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

Authors

• 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.

APA Citation

Nachega, Jean B.; Sam-Agudu, Nadia A.; Machekano, Rhoderick N.; Rosenthal, Philip J.; Schell, Sonja; de Waard, Liesl; Bekker, Adrie; Gachuno, Onesmus W.; Kinuthia, John; Mwongeli, Nancy; Budhram, Samantha; Vannevel, Valerie; Somapillay, Priya; Prozesky, Hans W.; Taljaard, Jantjie; Parker, Arifa; Agyare, Elizabeth; Opoku, Akwasi Baafuor; Makarfi, Aminatu Umar; Abdullahi, Asara M.; Adirieje, Chibueze; Ishoso, Daniel Katuashi; Pipo, Michel Tshiasuma; Tshilanda, Marc B.; Bongo-Pasi Nswe, Christian; Ditekemena, John; Sigwadhi, Lovemore Nyasha; Nyasulu, Peter S.; Hermans, Michel P.; Sekikubo, Musa; Musoke, Philippa; and Nsereko, Christopher, "Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis" (2022). GW Authored Works. Paper 1884.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1884

Department

Global Health