COVID­19 in pregnant women in South Africa: A retrospective review.

BACKGROUND: The majority of maternal deaths in South Africa (SA) occur as a result of non-pregnancy-related infections (NPRI). Pregnancy is a known risk factor in severe COVID­19, increasing the burden of NPRI in SA. In this study, we describe the prevalence, profile and clinical outcomes of pregnant women with COVID­19 admitted to a tertiary facility. OBJECTIVES: To describe the prevalence, profile and clinical outcomes of pregnant women with COVID­19 admitted to a tertiary facility in Gauteng, SA. METHODS: We performed a retrospective review of all pregnant women with COVID­19 admitted to Charlotte Maxeke Johannesburg Academic Hospital between 6 March and 30 August 2020. Data collected included demographics, medical history, obstetric history, clinical findings and laboratory variables. Outcomes assessed were mortality, admission to intensive care unit (ICU), symptomatic v. asymptomatic disease, maternal and fetal outcome and mode of delivery. RESULTS: A total of 204 pregnant women were included in the study. Of these, 33 (16.2%) women were critically ill, with 21 (10.3%) admitted to the ICU and 3 (1.5%) deaths related to COVID­19. The median gestational age was 37 weeks and median birthweight 2 940 g. Sixty-seven women (33%) were HIV-positive, in keeping with national statistics regarding HIV in pregnancy. Caesarean section was the most common mode of delivery (n=105, 60%). However, no women underwent caesarean section for indications related to COVID­19. CONCLUSION: COVID­19-related mortality in our cohort was higher than that seen internationally, likely due to differences in background maternal mortality rates and difficulty in accessing care.

Vaccinate: protecting pregnant patients from COVID-19

It is now clear that there are increased risks of maternal and fetal morbidity and mortality when COVID-19 is contracted during pregnancy. Preventing severe COVID-19 in this population must be a priority.

Considerations for COVID-19 vaccination in pregnancy

Pregnant women are at greater risk of severe COVID-19 than non-pregnant women. Despite limited safety data on use of COVID-19 vaccines in pregnancy, many international societies have recommended their use when pregnant women are at particularly high risk of acquiring COVID-19, or have suggested that vaccines should not be withheld from pregnant women where no other contraindications to COVID-19 vaccination exist. A number of vaccines, including those against influenza, tetanus and pertussis, have been shown to reduce both maternal and infant morbidity and mortality when used antenatally. We explore the role of COVID-19 vaccination in the setting of pregnancy, discuss the limited data available, and summarise current international guidelines.