新冠疫苗接種率過(guò)低,，美國(guó)孕婦成“高危人群”
Shira Stein, 彭博社
2021-08-30
德?tīng)査兎N病毒在美國(guó)掀起新一波疫情,。在此期間,，許多健康的年輕孕婦因?yàn)楦腥拘鹿诓《荆罱K不得不住院接受呼吸機(jī)治療,，有的甚至導(dǎo)致早產(chǎn)或者死亡,。
美國(guó)各地的醫(yī)生均報(bào)告了這種趨勢(shì)，主要集中在南方各州,，但加利福尼亞州和華盛頓等地也有類(lèi)似的情況,。在之前的幾波疫情當(dāng)中并未出現(xiàn)過(guò)這種情況。截至8月14日,，美國(guó)有76.2%的孕婦未接種疫苗,。
《美國(guó)醫(yī)學(xué)會(huì)雜志—網(wǎng)絡(luò)公開(kāi)版》（JAMA Network Open）本月發(fā)表的一篇論文稱(chēng)，與未感染新冠病毒的孕婦相比,，感染新冠病毒的孕婦死亡概率要高出15倍,，需要接受插管治療的概率高出14倍,，早產(chǎn)的概率高出22倍。華盛頓大學(xué)（University of Washington）的婦產(chǎn)科教授琳達(dá)??？颂卣f(shuō)：“我從未見(jiàn)過(guò)這類(lèi)風(fēng)險(xiǎn),。”
孕婦不愿意接種疫苗的情況非常普遍,，因?yàn)檩x瑞（Pfizer Inc.）-BioNTech,、Moderna Inc.和強(qiáng)生（Johnson & Johnson）的新冠疫苗在臨床試驗(yàn)時(shí)均排除了孕婦。針對(duì)孕婦接種疫苗的研究在2月啟動(dòng),，目前有證據(jù)表明孕婦接種疫苗不會(huì)導(dǎo)致流產(chǎn)風(fēng)險(xiǎn)增加,。美國(guó)衛(wèi)生官員本月呼吁孕婦接種疫苗。
?？颂胤Q(chēng)：“現(xiàn)在我們已經(jīng)掌握了大量更有說(shuō)服力的數(shù)據(jù),，可以證明孕婦接種新冠疫苗的安全性，以及不接種疫苗可能面臨的危險(xiǎn)性,?！?/p>
得克薩斯大學(xué)（University of Texas）奧斯丁?戴爾醫(yī)學(xué)院（Austin Dell Medical School）女性健康教授、該校女性健康學(xué)會(huì)（Women’s Health Institute）婦幼內(nèi)科專(zhuān)家艾莉森?卡希爾表示,，孕婦較低的新冠疫苗接種比例和德?tīng)査兎N病毒“導(dǎo)致出現(xiàn)重癥和需住院治療的孕婦數(shù)量大幅增加,，有些患者甚至需要在重癥監(jiān)護(hù)室內(nèi)接受治療。因新冠病毒出現(xiàn)的極端重癥的患者,，讓我們的醫(yī)療服務(wù)變得異常忙碌,。”
對(duì)新冠疫苗的擔(dān)憂(yōu)
已經(jīng)懷孕六個(gè)月的加布里埃爾?納迪-麥吉住在紐約市,。她在懷孕三個(gè)月之后接種了第一劑疫苗,。此前她曾經(jīng)擔(dān)心疫苗會(huì)對(duì)胎兒造成傷害。但她表示,，自己同時(shí)又擔(dān)心免疫系統(tǒng)受損的其他媽媽們感染病毒,，“我不想在沒(méi)有接種疫苗的情況下去醫(yī)院。我真的非常害怕,?！?/p>
南佛羅里達(dá)大學(xué)（University of South Florida）婦產(chǎn)科醫(yī)學(xué)院（College of Medicine Obstetrics and Gynecology）的院長(zhǎng)朱迪特?路易斯表示，絕大多數(shù)因?yàn)樾鹿诜窝鬃≡褐委煹脑袐D都沒(méi)有接種疫苗,。
路易斯說(shuō)：“確實(shí)有一兩例接種新冠疫苗后的突破性感染病例最終需要接受住院治療,，但她們不必使用呼吸機(jī)?！?/p>
佛羅里達(dá)州婦產(chǎn)科醫(yī)生施薇塔?帕特爾指出,，人們?cè)趹言衅陂g通常會(huì)出現(xiàn)免疫系統(tǒng)變化，這增加了她們出現(xiàn)重癥新冠肺炎的風(fēng)險(xiǎn),，可能發(fā)生呼吸道問(wèn)題,。
在《美國(guó)醫(yī)學(xué)會(huì)雜志》（JAMA）發(fā)表的論文中,，加州大學(xué)歐文分校（University of California, Irvine）、醫(yī)生和一名統(tǒng)計(jì)學(xué)家分析了美國(guó)超過(guò)650家學(xué)術(shù)醫(yī)院的臨床數(shù)據(jù)庫(kù),，對(duì)比了自2020年3月1日至2021年2月28日期間分娩的新冠肺炎患者和非新冠肺炎患者,。
在感染新冠病毒和未感染新冠病毒的兩組產(chǎn)婦中，前者有5.2%被送入了重癥監(jiān)護(hù)室,，后者只有0.9%,；前者有1.5%接受了插管治療，后者只有0.1%,。此外,，感染新冠病毒的孕婦未滿(mǎn)37周分娩的比例為16.4%，而未感染病毒的孕婦只有11.5%,。
卡希爾說(shuō)：“有時(shí)候患者的病情非常嚴(yán)重,，我們不得不讓孕婦提前分娩，而過(guò)早出生的新生兒將承擔(dān)早產(chǎn)的所有風(fēng)險(xiǎn),，可能患終生疾病甚至夭折,。”
免疫系統(tǒng)
加州大學(xué)洛杉磯分校羅納德里根醫(yī)療中心（Ronald Reagan UCLA Medical Center）重癥監(jiān)護(hù)室副主任尼達(dá)?卡迪爾表示,，該醫(yī)院在新冠疫情期間收治了許多被送入重癥監(jiān)護(hù)室的孕婦,。該醫(yī)院是洛杉磯少數(shù)幾家為患者提供體外膜肺氧合（ECMO）治療的醫(yī)療設(shè)施。體外膜肺氧合可以繞過(guò)心肺,，支持身體康復(fù),。
隨著新冠肺炎病例增多,，卡迪爾所在的重癥監(jiān)護(hù)室收治了更多患有新冠肺炎的孕婦,。
南佛羅里達(dá)大學(xué)醫(yī)學(xué)院的路易斯表示，早產(chǎn)和接受體外膜肺氧合治療的患者要經(jīng)歷“漫長(zhǎng)的康復(fù)期”,。
對(duì)患有重癥新冠肺炎的孕婦的治療更有挑戰(zhàn)性,。幫助呼吸困難患者的一種重要方法是將患者腹部朝下置于俯臥位?？ǖ蠣柋硎荆骸氨M管能夠采用這種方式,，但由于顯而易見(jiàn)的原因，這對(duì)孕晚期的患者更有難度,?！?/p>
卡迪爾稱(chēng)，醫(yī)生還需要為懷孕的患者保證體內(nèi)的含氧量,，因?yàn)椤拔覀儽M量考慮到胎兒的氧氣輸送,。胎兒對(duì)于氧合變化非常敏感?！?/p>
早產(chǎn)
卡迪爾治療的一名年輕女性的妊娠并不復(fù)雜,，在懷孕之前是一名運(yùn)動(dòng)員,。但這名女性被迫早產(chǎn)，“多次出現(xiàn)病?！?，住院幾個(gè)月后才得以出院回家。
位于南卡羅來(lái)納州芒特普萊森特的東庫(kù)博醫(yī)療中心（East Cooper Medical Center）婦產(chǎn)科主任兼婦幼內(nèi)科主任克里斯托弗?羅賓遜說(shuō)：“我們無(wú)法預(yù)測(cè)哪些人會(huì)出現(xiàn)嚴(yán)重的新冠肺炎呼吸衰竭,。唯一可以用來(lái)判斷哪些患者較為安全的指標(biāo)似乎只有疫苗接種記錄,。”
來(lái)自紐約州杜魯門(mén)斯堡的莫莉?瓦德克?克勞斯在懷孕期間曾經(jīng)考慮接種新冠疫苗,，但當(dāng)時(shí)還沒(méi)有疫苗安全性數(shù)據(jù),。她說(shuō)：“我曾經(jīng)糾結(jié)過(guò)是否要接種疫苗?！?/p>
她的產(chǎn)科醫(yī)生稱(chēng)這取決于她自己,。在新冠疫苗安全性數(shù)據(jù)發(fā)布之后，瓦德克?克勞斯再次與產(chǎn)科醫(yī)生進(jìn)行了討論,，然后決定接種疫苗,。四周后，她生下了一名健康的女?huà)搿?/p>
瓦德克?克勞斯說(shuō)：“我寧愿承擔(dān)疫苗接種帶來(lái)的流產(chǎn)風(fēng)險(xiǎn),，也不愿意死于新冠病毒,，讓兩個(gè)孩子失去媽媽?！保ㄘ?cái)富中文網(wǎng)）
翻譯：劉進(jìn)龍
審校：汪皓
德?tīng)査兎N病毒在美國(guó)掀起新一波疫情,。在此期間，許多健康的年輕孕婦因?yàn)楦腥拘鹿诓《?，最終不得不住院接受呼吸機(jī)治療,，有的甚至導(dǎo)致早產(chǎn)或者死亡。
美國(guó)各地的醫(yī)生均報(bào)告了這種趨勢(shì),，主要集中在南方各州,，但加利福尼亞州和華盛頓等地也有類(lèi)似的情況。在之前的幾波疫情當(dāng)中并未出現(xiàn)過(guò)這種情況,。截至8月14日,，美國(guó)有76.2%的孕婦未接種疫苗。
《美國(guó)醫(yī)學(xué)會(huì)雜志—網(wǎng)絡(luò)公開(kāi)版》（JAMA Network Open）本月發(fā)表的一篇論文稱(chēng),，與未感染新冠病毒的孕婦相比,，感染新冠病毒的孕婦死亡概率要高出15倍，需要接受插管治療的概率高出14倍,，早產(chǎn)的概率高出22倍,。華盛頓大學(xué)（University of Washington）的婦產(chǎn)科教授琳達(dá)?埃克特說(shuō)：“我從未見(jiàn)過(guò)這類(lèi)風(fēng)險(xiǎn)?！?/p>
孕婦不愿意接種疫苗的情況非常普遍,，因?yàn)檩x瑞（Pfizer Inc.）-BioNTech、Moderna Inc.和強(qiáng)生（Johnson & Johnson）的新冠疫苗在臨床試驗(yàn)時(shí)均排除了孕婦,。針對(duì)孕婦接種疫苗的研究在2月啟動(dòng),，目前有證據(jù)表明孕婦接種疫苗不會(huì)導(dǎo)致流產(chǎn)風(fēng)險(xiǎn)增加。美國(guó)衛(wèi)生官員本月呼吁孕婦接種疫苗,。
?？颂胤Q(chēng)：“現(xiàn)在我們已經(jīng)掌握了大量更有說(shuō)服力的數(shù)據(jù)，可以證明孕婦接種新冠疫苗的安全性,，以及不接種疫苗可能面臨的危險(xiǎn)性,。”
得克薩斯大學(xué)（University of Texas）奧斯丁?戴爾醫(yī)學(xué)院（Austin Dell Medical School）女性健康教授,、該校女性健康學(xué)會(huì)（Women’s Health Institute）婦幼內(nèi)科專(zhuān)家艾莉森?卡希爾表示,，孕婦較低的新冠疫苗接種比例和德?tīng)査兎N病毒“導(dǎo)致出現(xiàn)重癥和需住院治療的孕婦數(shù)量大幅增加，有些患者甚至需要在重癥監(jiān)護(hù)室內(nèi)接受治療,。因新冠病毒出現(xiàn)的極端重癥的患者,，讓我們的醫(yī)療服務(wù)變得異常忙碌?！?/p>
對(duì)新冠疫苗的擔(dān)憂(yōu)
已經(jīng)懷孕六個(gè)月的加布里埃爾?納迪-麥吉住在紐約市,。她在懷孕三個(gè)月之后接種了第一劑疫苗。此前她曾經(jīng)擔(dān)心疫苗會(huì)對(duì)胎兒造成傷害,。但她表示,，自己同時(shí)又擔(dān)心免疫系統(tǒng)受損的其他媽媽們感染病毒，“我不想在沒(méi)有接種疫苗的情況下去醫(yī)院,。我真的非常害怕,。”
南佛羅里達(dá)大學(xué)（University of South Florida）婦產(chǎn)科醫(yī)學(xué)院（College of Medicine Obstetrics and Gynecology）的院長(zhǎng)朱迪特?路易斯表示,，絕大多數(shù)因?yàn)樾鹿诜窝鬃≡褐委煹脑袐D都沒(méi)有接種疫苗,。
路易斯說(shuō)：“確實(shí)有一兩例接種新冠疫苗后的突破性感染病例最終需要接受住院治療,，但她們不必使用呼吸機(jī),。”
佛羅里達(dá)州婦產(chǎn)科醫(yī)生施薇塔?帕特爾指出,，人們?cè)趹言衅陂g通常會(huì)出現(xiàn)免疫系統(tǒng)變化,，這增加了她們出現(xiàn)重癥新冠肺炎的風(fēng)險(xiǎn)，可能發(fā)生呼吸道問(wèn)題,。
在《美國(guó)醫(yī)學(xué)會(huì)雜志》（JAMA）發(fā)表的論文中,，加州大學(xué)歐文分校（University of California, Irvine）、醫(yī)生和一名統(tǒng)計(jì)學(xué)家分析了美國(guó)超過(guò)650家學(xué)術(shù)醫(yī)院的臨床數(shù)據(jù)庫(kù)，對(duì)比了自2020年3月1日至2021年2月28日期間分娩的新冠肺炎患者和非新冠肺炎患者,。
在感染新冠病毒和未感染新冠病毒的兩組產(chǎn)婦中,，前者有5.2%被送入了重癥監(jiān)護(hù)室，后者只有0.9%,；前者有1.5%接受了插管治療,，后者只有0.1%。此外,，感染新冠病毒的孕婦未滿(mǎn)37周分娩的比例為16.4%,，而未感染病毒的孕婦只有11.5%。
卡希爾說(shuō)：“有時(shí)候患者的病情非常嚴(yán)重,，我們不得不讓孕婦提前分娩,，而過(guò)早出生的新生兒將承擔(dān)早產(chǎn)的所有風(fēng)險(xiǎn)，可能患終生疾病甚至夭折,?！?/p>
免疫系統(tǒng)
加州大學(xué)洛杉磯分校羅納德里根醫(yī)療中心（Ronald Reagan UCLA Medical Center）重癥監(jiān)護(hù)室副主任尼達(dá)?卡迪爾表示，該醫(yī)院在新冠疫情期間收治了許多被送入重癥監(jiān)護(hù)室的孕婦,。該醫(yī)院是洛杉磯少數(shù)幾家為患者提供體外膜肺氧合（ECMO）治療的醫(yī)療設(shè)施,。體外膜肺氧合可以繞過(guò)心肺,，支持身體康復(fù),。
隨著新冠肺炎病例增多，卡迪爾所在的重癥監(jiān)護(hù)室收治了更多患有新冠肺炎的孕婦,。
南佛羅里達(dá)大學(xué)醫(yī)學(xué)院的路易斯表示,，早產(chǎn)和接受體外膜肺氧合治療的患者要經(jīng)歷“漫長(zhǎng)的康復(fù)期”。
對(duì)患有重癥新冠肺炎的孕婦的治療更有挑戰(zhàn)性,。幫助呼吸困難患者的一種重要方法是將患者腹部朝下置于俯臥位,。卡迪爾表示：“盡管能夠采用這種方式,，但由于顯而易見(jiàn)的原因,，這對(duì)孕晚期的患者更有難度?！?/p>
卡迪爾稱(chēng),，醫(yī)生還需要為懷孕的患者保證體內(nèi)的含氧量，因?yàn)椤拔覀儽M量考慮到胎兒的氧氣輸送,。胎兒對(duì)于氧合變化非常敏感,。”
早產(chǎn)
卡迪爾治療的一名年輕女性的妊娠并不復(fù)雜,，在懷孕之前是一名運(yùn)動(dòng)員,。但這名女性被迫早產(chǎn)，“多次出現(xiàn)病危”,，住院幾個(gè)月后才得以出院回家,。
位于南卡羅來(lái)納州芒特普萊森特的東庫(kù)博醫(yī)療中心（East Cooper Medical Center）婦產(chǎn)科主任兼婦幼內(nèi)科主任克里斯托弗?羅賓遜說(shuō)：“我們無(wú)法預(yù)測(cè)哪些人會(huì)出現(xiàn)嚴(yán)重的新冠肺炎呼吸衰竭。唯一可以用來(lái)判斷哪些患者較為安全的指標(biāo)似乎只有疫苗接種記錄,?！?/p>
來(lái)自紐約州杜魯門(mén)斯堡的莫莉?瓦德克?克勞斯在懷孕期間曾經(jīng)考慮接種新冠疫苗，但當(dāng)時(shí)還沒(méi)有疫苗安全性數(shù)據(jù),。她說(shuō)：“我曾經(jīng)糾結(jié)過(guò)是否要接種疫苗,。”
她的產(chǎn)科醫(yī)生稱(chēng)這取決于她自己,。在新冠疫苗安全性數(shù)據(jù)發(fā)布之后,，瓦德克?克勞斯再次與產(chǎn)科醫(yī)生進(jìn)行了討論，然后決定接種疫苗,。四周后,，她生下了一名健康的女?huà)搿?/p>
瓦德克?克勞斯說(shuō)：“我寧愿承擔(dān)疫苗接種帶來(lái)的流產(chǎn)風(fēng)險(xiǎn)，也不愿意死于新冠病毒,，讓兩個(gè)孩子失去媽媽,。”（財(cái)富中文網(wǎng)）
翻譯：劉進(jìn)龍
審校：汪皓
More young and healthy pregnant people are ending up hospitalized on ventilators, delivering babies prematurely and sometimes dying from COVID-19 during the Delta-fueled spike in cases.
Doctors across the country are reporting this trend, not seen in previous surges, largely in the South but also in states like California and Washington. As of Aug. 14, 76.2% of pregnant people were unvaccinated.
Pregnant women with COVID-19 are 15 times more likely to die, 14 times more likely to need to be intubated, and 22 times more likely to have pre-term birth than those who are uninfected, according to a study published this month in JAMA Network Open. “I have not seen risks like this,” said Linda Eckert, professor of obstetrics and gynecology at the University of Washington.
Reluctance to get the shots has been widespread among the pregnant population because they were excluded from clinical trials for the Pfizer Inc.-BioNTech SE, Moderna Inc., and Johnson & Johnson vaccines. Studies on pregnant women began in February, and evidence has shown no increased risk of miscarriage from the shots. U.S. health officials this month stepped up calls for pregnant people to get vaccinated.
“Now we have a lot more compelling data about the safety of the vaccine in pregnancy and we have amazingly compelling data about how dangerous it is to get COVID when you’re pregnant,” Eckert said.
The low numbers of pregnant people who are vaccinated and the Delta variant have “created this perfect storm of pregnant people getting extremely sick and being hospitalized, and even requiring care in the intensive care unit,” said Alison Cahill, a professor of women’s health at the University of Texas at Austin Dell Medical School and maternal-fetal medicine specialist at the school’s Women’s Health Institute. “We have very, very busy services with patients extremely sick from COVID.”
Vaccine worries
Gabriella Nardi-McGee, who is six months pregnant and lives in New York City, got her first vaccine dose after the end of the first trimester of her pregnancy after initially worrying about harming her unborn child. However, she also was concerned about exposing her immuno-compromised mother to the virus and “did not want to be in a hospital and not be vaccinated,” she said. “That really scared me.”
Judette Louis, chair of the University of South Florida College of Medicine Obstetrics and Gynecology, said the vast majority of pregnant people getting hospitalized with COVID are unvaccinated.
“We did have a couple of vaccine breakthroughs that did end up needing to be hospitalized, but they did not end up on the ventilator,” Louis said.
People often undergo immune changes during pregnancy that can increase vulnerability to a severe type of COVID, potentially with respiratory issues, said Shweta Patel, an obstetrician and gynecologist in Florida.
In the study published in JAMA, University of California, Irvine, doctors and a statistician analyzed a clinical database of more than 650 academic hospitals in the U.S. to compare patients who gave birth with or without COVID-19 between March 1, 2020 and Feb. 28, 2021.
Of those cases, 5.2% of those giving birth with COVID were admitted to the ICU, compared with 0.9% of women without the virus; 1.5% of those with COVID were intubated, compared with 0.1% of women without the virus. Additionally, 16.4% of women with COVID delivered at less than 37 weeks, compared with 11.5% of those without the virus.
“Sometimes the illness can be significant enough such that we have to deliver folks early and when that happens, then that newborn baby who’s delivered extremely prematurely takes on all of the risks of a very preterm delivery that can be lifelong morbidities and even death,” Cahill said.
Immune systems
Ronald Reagan UCLA Medical Center in Los Angeles has seen a lot of pregnant people admitted to the ICU throughout the pandemic, said Nida Qadir, associate director of the hospital’s medical ICU. It is one of the few facilities in the Los Angeles area that can put patients on extracorporeal membrane oxygenation (ECMO), a machine that bypasses the heart and lungs to allow the body to heal.
Now that there are more cases overall, there are even more pregnant COVID patients in her ICU.
People who have to deliver early and end up on ECMO have a “l(fā)ong course to recovery,” said South Florida College’s Louis.
Taking care of severely ill COVID-19 patients can be more challenging if they’re pregnant. One important way to help patients in respiratory distress involves putting someone on their belly, known as proning. “While we’re able to do it, it for obvious reasons becomes more difficult if somebody is further along in their pregnancy,” Qadir said.
Doctors also need to keep oxygen levels higher for pregnant patients because “we are trying to keep in mind oxygen delivery to the fetus, which is very sensitive to changes in oxygenation,” Qadir said.
Premature birth
Qadir took care of one young woman who had an uncomplicated pregnancy and was athletic prior to getting COVID. The woman had to deliver her baby prematurely, “nearly died so many times,” and was in the hospital for months before she was able to go home.
“We cannot predict who is going to have that severe COVID pneumonia respiratory failure outcome,” said Christopher Robinson, chair of obstetrics and gynecology and director of maternal fetal medicine at East Cooper Medical Center in Mount Pleasant, South Carolina. “The only thing that appears to be suggestive of who is safe and who is not is vaccination history.”
When Molly Wadzeck Kraus from Trumansburg, New York was considering getting vaccinated while pregnant, safety data still wasn’t available. “I struggled with the decision of whether or not to do it,” she said.
Her obstetrician said it was up to her. When data came out, Wadzeck Kraus discussed it again with her obstetrician and decided to get the vaccine. Four weeks ago, she gave birth to a healthy baby girl.
“Even if there was a risk of miscarriage, I would’ve much rather risked that than risk me getting COVID and dying and leaving my two children I already have without a mom,” Wadzeck Kraus said.
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