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1.
Clinical Infectious Diseases ; : 12, 2022.
Article in English | Web of Science | ID: covidwho-1895803

ABSTRACT

In hospitalized African women, both SARS-CoV-2 infection and pregnancy independently increased risks of morbidity and mortality. In addition, among pregnant and nonpregnant women with SARS-CoV-2 infection, HIV, prior tuberculosis, sickle cell anemia, and nongestational diabetes increased risk of ICU admission. 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.

2.
Topics in Antiviral Medicine ; 30(1 SUPPL):265, 2022.
Article in English | EMBASE | ID: covidwho-1880623

ABSTRACT

Background: Limited data are available on pregnancy and COVID-19 in sub-Saharan Africa (SSA). Methods: We conducted a retrospective cohort study of women ≥18 years old hospitalized at 23 health facilities in six SSA countries between March 1, 2020, and March 31, 2021. We assessed the impact of pregnancy on SARS-CoV-2 infection, and of SARS-CoV-2 on pregnant women, through comparisons of clinical outcomes among: 1) pregnant and non-pregnant women hospitalized with RT-PCR-confirmed SARS-CoV-2 infection, and 2) pregnant women confirmed to be positive or negative for SARS-CoV-2 infection by RT-PCR. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included need for oxygen supplementation or mechanical ventilation, pregnancy outcomes, and maternal or neonatal mortality. We performed negative log-binomial regression models to estimate the impact of pregnancy on SARS-CoV-2 among all women in the cohort, and the impact of SARS-CoV-2 on pregnancy outcomes. Factors associated with mortality were evaluated using competing-risk regression based on Fine and Gray's proportional hazards model. Results: We analyzed data on 1,315 hospitalized women: 510 pregnant women with SARS-CoV-2 infection;403 non-pregnant women with SARS-CoV-2 infection, and 402 pregnant women without SARS-CoV-2 infection. Among those with SARS-CoV-2 infection, pregnancy was associated with increased risk of ICU admission (adjusted rate ratio [aRR]= 1.86, 95% CI: 1.07-3.22, p=0.003) and oxygen supplementation (aRR= 1.48, 95% CI: 1.06-2.08, p=0.001). Among pregnant women, those with SARS-CoV-2 infection had increased risk of ICU admission (aRR = 2.0, 95% CI: 1.20-3.35, p=0.008), oxygen supplementation (aRR = 1.57, 95% CI: 1.17-2.11, p=0.002) and maternal mortality (aRR=3.08, 95% CI: 1.21-7.85, p=0.018) (Figure). Comparing SARS-CoV-2-infected vs. uninfected pregnant women, infected women were more likely to deliver by Caesarean section (59.3% vs 37.9%, RR = 1.56, 95% CI: 1.29-1.89, p<0.001);however, proportions of pre-term infants (32.4% vs. 31.1%, respectively, p = 0.870), infants with low birth weight (33.8% vs. 30.9%, respectively, p=0.711) and neonatal deaths [8/209 (3.8%) vs. 8/306 (2.6%) (RR=1.46, 95% CI: 0.56-3.84, p=0.436, respectively)] were similar. Conclusion: Among hospitalized pregnant women, SARS-CoV-2 infection increased morbidity and mortality. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.

3.
Topics in Antiviral Medicine ; 30(1 SUPPL):264, 2022.
Article in English | EMBASE | ID: covidwho-1879989

ABSTRACT

Background: People living with HIV may have increased risk of SARS-CoV-2 infection and severe COVID-19. However, few studies have examined the risk and outcomes of SARS-CoV-2 infection specific to postpartum women living with HIV and their HIV-exposed, uninfected (HEU) infants. To address this gap, we compared incidence, risk factors, and symptomatology of SARS-CoV-2 infection among mother-infant pairs living with and without HIV. Methods: We conducted a nested study of healthy mothers and infants enrolled in a Nairobi, Kenya-based prospective cohort study. Women living with HIV were enrolled in the parent cohort only if on antiretroviral therapy (ART) for ≥6 months. SARS-CoV-2 serology was performed on plasma collected between 1 May-31 December 2020 to assess incidence of infection and duration of antibody detection. SARS-CoV-2 RNA PCR and sequencing was also conducted on stool from seropositive participants. Sociodemographic and clinical data were used to evaluate risk factors for SARS-CoV-2 with Cox regression and to assess symptomatic COVID-19 with generalized estimating equations. Results: Among 104 mothers (51 living with HIV, 53 HIV-uninfected) and 89 infants (41 HEU, 48 HIV-unexposed), SARS-CoV-2 seropositivity was 38% and 17%, respectively. Incidence of infection did not differ significantly between women living with HIV and HIV-uninfected women (Hazard Ratio [HR]=1.51, 95% CI:0.78-2.94) or HEU and HIV-unexposed infants (HR=1.48, 95% CI:0.54-4.09). Maternal SARS-CoV-2 substantially increased risk of infant infection, regardless of HIV exposure (HR=10.3, 95% CI:2.89-36.8). However, no other factors-including CD4 count and years on ART among women living with HIV-were associated with infection. Antibody levels waned below detection in ∼30% of mothers and infants after a mean of 6 and 5 months, respectively. Among seropositive participants, SARS-CoV-2 RNA was detected among 5 of 27 mothers (19%) and one of 13 infants (8%) with samples. Sequences recovered from 2 samples were related to circulating variants in Kenya in 2020. One-fifth of participants had mild to moderate symptoms, but there were no cases of severe COVID-19 or death. Conclusion: Our findings show there was a high risk of SARS-CoV-2 infection among postpartum Kenyan women and their infants in 2020, though this risk was not substantially increased for women with well-managed HIV and most cases were asymptomatic. Rapidly waning antibody responses suggest continued preventive measures are needed until vaccination is widely available.

4.
PubMed; 2022.
Preprint in English | PubMed | ID: ppcovidwho-338336

ABSTRACT

Pre-existing antibodies that bind endemic human coronaviruses (eHCoVs) can cross-react with SARS-CoV-2, the betacoronavirus that causes COVID-19, but whether these responses influence SARS-CoV-2 infection is still under investigation and is particularly understudied in infants. In this study, we measured eHCoV and SARS-CoV-1 IgG antibody titers before and after SARS-CoV-2 seroconversion in a cohort of Kenyan women and their infants. Pre-existing eHCoV antibody binding titers were not consistently associated with SARS-CoV-2 seroconversion in infants or mothers, though we observed a very modest association between pre-existing HCoV-229E antibody levels and lack of SARS-CoV-2 seroconversion in infants. After seroconversion to SARS-CoV-2, antibody binding titers to endemic betacoronaviruses HCoV-OC43 and HCoV-HKU1, and the highly pathogenic betacoronavirus SARS-CoV-1, but not endemic alphacoronaviruses HCoV-229E and HCoV-NL63, increased in mothers. However, eHCoV antibody levels did not increase following SARS-CoV-2 seroconversion in infants, suggesting the increase seen in mothers was not simply due to cross-reactivity to naively generated SARS-CoV-2 antibodies. In contrast, the levels of antibodies that could bind SARS-CoV-1 increased after SARS-CoV-2 seroconversion in both mothers and infants, both of whom are unlikely to have had a prior SARS-CoV-1 infection, supporting prior findings that SARS-CoV-2 responses cross-react with SARS-CoV-1. In summary, we find evidence for increased eHCoV antibody levels following SARS-CoV-2 seroconversion in mothers but not infants, suggesting eHCoV responses can be boosted by SARS-CoV-2 infection when a prior memory response has been established, and that pre-existing cross-reactive antibodies are not strongly associated with SARS-CoV-2 infection risk in mothers or infants.

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