ADVERSE PREGNANCY OUTCOMES ASSOCIATED with COVID-19 INFECTION in WESTERN KENYA

ABSTRACT

Background: The COVID-19 pandemic has caused over 240 million infections and 5 million deaths. Little is known about the impact of COVID-19 on pregnancy outcomes in Sub-Saharan Africa. We followed a cohort of COVID-infected and uninfected pregnant women in Kenya until six weeks postpartum to assess the burden of COVID-19 and its association with poor maternal and neonatal outcomes. Methods: We conducted repeat SARS-CoV-2 testing using polymerase chain reaction (PCR) on pregnant women enrolled in an antenatal COVID-19 cohort study (AnCOV). Those infected were managed according to Kenya Ministry of Health COVID-19 clinical guidelines. Adverse pregnancies outcomes were compared among SARS-CoV-2 infected and uninfected women using multivariate log-binomial generalized linear models. Results: Between August 2020 and August 2021, 1688 pregnant women were enrolled;998 completed pregnancy follow-up. Of those, 259 (26.0%) had adverse outcomes, and 169 (22%) tested positive for SARS-CoV-2, of whom 93 (55%) were symptomatic. The most prevalent symptoms included cough (76.1%), headache (47.9%), anorexia (41%), anosmia (35.0%), fatigue (30.8%), joint pains (29.1%), fever (28.2%), runny nose (23.1%), chills (19.7%) and myalgia (12.8%). Fourteen COVID-19 pregnant women required hospitalization;none were admitted in ICU. Very low birthweight (<1500g) (adjusted relative risk (aRR) 4.78, 95% CI 1.11-20.49), very preterm birth (<34 weeks) (aRR=2.57, 1.34-4.90) and preterm birth (<37 weeks) (aRR=1.54, 1.03-2.29) were more common among women with COVID-19. There were no significant associations between COVID-19 in pregnancy and hypertensive disorders of pregnancy, preeclampsia, stillbirths and perinatal deaths. Conclusion: SARS-CoV-2 infection increases the risk of very low birth weights and very preterm births in western Kenya.