Description of comorbidities.

Background
SARS-CoV-2 infection is associated with worse maternal and fetal outcomes. This study aims to describe the characteristics of pregnant and postpartum women with severe Covid-19 admitted to ICU.
Methods and findings
It’s a retrospective cohort study evaluating pregnant and postpartum women referenced to a specialized ICU between May 2020 and June 2022. Covid-19 was confirmed with RT-PCR or rapid antigen test on a nasopharyngeal swab. Variables were described by median and IQR when numerical, and by frequency and percentage when categorical. OR with 95% CI were calculated for the evaluation of factors related to death. P-values were calculated using Pearson’s ꭓ2-test, Fisher’s exact test, Wilcoxon rank sum test, and Kruskall-Wallis test, and statistical significance was established as < 0·05. Missing data were excluded. All statistical analysis were performed using R software version 4.2.2. Of the 101 admissions, 85 (84·2%) were of pregnant women. Obesity (23·0%) and systemic arterial hypertension (13·0%) were the most prevalent medical conditions. Sixty-six (65·3%) were admitted using some type of oxygen support. Forty-seven (46·5%) evolved to mechanical ventilation. There were 61 events considered obstetric complications, with 8 stillbirths/fetal losses. The overall lethality was 15·8%. Pregnancy interruption, need for non-invasive mechanical ventilation, level of oxygen support at admission, prone maneuver, hemodialysis, and healthcare-related infections were factors associated with death. Evaluating the WHO 7-category ordinary scale, there was a trend of increase in the risk of death with higher punctuation, with a statistically significant difference of women with 5 (OR = 7·27; 95% IC = 1·17–194; p = 0·031) or 6 points (OR = 12·0; 95% IC = 1·15–391; p = 0·038) when compared to the ones with 3 points, i.e., of women admitted with a high-flow non-rebreathing mask or invasive mechanical ventilation, compared with the ones admitted at room air, respectively. The main limitations of this study are the relatively small number of participants, and the use of data derived of medical records—which are susceptible to misclassification and variable amounts of missing data.
Conclusions
Pregnant and postpartum women with severe Covid-19 have high lethality and a high incidence of clinical and obstetric complications. These findings support that this population should be prioritized in public health strategies that address Covid-19.

研究背景
新型冠状病毒（SARS-CoV-2）感染与不良母胎结局显著相关。本研究旨在描述因重症新型冠状病毒肺炎（COVID-19）入住重症监护病房（ICU）的妊娠及产后女性的临床特征。

研究方法与结果
本研究为一项回顾性队列研究，纳入2020年5月至2022年6月期间转诊至专科ICU的妊娠及产后女性。通过鼻咽拭子的逆转录聚合酶链反应（RT-PCR）或快速抗原检测确诊COVID-19。数值型变量以中位数及四分位数间距（IQR）描述，分类变量以频数及百分比描述。通过比值比（OR）及95%置信区间（95% CI）评估与死亡相关的危险因素。采用皮尔逊卡方检验、费舍尔精确检验、威尔科克森秩和检验及克鲁斯卡尔-沃利斯检验计算P值，将统计学显著性阈值设定为P<0.05。缺失数据予以排除。所有统计分析均采用R软件4.2.2版本完成。
本研究共纳入101例住院患者，其中85例（84.2%）为妊娠女性。最常见的基础疾病为肥胖（23.0%）与系统性动脉高血压（13.0%）。66例（65.3%）患者入院时需接受不同类型的氧疗支持；47例（46.5%）患者进展为需要机械通气。共计发生61起产科不良事件，其中8例为死胎/胎儿丢失。总体病死率为15.8%。
与死亡相关的危险因素包括终止妊娠、无创机械通气需求、入院时氧疗级别、俯卧位通气、血液透析及医疗相关感染。通过WHO 7分类普通病情量表评估发现，死亡风险随量表评分升高呈上升趋势；相较于评分3分的患者（即入院时吸入常压空气者），评分5分（OR=7.27；95% CI=1.17~194；P=0.031）及评分6分（OR=12.0；95% CI=1.15~391；P=0.038）的患者死亡风险显著升高，其中评分5分对应入院时使用高流量非重复呼吸面罩，评分6分对应入院时接受有创机械通气。
本研究的主要局限性为研究样本量相对较小，且数据来源于病历记录，易存在分类偏倚及不同程度的缺失数据。

研究结论
因重症COVID-19入住ICU的妊娠及产后女性病死率较高，临床并发症与产科并发症的发生率均处于较高水平。本研究结果提示，在针对COVID-19的公共卫生防控策略中，应将该人群列为优先关注群体。