Maternal and neonatal outcomes of COVID-19 in a high-risk pregnant cohort with and without HIV.

BACKGROUND: The impact of SARS-CoV-2 infection in pregnant women living with HIV (PLHIV) has not been described previously. OBJECTIVES: To describe the clinical presentation and outcomes of a cohort of women with high-risk pregnancies with confirmed COVID-19 to determine whether risk factors for disease severity and adverse outcomes of COVID-19 differed in pregnant women without HIV compared with PLHIV. METHODS: We prospectively enrolled pregnant women with COVID-19 attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, South Africa, from 1 May to 31 July 2020, with follow-up until 31 October 2020. Women were considered high risk if they required specialist care for maternal, neonatal and/or anaesthetic conditions. Common maternal or obstetric conditions included hypertensive disorders, morbid obesity (body mass index (BMI) ≥40 kg/m2) and diabetes. Information on demographics, clinical features, and maternal and neonatal outcomes was collected and compared for PLHIV v. pregnant women without HIV. RESULTS: One hundred women (72 without HIV and 28 PLHIV) with high-risk pregnancies had laboratory-confirmed COVID-19. Among the 28 PLHIV, the median (interquartile range) CD4 count was 441 (317 - 603) cells/µL, and 19/26 (73%) were virologically suppressed. COVID-19 was diagnosed predominantly in the third trimester (81%). Obesity (BMI ≥30 in n=61/81; 75%) and hypertensive disorders were frequent comorbidities. Of the 100 women, 40% developed severe or critical COVID-19, 15% required intensive care unit admission and 6% needed invasive ventilation. Eight women died, 1 from advanced HIV disease complicated by bacteraemia and urosepsis. The crude maternal mortality rate was substantially higher in women with COVID-19 compared with all other deliveries at our institution during this period (8/91 (9%) v. 7/4 058 (0.2%); p<0.001). Neonatal outcomes were favourable. No significant differences in COVID-19 risk factors, disease severity, and maternal/neonatal outcome were noted for PLHIV v. those without HIV. CONCLUSIONS: In this cohort of high-risk pregnant women, the impact of COVID-19 was severe, significantly increasing maternal mortality risk compared with baseline rates. Virally suppressed HIV infection was not associated with worse COVID-19 outcomes in pregnancy.

COVID-19 infection in high-risk south african pregnancies with and without HIV

Background: Data from Africa reporting the outcomes of COVID-19 infection in pregnancy are limited, particularly for women with high-risk pregnancies (hypertension, diabetes and obesity) and pregnant women living with HIV (PLHIV). We describe the clinical features, maternal and birth outcomes of COVID-19 high-risk pregnancies at a South African tertiary care referral hospital with a 24% antenatal HIV prevalence. Methods: We prospectively collected data from COVID-19 infected pregnant women attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, between 1 May 2020 and 31 July 2020, and documented pregnancy and birth outcomes until 30 October 2020. Laboratory testing for SARS-CoV-2 infection was performed only in symptomatic pregnant women. Descriptive analysis was performed for all COVID-19 infected women with high-risk pregnancies;demographic and outcome variables were compared for PLHIV versus pregnant women without HIV. Results: One hundred pregnant women (72 without HIV and 28 PLHIV) had laboratory-confirmed COVID-19 infection (Table 1). Obesity, hypertensive disorders and gestational diabetes were frequent comorbidities. Among 28 PLHIV, the majority received antiretroviral treatment 27 (96%);median CD4 count was 441 (14-838) cell/mm3 for 21 (75%) and 19 (73%) were virologically suppressed. COVID-19 infection was diagnosed predominantly in the 3rd trimester (81%);50% of women delivered within 2 weeks of infection onset. Forty women developed pneumonia;13 developed adult respiratory distress syndrome (ARDS) and 6 required invasive ventilation. Eight women died, 7 from ARDS and 1 from advanced HIV disease with bacteraemia. Pregnancy outcomes included 91 live births (including 5 sets of twins), 5 stillbirths, 4 miscarriages, 2 mothers who died with the fetus in situ and 1 medical termination of pregnancy. Birth outcomes for 2 women were unknown. Outcome for the 91 liveborn neonates were good except for one who died from complications related to perinatal asphyxia. No significant differences for COVID-19 infection impact and outcome were noted for PLHIV versus those without HIV. Conclusion: In this cohort of high-risk pregnant women with COVID-19 infection, no clinical differences in outcome attributable to HIV-infection were noted, however the majority of PLHIV were virally suppressed. The impact of COVID-19 infection in pregnancy was severe (40% complicated by pneumonia;8% crude mortality rate);neonatal outcomes were favourable.