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