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

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.

Comparison of maternal and neonatal outcomes of COVID-19 before and after SARS-CoV-2 omicron emergence in maternity facilities in Malawi (MATSurvey): data from a national maternal surveillance platform

“…The high mortality in our cohort is consistent with a retrospective analysis published in 2022 that used data from the Democratic Republic of Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda. 8 This previous work found an increased risk of in-hospital death in pregnant women with SARS-CoV-2 compared with uninfected pregnant women (adjusted sub-hazard ratio 5·03 [95% CI 1·79–14·13]) and infected non-pregnant women (2·00 [1·08–3·70]). Reassuringly, the data for this retrospective analysis were collected before omicron emergence, and our findings suggest significantly lower maternal mortality during our observation period of omicron dominance.…”

“… 1 However, very little is known about the impact of COVID-19 on maternal health outcomes in sub-Saharan Africa. 2 , 3 , 4 , 5 , 6 , 7 , 8 Although it is likely that COVID-19 outcomes in pregnancy differ between global regions—due to differences in health-care systems, resources, and prevalence of background disease—data from low-resource settings are scarce. One of the most robust systematic reviews reporting maternal and neonatal outcomes for COVID-19 in pregnancy, updated in late May, 2022, included extremely few studies from sub-Saharan Africa or low-resource settings, despite comprising data from 435 studies.…”

Models of determinants of COVID-19 vaccine hesitancy in non-pregnant and pregnant population: Review of current literature”

“…1 Similar findings were seen in countries outside the US, with over 90% of COVID-19 infection-related hospitalizations and 98% of critical care admissions occurring in unvaccinated pregnant persons. 10 , 11 …”

Antepartum SARS-CoV-2 infection and adverse birth outcomes in South African women

“…Several clinical studies, analyses from national surveillance systems and systematic reviews have been published on COVID-19 in pregnant women. Nevertheless, studies evaluating the impact of SARS-CoV-2 infection on birth outcomes in African women are sparse, and mainly describe retrospective analyses or without contemporaneous control group of SARS-CoV-2 uninfected pregnant women [6][7][8][9][10][11].…”

“…SARS-CoV-2 infection during pregnancy has been associated with approximately a 2-fold increased risk of hospital admission, maternal admission to an intensive care unit (ICU) and invasive ventilation, compared with non-pregnant women [2,[11][12][13]. Pregnant women with COVID-19 have also been reported to have a higher case fatality risk compared with non-infected pregnant women [11,14,15]. Risk-factors associated with severe COVID-19 in pregnant women are similar to those in non-pregnant adults [2,3,12,[16][17][18].…”