UK comparing pregnant and non-pregnant women with COVID-19. The studies in this section are from countries with different healthcare systems, populations and different baseline maternal risks, and should therefore be interpreted with caution from a UK perspective.
疫情早期尚不清楚懷孕本身是否為 Covid-19 重症的危險因子，但是現在有越來越多的證據顯示，與非孕婦相比，孕婦罹患 Covid-19 重症的風險可能更高， 特別是在第三孕期。對於孕期染疫增加重症狀況，持續出現的徵兆，是孕婦入住加護病房的人數增加。 然而，必須謹慎解讀加護病房入住率，因為孕婦入住加護病房的門檻，可能低於非孕婦。 此外，目前英國沒有嚴謹可靠的資料，來比較染疫孕婦與非染疫孕婦的差異。本節中的研究，來自健康照護系統、人口數，以及孕產風險基準都各不相同的幾個國家、因此從英國的角度來看，應要謹慎解釋。
Intensive care admission is likely to be more common in pregnant women with COVID-19 than in non-pregnant women with COVID-19 of the same age. The PregCOV-19 Living Systematic Review Consortium analysis concluded that pregnant women are more likely than non-pregnant women to be admitted to intensive care (OR 1.62, 95% CI 1.33–1.96) and require invasive ventilation (OR 1.88, 95% CI 1.36–2.60). This finding was based overwhelmingly on a single study published by the US Centers for Disease Control and Prevention (CDC); in this study two major limitations of the results were acknowledged. The first was that admissions for indications related to pregnancy and those for COVID-19 could not be distinguished. The second was that pregnancy status was missing for three-quarters of the women of reproductive age; a pregnancy rate of 9% was identified – higher than the expected 5%. This could account for significant bias in the results.
染疫的孕婦，可能比同年紀沒有懷孕的女性，更容易收治在加護病房。 這份有關孕產婦染疫的系統性回顧研究（PregCOV-19 Living Systematic Review Consortium） 分析得出的結論是，孕婦比非孕婦更有可能被收治在加護病房內接受重症照顧 (勝算比 1.62, 95% 信賴區間1.33–1.96) ，而且更需要使用侵入性的正壓呼吸器 (勝算比 1.88, 95% 信賴區間 1.36–2.60) 。 這個發現主要基於美國疾病管制與預防中心 (CDC) 發表的一項研究； 在這項研究中，結論有兩大限制，已被提出。 第一、我們無法區分入院治療是因為妊娠的相關適應症，還是Covid-19的適應症。第二、四分之三的育齡婦女，缺乏其懷孕狀態的資料; 懷孕率算出來是9% –高於預期的 5%。 這可能會導致結果存在重大偏差。
Since the last update of that systematic review, a small number of studies from the USA and Mexico have also pointed to increased illness severity from COVID-19 in pregnant women compared to non-pregnant women. The US CDC published an updated study in November 2020, based on surveillance of COVID-19 cases in the USA from January–October 2020. This study addressed some of the limitations of their earlier work quoted above, although missing data might still have led to bias (e.g. pregnancy status was missing for more than half the cases reported to the CDC). This report compared pregnant women with symptomatic COVID-19 (n = 23 434) to non-pregnant women of reproductive age with symptomatic COVID-19 (n = 386 028). The pregnancy rate in this study was 5.7%, close to the expected value, and by focussing on symptomatic women, this study was less likely to be biased by women being admitted principally for obstetric reasons. This large study found that pregnant women were more likely be admitted to ICU (adjusted risk ratio [aRR] 3.0, 95% CI 2.6–3.4), to receive invasive ventilation (aRR 2.9, 95% CI 2.2–3.8), ECMO (aRR 2.4, 95% CI 1.5–4.0), and to die (1.5 versus 1.2 per 1000 cases; aRR 1.7, 95% CI 1.2–2.4).
自上次 PregCOV-19 Living Systematic Review Consortium 更新以來，少數幾篇來自美國和墨西哥的研究也指出，與非孕婦相比，孕婦因 Covid-19 引起的症狀更加嚴重。 美國CDC在2020 年 1 月至 10 月監控染疫病例，並於 2020 年 11 月發布了一項最新研究，這個研究解決了上述早期研究的一些局限性，但是數據不足仍可能導致偏差（例如，回報給美國 CDC 的所有病例中，一半以上缺少了懷孕狀態資料）。該報告比較了有症狀的Covid-19孕婦（n = 23,434）跟有症狀但沒有懷孕的育齡婦女(n = 386,028)。在這個研究裡，懷孕率為接近預期值的5.7%，且將重點放在有症狀的女性身上，因此本研究不太可能會因為其他產科原因而入院而產生偏誤。這項大型研究發現，染疫孕婦更有可能被收治在加護病房（絕對風險比率差 [aRR] 3.0，95% 信賴區間 2.6-3.4），接受侵入性的正壓呼吸器（絕對風險比率差 2.9，95% 信賴區間 2.2-3.8），使用葉克膜（絕對風險比率差 2.4, 95 % 信賴區間 1.5–4.0），以及更高的死亡率（每 1000 例 1.5 對 1.2；絕對風險比率差 1.7，95% 信賴區間 1.2–2.4）
A large case–control study from Mexico compared 5183 pregnant women with symptomatic COVID-19 with 5183 matched non-pregnant controls. The data were taken from a prospective cohort of people of any age with clinically suspected SARS-CoV-2 infection who were admitted to one of 475 monitoring hospitals in Mexico. This data therefore suffers from some of the same limitations as the CDC data above, with some outcomes missing for large numbers of individuals. For example, information on ICU admission was only available for one-fifth of pregnant women. Pregnant women had higher odds of death (OR 1.84, 95% CI 1.30–2.61), pneumonia (OR 1.99, 95% CI 1.81–2.19) and ICU admission (OR 2.25, 95% CI 1.86–2.71), but similar odds of intubation (OR 0.93, 95% CI 0.70–1.25).
墨西哥一項大型病例對照研究，將 5183 名有症狀的染疫孕婦與 5183 名染疫卻沒有懷孕的婦女對照比較。這些數據取自收治在墨西哥 475 家監測醫院的其中一間裡的所有年齡疑似 SARS-CoV-2 感染者的前瞻性隊列。該研究數據因為缺少許多人的懷孕狀態的數據，因此與上述 CDC 數據存在一些相同的局限性， 例如， 只有五分之一的孕婦可以取得入住加護病房的資訊 。 孕婦有更高的死亡機率 (OR 1.84, 95% CI 1.30–2.61)、肺炎 (OR 1.99, 95% CI 1.81–2.19) 和入住加護病房 (OR 2.25, 95% CI 1.86–2.71)，但與染疫非孕婦插管的機率接近（OR 0.93，95% CI 0.70–1.25）。
A smaller study from the New York area also found higher ICU admission rates for pregnant women with COVID-19: 38 pregnant women admitted to hospital with severe or critical COVID-19 were compared to 94 non-pregnant women with severe or critical COVID-19. Pregnant women were only included in this study if they were admitted for treatment of COVID-19 (and not for any obstetric reason). Pregnant women were more likely to be admitted to ICU (39.5% versus 17.0%, P < 0.01; adjusted OR 5.2, 95% CI 1.5–17.5). This was despite the fact that the control group had higher rates of comorbidities (hypertension, diabetes, obesity) and was slightly older. A similar study from France during the initial wave of the pandemic compared the clinical outcomes of 83 pregnant women (above 20 weeks of gestation) with COVID-19 to 107 non-pregnant women with COVID-19, after matching the two groups using a propensity score. Pregnant women were at higher risk for ICU admission than non-pregnant women (11.08% versus 2.38%, P = 0.024), for needing hospital admission because of COVID-19 respiratory decompensation (58.21% versus 17.4%), for the need for oxygen therapy (36.04% versus 17.24%, P = 0.006), and for endotracheal intubation (10.16% versus 1.67%, P = 0.022).
紐約一項規模較小的研究也發現，染疫孕婦有較高的加護病房入住率：將 38 名因 Covid-19 入院的重症或極重症孕婦與 94 名患有重症或極重症 Covid-19 的非孕婦進行比較。只有在接受 Covid-19 治療（而非任何產科原因）的孕婦才被納入本研究。染疫孕婦更有可能入住加護病房（39.5% 與 17.0%，P < 0.01；調整後的 OR 5.2，95% CI 1.5-17.5）。儘管對照組的共併症發生率較高（高血壓、糖尿病、肥胖），且年齡稍大。在疫情大流行剛開始時，法國有一項類似的研究，使用傾向性的評分匹配後比較了83 名染疫的孕婦（妊娠 20 週以上）與 107 名染疫的非孕婦的臨床結果。孕婦因為染疫而產生呼吸代償障礙需要入院者與沒有懷孕的染疫婦女比（58.21% ：17.4%），因為需要氧氣而需要住院的孕婦（11.08% ： 2.38%，P = 0.024）（36.04% ： 17.24%，P = 0.006）和插管治療（10.16% 對 1.67%：P = 0.022）。
Another study from the US, published in January 2021, compared 22 pregnant women with symptomatic COVID-19 to 240 non-pregnant controls. This study found that pregnant women were more likely than non-pregnant controls to have severe COVID-19, based on two different measures of disease severity (adjusted relative risk [RR] for severe COVID-19 was 3.59 [95% CI 1.49–7.01] for one measure of severity, and 5.65 [95% CI 1.36–17.31] for the other measure of severity). Finally, a study from the Washington State COVID-19 in Pregnancy Collaborative, published at the end of January 2021, found a higher mortality rate for pregnant women with COVID-19 than for non-pregnant controls. This study analysed data on 240 women who tested positive for COVID-19 in pregnancy. Of these, 24 women (10%) were admitted to hospital specifically for COVID-19-related respirator y concerns; this is approximately three times the hospitalisation rate with COVID-19 compared to all adults aged 20–39 years in Washington state (RR 3.5, 95% CI 2.3–5.3).There were three maternal deaths directly attributed to COVID-19, giving a maternal mortality rate of 1250/100 000 pregnancies (95% CI 257–3653) and a COVID-19 case fatality in pregnancy that was 13.6 times (95% CI 2.7–43.6) higher than for all adults aged 20–39 years.This study also highlighted the increased risk of severe COVID-19 in the third trimester: of the 24 women who were admitted unwell with COVID-19, the median gestation was 32+4 weeks (interquartile range [IQR] 26–36+1 weeks of gestation).
2021 年 1 月發表的另一項來自美國的研究將 22 名有症狀的染疫孕婦與 240 名未懷孕的對照組進行了比較。這項研究發現，依據兩種不同的重症衡量標準 (adjusted relative risk [RR] for severe COVID-19 was 3.59 [95% CI 1.49–7.01] for one measure of severity, and 5.65 [95% CI 1.36–17.31] for the other measure of severity)，染疫的孕婦比染疫非孕婦更可能罹患重症。最後，2021 年 1 月底華盛頓州 Covid-19 妊娠合作組織( Washington State COVID-19 in Pregnancy Collaborative) 發表，染疫孕婦的死亡率高於沒有懷孕的對照組。該研究分析了 240 名在懷孕期間檢測出 Covid-19 陽性婦女的數據。其中有24 名女性 (10%) 因Covid-19 產生呼吸問題而入院，這大約是華盛頓州所有因為Covid-19而住院的20-39歲成年人的3倍 （RR 3.5，95% CI 2.3-5.3）。有 3 名孕產婦死亡直接歸因於 Covid-19，導致孕產婦死亡率為 1250/100,000（95% CI 257–3653），染疫孕婦的死亡率是所有 20–39 歲成年人的 13.6 倍（95% CI 2.7–43.6）。這研究還強調了第三孕期會增加重症風險;在因 Covid-19 入院的 24 名孕婦中，中位妊娠週數(median gestation)為 32+4 週（四分位距 [IQR] 26-36+1 週）。
Taken together, these studies point to a possibly increased risk of severe disease from COVID-19 for pregnant women compared to non-pregnant women with COVID-19. However, the most consistent finding was of increased ICU admission rates for pregnant women, and this may in part be explained by a lower threshold for ICU admission in pregnancy in general.
綜合來說，這些研究皆指出染疫孕婦可能比與染疫婦女罹患重症的風險較高。 然而，最一致的發現是孕婦入住加護病房的比率增加 ，其可能部分的原因是懷孕婦女被收治在加護病房的門檻普遍較低。
Recent studies on the risk of severe disease from COVID-19 in pregnancy are summarised in Appendix IV, Table 2. The care of pregnant women with severe COVID-19 is covered in section 5 of this guidance.
近期關於妊娠染疫導致重症風險的研究總結在附錄 IV 表 2 中。本指南第 5 節涵蓋了重症孕婦的護理。
1.5.3 染疫對懷孕的影響
Symptomatic maternal COVID-19 is associated with a two to three times greater risk of preterm birth, principally from iatrogenic preterm birth. The PregCOV-19 Living Systematic Review estimated the risk of preterm birth at approximately 17%. Most of these preterm births (94%) were iatrogenic. In the initial UKOSS study, the median gestational age at birth was 38 weeks of gestation (IQR 36–39 weeks of gestation). Of the women who gave birth, 27% had preterm births: 47% of these were iatrogenic for maternal compromise and 15% were iatrogenic for fetal compromise. The updated UKOSS study confirmed that preterm birth was more likely for women with COVID-19: 19% of women with symptomatic COVID-19 and 9% of women with asymptomatic COVID-19 gave birth before 37 weeks of gestation. Compared to a historical cohort of pregnant women without SARS-CoV-2, pregnant women with symptomatic COVID-19 were more likely to give birth before 32 weeks of gestation (adjusted OR [aOR] 3.98, 95% CI 1.48–10.70) and before 37 weeks of gestation (aOR 1.87, 95% CI 1.23–2.85). Pregnant women with asymptomatic COVID-19 were not, however, at increased risk of preterm birth. For women with symptomatic COVID-19, 78% of preterm births were iatrogenic. Preterm birth is associated with perinatal mortality, but also with long term morbidity. It is the single biggest cause of neonatal morbidity and mortality in the UK, with about 7% of babies in the UK born preterm. The preterm birth rate in women with symptomatic COVID-19 appears to be two to three times higher than this background rate. Although the PregCOV-19 Living Systematic Review found that stillbirth and neonatal death rates were not raised for women with COVID-19, it is concerning that the preterm birth rate is raised to such an extent.
孕婦之所以多出 2 到 3 倍早產風險（主要為醫源性早產）與感染Covid-19有關。 PregCOV-19 Living Systematic Review 估計早產風險大約為 17%。大多數這些早產 (94%) 是醫源性的。在最初的 UKOSS 研究中，出生時的胎齡為 38 週（IQR 為妊娠 36-39 週）。在分娩的婦女中，27% 發生早產：其中 47% 是醫源性導致母體損害，15% 是醫源性胎兒損害。最新的 UKOSS 研究證實，患有 Covid-19 的婦女更可能早產：19％有症狀的染疫孕婦和 9%無症狀的染疫孕婦在妊娠 37 週前分娩。與未感染 SARS-CoV-2 的歷史孕婦隊列相比，有症狀的染疫孕婦更有可能在妊娠 32 週之前分娩（調整後 OR [aOR] 3.98，95% CI 1.48–10.70）妊娠 37 週（aOR 1.87，95% CI 1.23–2.85）。然而，無症狀的染疫孕婦早產風險並未增加。對於有症狀的染疫孕婦，78% 的早產是醫源性的。早產與周產期死亡率有關，但也與長期發病率有關。它是英國新生兒發病率和死亡率的最大單一原因，英國約有 7% 的嬰兒早產。有症狀的染疫孕婦的早產率似乎比正常高出兩到三倍。儘管 PregCOV-19 Living Systematic Review 發現染疫孕婦的死產率和新生兒死亡率並未提高，但早產率升高到如此程度還是令人擔憂。
Maternal COVID-19 is also associated with an increased rate of caesarean birth. Again,from the initial UKOSS study, 59% of women had caesarean births; approximately half of these were because of maternal or fetal compromise. The remainder were for obstetric reasons (e.g. progress in labour, previous caesarean birth) or maternal request (6%). Of the women having a caesarean birth,20% required general anaesthesia (GA). Approximately two-thirds of the women who had a GA were intubated for maternal respiratory compromise, and the other third to facilitate urgent birth.The updated UKOSS data confirmed this trend, with a 49% caesarean birth rate for women with symptomatic COVID-19 versus 29% for a historical control group from 2018 (before COVID-19).
剖腹產率增加也與孕期染疫相關。同樣，從最初的 UKOSS 研究中，59% 的染疫孕婦進行了剖腹產； 其中大約一半是由於母體或胎兒危機。其餘的原因是產科原因（例如產程、前胎剖腹）或孕婦要求（6%）。 在剖腹產的婦女中，20% 需要全身麻醉 (GA)。大約三分之二全身麻醉的孕婦插管是因為呼吸道受損，另外三分之一是因為緊急生產。最新的 UKOSS 數據證實了這一趨勢，有症狀的染疫婦女剖腹產率為 49%，而2018年開始到疫情爆發以前的歷史對照組，剖腹產率為 29%。
1.6 妊娠期感染 Covid-19 入院的危險因素
因為染疫而住院的危險因子可能有：
- Black, Asian and minority ethnic (BAME) background
黑人、亞洲人和少數族裔（BAME）背景 - Having a BMI of 25 kg/m2 or more
身體質量指數為25 kg/m2 或超過25 kg/m2 - Pre-pregnancy co-morbidity, such as pre-existing diabetes and chronic hypertension
孕前合併症（例如：孕前就有糖尿病、慢性高血壓） - Maternal age 35 years or older
35歲以上的高齡產婦 - Living in areas or households of increased socioeconomic deprivation (data not specific to pregnancy)
生活在社經狀況較貧窮的地區（數據不侷限在懷孕婦女身上）
In addition to these, the risk of becoming infected with SARS-CoV-2 is higher in individuals who are more exposed, for example, those working in healthcare or other public-facing occupations. In the PregCOV-19 Living Systematic Review, the estimates of association were: for age 35 years and older, OR 1.78 (95% CI 1.25–2.55); for BMI 30 kg/m2 and above, OR 2.38 (95% CI 1.67–3.39); for chronic hypertension, OR 2.0 (95% CI 1.14–3.48); and for pre-existing diabetes, OR 2.51 (95% CI 1.31–4.80).
除此之外，任職於醫療院所或是暴露在公共場域的人染疫風險也較高。在 PregCOV-19 Living Systematic Review 中相關估計值： 35 歲及以上，OR 1.78（95% CI 1.25–2.55）； BMI 30 kg/m2 及以上，OR 2.38 (95% CI 1.67–3.39)； 慢性高血壓，OR 2.0 (95% CI 1.14–3.48)； 先前存在的糖尿病，OR 2.51 (95% CI 1.31–4.80)。
The updated report from UKOSS on 1148 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in the UK between 1 March and 31 August 2020, found that women hospitalised with symptomatic SARS-CoV-2 were more likely to be from a Black, Asian or other minority ethnic background (aOR 6.24, 95% CI 3.93–9.90, aOR 4.36, 95% CI 3.19–5.95 and aOR 12.95, 95% CI 4.93–34.01 respectively), to be overweight or obese (aOR 1.86, 95% CI 1.39–2.48 and aOR 2.07, 95% CI 1.53–2.29 respectively) and to have a relevant medical comorbidity (aOR 1.83, 95% CI 1.32–2.54).
UKOSS 針對 2020 年 3 月 1 日至 8 月 31 日期間在英國因確診 SARS-CoV-2 感染入院的 1148 名孕婦的最新報告發現，因有症狀的 SARS-CoV-2 住院的婦女更有可能來自黑人 、亞洲或其他少數族裔背景（分別為 aOR 6.24、95% CI 3.93–9.90、aOR 4.36、95% CI 3.19–5.95 和 aOR 12.95、95% CI 4.93–34.01），超重或肥胖（aOR 195，aOR 19 % CI 1.39–2.48 和 aOR 2.07、95% CI 1.53–2.29）並有相關的合併症（aOR 1.83、95% CI 1.32–2.54）。
The association between being of BAME background and severe COVID-19 in pregnancy echoes findings from before the pandemic that showed women of BAME background had higher morbidity and mortality in pregnancy than white women. For example, the most recent MBRRACE-UK report of the Confidential Enquiry into Maternal Death and Morbidity 2016– 2018, showed that there remains a more than four-fold difference in mortality rates among women from Black ethnic backgrounds and an almost two-fold difference among women from Asian backgrounds compared to white women.
BAME 背景與重症孕婦之間的關聯性，與大流行之前的研究發現BAME背景的女性在懷孕期間的發病率和死亡率高於白人女性相呼應。 例如，最近的 MBRRACE-UK 針對 2016-2018 年孕產婦死亡和發病率的『機密調查』報告表示，來自黑人種族背景的婦女的死亡率仍然高於白人女性的四倍以上，而亞裔女性的死亡率則高於白人女性將近兩倍。
The association between BAME background and severe COVID-19 or death from COVID-19 is not confined to pregnant women. In the UK, 13% of the total population identify as being from a BAME background, but 30% of all individuals admitted to UK critical care for COVID-19 were from BAME backgrounds, and individuals from BAME backgrounds were more likely to die from COVID-19. In the case of COVID-19, it has been postulated that this association may be related to health inequalities or socioeconomic factors; however, further research is needed.
染疫重症率及死亡率與BAME 背景的關聯繫並不僅限於孕婦。 在英國，BAME佔總人口的 13% ，而收治入院接受重症照護的人數裡，有30%來自BAME，且BAME背景的患者更有可能死於Covid-19。這些關聯性被假設可能與健康不平等或社會經濟因素有關； 然而，這還需要進一步研究。
Another possible contributing factor to the observed association between severe illness and BAME background is vitamin D deficiency. UK advice recommends vitamin D supplementation to all pregnant women and individuals of BAME background, regardless of the COVID-19 pandemic.
另一個可能造成BAME較容易感染的原因是缺少維生素 D 。 英國議建議不管Covid-19如何流行，所有孕婦和 BAME 背景的人都要補充維生素 D。
1.7 染疫對胚胎的影響
主要發現：
- Symptomatic maternal COVID-19 is associated with an increased likelihood of iatrogenic preterm birth.
有染疫症狀的孕婦醫源性早產的機率可能會增加。 - Aside from preterm birth, there is no evidence that COVID-19 infection has an adverse effect on the fetus or on neonatal outcomes.
除了早產，沒有證據表明Covid-19感染對胎兒或新生兒有不利影響。
Despite over 100 million confirmed COVID-19 infections worldwide, there has been no reported increase in the incidence of congenital anomalies. In the PregCOV-19 Living Systematic Review, there was no evidence of an increase in stillbirth or neonatal death among women with COVID-19, although there was insufficient available evidence to comment on the risk of miscarriage.
儘管全球有超過 1 億Covid-19 的確診案例，但尚未有先天性異常發病率的增加報告。 在 PregCOV-19 Living Systematic Review 中，沒有證據表明染疫婦女的死產或新生兒死亡率增加，儘管沒有足夠的證據來評論流產的風險。
There has also been no evidence to date that fetal growth restriction (FGR) is a consequence of COVID-19.The results of two large COVID-19 in pregnancy registries found that the number of small-for-gestational age neonates was comparable to historical and contemporaneous UK and US data; however, growth restriction is considered a theoretical possibility in pregnancies complicated by COVID-19 as two-thirds of pregnancies with SARS were affected by FGR.
迄今為止，也沒有證據表示感染Covid-19會導致子宮內胎兒生長遲滯 (FGR) 。兩個大型妊娠 Covid-19 登記站發現，胎兒小於妊娠年齡的數量與英國和美國的歷史和同期數據相當； 然而理論上，子宮內胎兒生長遲滯在罹患 Covid-19 的妊娠中是有可能發生的，因為有三分之二的 SARS 妊娠有受到子宮內胎兒生長遲滯的影響。
For babies born to women with COVID-19, the overall outcomes are positive, with over 95% of newborns included in the PregCOV-19 Living Systematic Review reported as being born in good condition. A large study from New York also reported reassuring neonatal outcomes during the pandemic. Of 1481 births overall, 116 (8%) women (giving birth to 120 neonates) tested positive for SARS-CoV-2. All 120 neonates were tested at 24 hours of life and none were positive for SARS-CoV-2. Of 79 neonates who had a repeat SARS-CoV-2 polymerase chain reaction test at age 5–7 days (66% follow-up rate), all tested negative; 72 neonates were also tested at 14 days old and again, none were positive. None of the neonates had signs of COVID-19.
對於染疫女性所生的嬰兒，總體結果是正面的，PregCOV-19 Living Systematic Review 中有 95% 以上的新生兒報告出生狀況良好。來自紐約的一項大型研究也報告在疫情期間的新生兒健康狀況是良好的。 在 1481 名新生兒中，116 名（8%）婦女（生 120 名新生兒）的 SARS-CoV-2 檢測呈陽性。所有 120 名新生兒在出生後 24 小時均接受了檢測，沒有新生兒的檢驗呈現陽性。 在 5-7 天時重複進行 SARS-CoV-2 聚合酶鏈反應檢測的 79 名新生兒中（66% 的隨訪率），所有檢測結果均為陰性； 72 名新生兒也在 14 天大時接受了檢測，結果沒有一個呈陽性。 所有新生兒都沒有染疫的跡象。
In the updated UKOSS study, 19% of babies born in the UK to women with symptomatic SARS-CoV-2 infection, were admitted to the neonatal unit. These admissions may, in part, represent the policy of the maternity unit rather than concerns about wellbeing of the neonate. As discussed in section 1.5.3, symptomatic maternal COVID-19 is associated with an increased risk of preterm birth, principally from iatrogenic preterm birth. Preterm birth is a major cause of perinatal mortality, short- and long-term morbidity. The PregCOV-19 Living Systematic Review estimated the risk of preterm birth at approximately 17%. Most of these preterm births (94%) were iatrogenic and undertaken to improve maternal oxygenation. The updated UKOSS study confirmed that preterm birth was more likely for women with symptomatic COVID-19: 19% of women with symptomatic COVID-19, and 9% of women with asymptomatic COVID-19 gave birth before 37 weeks of gestation. Compared to a historical cohort of pregnant women without SARS-CoV-2, pregnant women with symptomatic COVID-19 were more likely to give birth before 32 weeks of gestation (aOR 3.98, 95% CI 1.48–10.70) and before 37 weeks of gestation (aOR 1.87, 95% CI 1.23–2.85). Pregnant women with asymptomatic COVID-19 were not at increased risk of preterm birth. The care of women at risk of iatrogenic preterm birth is addressed in section 5.2.
在最新的 UKOSS 研究中，有症狀的 SARS-CoV-2 感染婦女在英國出生的嬰兒中有 19% 被送入新生兒病房。這些入院可能在一定程度上代表產科病房的政策，而不是擔憂新生兒的健康狀況。如第 1.5.3 節所述，孕產婦的早產風險增加與感染Covid-19有關，為些早產的發生主要為醫源性早產。早產是週產期死亡、短期和長期發病率的主要原因。PregCOV-19 Living Systematic Review 估計早產風險約為 17%。這些早產中的大多數 (94%) 是醫源性的，且用於改善母體氧合。最新的 UKOSS 研究證實，有症狀的Covid-19 孕婦更可能早產：19%有症狀的染疫孕婦和 9%的無症狀染疫孕婦在妊娠 37 週前分娩。與未感染 SARS-CoV-2 的歷史孕婦隊列相比，有症狀的染疫孕婦更有可能在妊娠 32 週之前（aOR 3.98，95% CI 1.48–10.70）和妊娠 37 週之前分娩（aOR 1.87，95% CI 1.23–2.85）。無症狀的染疫孕婦的早產風險並未增加。有醫源性早產風險的婦女的護理在第 5.2 節中討論。
1.8 Covid-19 大流行期間服務調整對孕產婦和週產期體驗和結果的影響
During the first wave of the COVID-19 pandemic, changes were made to the provision of maternity services with the aim of reducing nosocomial transmission, the unintended consequences of which have yet to be determined.
在第一波Covid-19 大流行期間，產科服務的提供發生了變化，目的是減少院內傳染，其意外後果尚未被確定。
In the UK, two survey studies have demonstrated that during April 2020, the majority of units reduced antenatal and postnatal appointments, adopted remote consultation methods, restricted access to midwifery-led birth settings or home birth, and changed methods of screening for FGR and gestational diabetes. These service changes impacted on the experience of women and their families. An online questionnaire survey of 1451 pregnant or recently pregnant women in the UK found that the majority felt there were barriers to accessing maternity care while anxieties were expressed about changes to antenatal, intrapartum and postnatal services.
在英國有兩項調查研究表明，在 2020 年 4 月期間，大多數單位減少了產前和產後約診，改採遠程諮詢方法，限制進入助產士主導的分娩場所或居家生產，並改變了 FGR 和篩檢妊娠糖尿病的方法。這些服務變化影響了婦女及其家人的經驗。一項針對英國 1451 名已懷孕或近期懷孕婦女的線上問卷調查發現，大多數的人認為當他們表達對於產前、產中以及產後的服務改變感到焦慮時，他們同時仍有取得產科護理方面的困難。
A small, single-centre study from a London hospital showed an increase in the stillbirth rate during the pandemic (n = 16, 9.31 per 1000 births) compared with pre-pandemic (n = 4, 2.38 per 1000 births; P = 0.01). This finding has not been replicated in larger studies. A retrospective review of maternity statistics to July 2020, from a large maternity unit in Dublin, found no negative impact of service modifications during the pandemic on maternal or neonatal outcomes including stillbirth. The Office for National Statistics has reported a non-significant decrease in the stillbirth rate in England and Wales from 4.0 stillbirths per 1000 in 2019 to 3.9 in January–September 2020. This has been in line with the long-term trend of decreasing rates of stillbirth.
倫敦一家醫院的一項小型單一中心的研究顯示，疫情期間的死產率（n = 16，每 1000 名嬰兒出生 9.31 名） 與大流行前（n = 4，每 1000 名嬰兒出生 2.38 名；P = 0.01）相比是增加的。這個發現尚未被複製在更大的研究中。都柏林一家大型婦產單位，針對截至 2020 年 7 月的婦產統計數據進行的回顧性審查發現，大流行期間服務調整對孕產婦或新生兒出生結果（包括死產）沒有負面影響。國家統計局報告稱，英格蘭和威爾斯的死產率從 2019 年的每 1000 人中的 4.0 例降至 2020 年 1 月至 9 月的 3.9 例。這符合死產率下降的長期趨勢。
Meta-analyses and systematic reviews have found higher rates of perinatal mental health disorders during the pandemic, including anxiety and depression. Some of these impacts may be attributed to modifications to maternity services. The MBRRACE-UK rapid report highlighted two instances where women died by suicide, where referrals to perinatal mental health teams were refused or delayed because of restrictions related to COVID-19.
Meta-analyses and systematic reviews 發現大流行期間週產期心理健康障礙的發生率較高，包括焦慮和抑鬱。其中一些影響可能歸因於對生育服務的改變。 MBRRACE-UK 快速報告強調了兩個女性死於自殺的案例是因為疫情的相關限制而被拒絕或延遲轉診到週產期心理健康團隊裡接受治療。
資料來源：Coronavirus (Covid-19) Infection in Pregnancy, Information for healthcare professionals, Version 13: 19 February 2021
