Clinical Features and Outcomes of COVID-19 Infection among Pregnant Women in South Africa

Background: Sub-Saharan Africa (SSA) has the highest age-adjusted burden of hypertension and cardiovascular disease (CVD). SSA also experiences many viral infections due to unique environmental and societal factors. The purpose of this narrative review is to examine evidence around how hypertension, CVD, and emerging viral infections interact in SSA. Methods: In September 2021, we conducted a search in MEDLINE, Embase, and Scopus, limited to English language studies published since 1990, and found a total of 1169 articles. Forty-seven original studies were included, with 32 on COVID-19 and 15 on other emerging viruses. Results: Seven articles, including those with the largest sample size and most robust study design, found an association between preexisting hypertension or CVD and COVID-19 severity or death. Ten smaller studies found no association, and 17 did not calculate statistics to compare groups. Two studies assessed the impact of COVID-19 on incident CVD, with one finding an increase in stroke admissions. For other emerging viruses, 3 studies did not find an association between preexisting hypertension or CVD on West Nile and Lassa fever mortality. Twelve studies examined other emerging viral infections and incident CVD, with 4 finding no association and 8 not calculating statistics. Conclusions: Growing evidence from COVID-19 suggests viruses, hypertension, and CVD interact on multiple levels in SSA, but research gaps remain especially for other emerging viral infections. SSA can and must play a leading role in the study and control of emerging viral infections, with expansion of research and public health infrastructure to address these interactions.

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“…Ten studies did not calculate statistics to compare those with and without preexisting hypertension or CVD on COVID-19 outcomes. 21–30…”

Section: Resultsmentioning

confidence: 99%

Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review

et al. 2022

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“…A high-quality systematic review and meta-analysis in 2021 found increased risk of preeclampsia, preterm delivery, gestational diabetes, low birth weight and still birth amongst pregnant women infected with COVID-19 than in pregnant women who were not infected [7] [8] [9] [10] [11]. Increased caesarean section rates, hypertensive disorders of pregnancy, premature rupture of membranes, maternal mortality, prematurity, foetal distress, neonatal asphyxia, neonatal deaths, are also commonly reported adverse pregnancy outcomes [12].…”

Section: Introduction 1backgroundmentioning

confidence: 99%

Maternal and Foetal Outcome among Pregnant Women Infected with COVID-19 in Three Referral Hospitals in Cameroon

Takang¹,

Nyuykighan²,

Pisoh³

et al. 2023

OJOG

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Introduction: Pregnancy is generally known to be an immune compromised state, thus placing pregnant women at risk of SARS-COV-2 infection. We therefore carried out this study to assess the maternal and foetal outcomes among pregnant women infected with COVID-19 in three referral hospitals in Cameroon. Methodology: This was a hospital-based retrospective case control study covering a two-year period. Data collection was done over a duration of four months at the Yaoundé Central Hospital, Douala Gynaeco-Obstetric and Paediatric Hospital and the Bamenda Regional Hospital. Cases were pregnant women who gave birth after a confirmed COVID-19 infection, matched 1:2 by age (±1 year) and parity (±1) to pregnant women not infected by COVID-19, who gave birth at the three hospitals within the same period. Results: The rate of caesarean section delivery among our cases was 52.4% as compared to 44.3% among controls (OR, 1.38, 95% CI, 0.74 -2.60, P = 0.296). Maternal mortality rate in our cases was at 8.2% as compared to 6.6% in controls (OR, 1.60, 95% CI, 0.50 -5.12, P = 0.422). The rate of preterm delivery in our cases was 24.6% as compared to 11.5% in the control group (OR, 2.39, 95% CI, 1.05 -5.42, P = 0.025). Perinatal death rate in our study was recorded at 8.2% as compared to 3.4% in the controls (OR, 2.63, 95% CI, 0.68 -10.18, PS = 0.162) Conclusion: Pregnant women infected with COVID-19 were found to have higher risks of preterm delivery and acute foetal distress as compared to pregnant women who were not infected. Caesarean section deliveries, maternal and foetal mortality were higher in COVID-19 infected pregnant women as compared to those not though these findings were not statistically significant.

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COVID-19 in pregnant women: a systematic review and meta-analysis on the risk and prevalence of pregnancy loss

van Baar,

Kostova,

Allotey

et al. 2023

Human Reproduction Update

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BACKGROUND Pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more likely to experience preterm birth and their neonates are more likely to be stillborn or admitted to a neonatal unit. The World Health Organization declared in May 2023 an end to the coronavirus disease 2019 (COVID-19) pandemic as a global health emergency. However, pregnant women are still becoming infected with SARS-CoV-2 and there is limited information available regarding the effect of SARS-CoV-2 infection in early pregnancy on pregnancy outcomes. OBJECTIVE AND RATIONALE We conducted this systematic review to determine the prevalence of early pregnancy loss in women with SARS-Cov-2 infection and compare the risk to pregnant women without SARS-CoV-2 infection. SEARCH METHODS Our systematic review is based on a prospectively registered protocol. The search of PregCov19 consortium was supplemented with an extra electronic search specifically on pregnancy loss in pregnant women infected with SARS-CoV-2 up to 10 March 2023 in PubMed, Google Scholar, and LitCovid. We included retrospective and prospective studies of pregnant women with SARS-CoV-2 infection, provided that they contained information on pregnancy losses in the first and/or second trimester. Primary outcome was miscarriage defined as a pregnancy loss before 20 weeks of gestation, however, studies that reported loss up to 22 or 24 weeks were also included. Additionally, we report on studies that defined the pregnancy loss to occur at the first and/or second trimester of pregnancy without specifying gestational age, and for second trimester miscarriage only when the study presented stillbirths and/or foetal losses separately from miscarriages. Data were stratified into first and second trimester. Secondary outcomes were ectopic pregnancy (any extra-uterine pregnancy), and termination of pregnancy. At least three researchers independently extracted the data and assessed study quality. We calculated odds ratios (OR) and risk differences (RDs) with corresponding 95% CI and pooled the data using random effects meta-analysis. To estimate risk prevalence, we performed meta-analysis on proportions. Heterogeneity was assessed by I2. OUTCOMES We included 120 studies comprising a total of 168 444 pregnant women with SARS-CoV-2 infection; of which 18 233 women were in their first or second trimester of pregnancy. Evidence level was considered to be of low to moderate certainty, mostly owing to selection bias. We did not find evidence of an association between SARS-CoV-2 infection and miscarriage (OR 1.10, 95% CI 0.81–1.48; I2 = 0.0%; RD 0.0012, 95% CI −0.0103 to 0.0127; I2 = 0%; 9 studies, 4439 women). Miscarriage occurred in 9.9% (95% CI 6.2–14.0%; I2 = 68%; 46 studies, 1797 women) of the women with SARS CoV-2 infection in their first trimester and in 1.2% (95% CI 0.3–2.4%; I2 = 34%; 33 studies; 3159 women) in the second trimester. The proportion of ectopic pregnancies in women with SARS-CoV-2 infection was 1.4% (95% CI 0.02–4.2%; I2 = 66%; 14 studies, 950 women). Termination of pregnancy occurred in 0.6% of the women (95% CI 0.01–1.6%; I2 = 79%; 39 studies; 1166 women). WIDER IMPLICATIONS Our study found no indication that SARS-CoV-2 infection in the first or second trimester increases the risk of miscarriages. To provide better risk estimates, well-designed studies are needed that include pregnant women with and without SARS-CoV-2 infection at conception and early pregnancy and consider the association of clinical manifestation and severity of SARS-CoV-2 infection with pregnancy loss, as well as potential confounding factors such as previous pregnancy loss. For clinical practice, pregnant women should still be advised to take precautions to avoid risk of SARS-CoV-2 exposure and receive SARS-CoV-2 vaccination.

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Clinical Features and Outcomes of COVID-19 Infection among Pregnant Women in South Africa

Cited by 5 publications

References 15 publications

Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review

Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review

Maternal and Foetal Outcome among Pregnant Women Infected with COVID-19 in Three Referral Hospitals in Cameroon

COVID-19 in pregnant women: a systematic review and meta-analysis on the risk and prevalence of pregnancy loss

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