Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis
Jean B. Nachega, Nadia A. Sam‐Agudu, Rhoderick Machekano, Philip J. Rosenthal, Sonja Schell, Liesl de Waard, Adrie Bekker, Onesmus Gachuno, John Kinuthia, Nancy Mwongeli, Samantha Budhram, Valerie Vannevel, Priya Soma‐Pillay, Hans Prozesky, Jantjie Taljaard, Arifa Parker, Elizabeth Agyare, Akwasi B. Opoku, Aminatu Umar Makarfi, Asara M. Abdullahi, Chibueze Adirieje, Daniel Katuashi Ishoso, Michel Tshiasuma Pipo, Marc Tshilanda, Christian Bongo-Pasi Nswe, John Ditekemena, Lovemore Nyasha Sigwadhi, Peter S. Nyasulu, Michel P. Hermans, Musa Sekikubo, Philippa Musoke, Christopher Nsereko, Evans Kofi Agbeno, Michael Yaw Yeboah, Lawal Umar, Mukanire Ntakwinja, Denis Mukwege, Etienne Kajibwami Birindwa, Serge Zigabe Mushamuka, Emily R. Smith, Edward J. Mills, John Otokoye Otshudiema, Placide Mbala‐Kingebeni, Jean‐Jacques Muyembe Tamfum, Alimuddin Zumla, Aster Tsegaye, Alfred Kien Mteta, Nelson K. Sewankambo, Fátima Suleman, Prisca Olabisi Adejumo, Jean Anderson, Emília Virgínia Noormahomed, Richard J. Deckelbaum, Jeffrey S. A. Stringer, Abdon Mukalay, Taha E. Taha, Mary Glenn Fowler, Judith N. Wasserheit, Refiloe Masekela, John W. Mellors, Mark J. Siedner, Landon Myer, André Pascal Kengne, Marcel Yotebieng, Lynne Mofenson, Eduard Langenegger
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.