Nachega, Jean B.Sam-Agudu, Nadia A.Machekano, Rhoderick N.Rosenthal, Philip J.Schell, SonjaDe Waard, LieslBekker, AdrieGachuno, Onesmus W.Kinuthia, JohnMwongeli, NancyBudhram, SamanthaVannevel, ValerieSoma-Pillay, PriyaProzesky, Hans W.Taljaard, JantjieParker, ArifaAgyare, ElizabethOpoku, Akwasi BaafuorMakarfi, Aminatu UmarAbdullahi, Asara M.Adirieje, ChibuezeIshoso, Daniel KatuashiPipo, Michel TshiasumaTshilanda, Marc B.Nswe, Christian Bongo-PasiDitekemena, JohnSigwadhi, Lovemore NyashaNyasulu, Peter S.Hermans, Michel P.Sekikubo, MusaMusoke, PhilippaNsereko, ChristopherAgbeno, Evans K.Yeboah, Michael YawUmar, Lawal W.Ntakwinja, MukanireMukwege, Denis M.Birindwa, Etienne KajibwamiMushamuka, Serge ZigabeSmith, Emily R.Mills, Edward J.Otshudiema, John OtokoyeMbala-Kingebeni, PlacideTamfum, Jean-Jacques MuyembeZumla, AlimuddinTsegaye, AsterMteta, AlfredSewankambo, Nelson K.Suleman, FatimaAdejumo, PriscaAnderson, Jean R.Noormahomed, Emilia V.Deckelbaum, Richard J.Stringer, Jeffrey S.A.Mukalay, AbdonTaha, Taha E.Fowler, Mary GlennWasserheit, Judith N.Masekela, RefiloeMellors, John W.Siedner, Mark J.Myer, LandonKengne, Andre-PascalYotebieng, MarcelMofenson, Lynne M.Langenegger, EduardAFREhealth Research Collaboration on COVID-19 and Pregnancy2023-11-202023-11-202022-06-08Nachega, J.B., Sam-Agudu, N.A., Macheko, R.N. et al. 2022, 'Severe acute respiratory syndrome coronavirus 2 infection and pregnancy in Sub-Saharan Africa : a 6-country retrospective cohort analysis', Clinical Infectious Diseases, vol. 75, pp. 1950-1961. DOI : 10.1093/cid/ciac294.1058-4838 (print)1537-6591 (online)10.1093/cid/ciac294http://hdl.handle.net/2263/93367DATA 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).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.en© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution- NonCommercial-NoDerivs licence.PregnancyMartenalNeonateAfricaCOVID-19 pandemicSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)Sub-Saharan Africa (SSA)Coronavirus disease 2019 (COVID-19)SDG-03: Good health and well-beingArticle