SARS-CoV-2 INFECTION and PREGNANCY in AFRICA: A 6-COUNTRY RETROSPECTIVE COHORT STUDY

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.