Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis

Jean B. Nachega, Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
Nadia A. Sam-Agudu, International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
Rhoderick N. Machekano, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Philip J. Rosenthal, Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA.
Sonja Schell, Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Liesl de Waard, Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Adrie Bekker, Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Onesmus W. Gachuno, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
John Kinuthia, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
Nancy Mwongeli, Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya.
Samantha Budhram, Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa.
Valerie Vannevel, Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa.
Priya Somapillay, Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria, Pretoria, South Africa.
Hans W. Prozesky, Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
Jantjie Taljaard, Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
Arifa Parker, Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
Elizabeth Agyare, Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana.
Akwasi Baafuor Opoku, Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Aminatu Umar Makarfi, Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Asara M. Abdullahi, Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Chibueze Adirieje, International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
Daniel Katuashi Ishoso, University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo.
Michel Tshiasuma Pipo, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo.
Marc B. Tshilanda, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo.
Christian Bongo-Pasi Nswe, Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo.
John Ditekemena, University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo.
Lovemore Nyasha Sigwadhi, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Peter S. Nyasulu, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Michel P. Hermans, Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium.
Musa Sekikubo, Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Philippa Musoke, Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda.
Christopher Nsereko, Department of Medicine, Entebbe Regional Reference Hospital, Entebbe, Uganda.

Document Type

Journal Article

Publication Date

11-30-2022

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Volume

75

Issue

11

DOI

10.1093/cid/ciac294

Keywords

Africa; COVID-19; maternal; neonate; pregnancy

Abstract

BACKGROUND: Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS: We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS: Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS: Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.

Department

Global Health

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