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Clin Infect Dis
. 2022 Jun 8;ciac294.
doi: 10.1093/cid/ciac294. Online ahead of print.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis
Jean B Nachega 1 2 3 4 , Nadia A Sam-Agudu 5 6 7 , Rhoderick N Machekano 8 , Philip J Rosenthal 9 , Sonja Schell 10 , Liesl de Waard 10 , Adrie Bekker 11 , Onesmus W Gachuno 12 , John Kinuthia 12 13 , Nancy Mwongeli 13 , Samantha Budhram 14 , Valerie Vannevel 15 , Priya Somapillay 16 , Hans W Prozesky 1 , Jantjie Taljaard 1 , Arifa Parker 1 , Elizabeth Agyare 17 , Akwasi Baafuor Opoku 18 , Aminatu Umar Makarfi 19 , Asara M Abdullahi 20 , Chibueze Adirieje 5 , Daniel Katuashi Ishoso 21 , Michel Tshiasuma Pipo 22 , Marc B Tshilanda 22 , Christian Bongo-Pasi Nswe 23 24 , John Ditekemena 21 , Lovemore Nyasha Sigwadhi 8 , Peter S Nyasulu 8 , Michel P Hermans 25 , Musa Sekikubo 26 , Philippa Musoke 27 , Christopher Nsereko 28 , Evans K Agbeno 29 , Michael Yaw Yeboah 19 , Lawal W Umar 30 , Mukanire Ntakwinja 31 , Denis M Mukwege 31 , Etienne Kajibwami Birindwa 32 , Serge Zigabe Mushamuka 32 , Emily R Smith 33 , Edward J Mills 34 , John Otokoye Otshudiema 35 , Placide Mbala-Kingebeni 36 , Jean-Jacques Muyembe Tamfum 36 , Alimuddin Zumla 37 38 , Aster Tsegaye 39 , Alfred Mteta 40 , Nelson K Sewankambo 41 , Fatima Suleman 42 , Prisca Adejumo 43 , Jean R Anderson 44 , Emilia V Noormahomed 45 , Richard J Deckelbaum 46 , Jeffrey S A Stringer 47 , Abdon Mukalay 48 , Taha E Taha 3 , Mary Glenn Fowler 49 , Judith N Wasserheit 50 , Refiloe Masekela 51 , John W Mellors 52 , Mark J Siedner 53 54 , Landon Myer 55 , Andre-Pascal Kengne 56 , Marcel Yotebieng 57 , Lynne M Mofenson 58 , Eduard Langenegger 10 , AFREhealth Research Collaboration on COVID-19 and Pregnancy
Affiliations
- PMID: 36130257
- DOI: 10.1093/cid/ciac294
Abstract
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.
Keywords: Africa; COVID-19; maternal; neonate; pregnancy.