Severe acute respiratory syndrome coronavirus 2 infection and pregnancy in Sub-Saharan Africa : a 6-country retrospective cohort analysis
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Severe acute respiratory syndrome coronavirus 2 infection and pregnancy in Sub-Saharan Africa : a 6-country retrospective cohort analysis
Nachega, Jean B.; Sam-Agudu, Nadia A.; Machekano, Rhoderick N.; Rosenthal, Philip J.; Schell, Sonja; De Waard, Liesl; Bekker, Adrie; Gachuno, Onesmus W.; Kinuthia, John; Mwongeli, Nancy; Budhram, Samantha; Vannevel, Valerie; Soma-Pillay, Priya; Prozesky, Hans W.; Taljaard, Jantjie; Parker, Arifa; Agyare, Elizabeth; Opoku, Akwasi Baafuor; Makarfi, Aminatu Umar; Abdullahi, Asara M.; Adirieje, Chibueze; Ishoso, Daniel Katuashi; Pipo, Michel Tshiasuma; Tshilanda, Marc B.; Nswe, Christian Bongo-Pasi; Ditekemena, John; Sigwadhi, Lovemore Nyasha; Nyasulu, Peter S.; Hermans, Michel P.; Sekikubo, Musa; Musoke, Philippa; Nsereko, Christopher; Agbeno, Evans K.; Yeboah, Michael Yaw; Umar, Lawal W.; Ntakwinja, Mukanire; Mukwege, Denis M.; Birindwa, Etienne Kajibwami; Mushamuka, Serge Zigabe; Smith, Emily R.; Mills, Edward J.; Otshudiema, John Otokoye; Mbala-Kingebeni, Placide; Tamfum, Jean-Jacques Muyembe; Zumla, Alimuddin; Tsegaye, Aster; Mteta, Alfred; Sewankambo, Nelson K.; Suleman, Fatima; Adejumo, Prisca; Anderson, Jean R.; Noormahomed, Emilia V.; Deckelbaum, Richard J.; Stringer, Jeffrey S.A.; Mukalay, Abdon; Taha, Taha E.; Fowler, Mary Glenn; Wasserheit, Judith N.; Masekela, Refiloe; Mellors, John W.; Siedner, Mark J.; Myer, Landon; Kengne, Andre-Pascal; Yotebieng, Marcel; Mofenson, Lynne M.; Langenegger, Eduard; AFREhealth Research Collaboration on COVID-19 and Pregnancy
Date:
2022-06-08
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.
Description:
DATA AVAILABILITY : The dataset used for this study, including individual deidentified participant data and a data dictionary defining each field in the set, will be made available at publication on request to Professor Jean Nachega (jbn16@pitt.edu).
