TY - JOUR
T1 - Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa
T2 - A 6-Country Retrospective Cohort Analysis
AU - for the AFREhealth Research Collaboration on COVID-19 and Pregnancy
AU - Nachega, Jean B.
AU - Sam-Agudu, Nadia A.
AU - Machekano, Rhoderick N.
AU - Rosenthal, Philip J.
AU - Schell, Sonja
AU - De Waard, Liesl
AU - Bekker, Adrie
AU - Gachuno, Onesmus W.
AU - Kinuthia, John
AU - Mwongeli, Nancy
AU - Budhram, Samantha
AU - Vannevel, Valerie
AU - Somapillay, Priya
AU - Prozesky, Hans W.
AU - Taljaard, Jantjie
AU - Parker, Arifa
AU - Agyare, Elizabeth
AU - Opoku, Akwasi Baafuor
AU - Makarfi, Aminatu Umar
AU - Abdullahi, Asara M.
AU - Adirieje, Chibueze
AU - Ishoso, Daniel Katuashi
AU - Pipo, Michel Tshiasuma
AU - Tshilanda, Marc B.
AU - Bongo-Pasi Nswe, Christian
AU - Ditekemena, John
AU - Sigwadhi, Lovemore Nyasha
AU - Nyasulu, Peter S.
AU - Hermans, Michel P.
AU - Sekikubo, Musa
AU - Musoke, Philippa
AU - Nsereko, Christopher
AU - Agbeno, Evans K.
AU - Yeboah, Michael Yaw
AU - Umar, Lawal W.
AU - Ntakwinja, Mukanire
AU - Mukwege, Denis M.
AU - Birindwa, Etienne Kajibwami
AU - Mushamuka, Serge Zigabe
AU - Smith, Emily R.
AU - Mills, Edward J.
AU - Otshudiema, John Otokoye
AU - Mbala-Kingebeni, Placide
AU - Tamfum, Jean Jacques Muyembe
AU - Zumla, Alimuddin
AU - Tsegaye, Aster
AU - Mteta, Alfred
AU - Sewankambo, Nelson K.
AU - Suleman, Fatima
AU - Yotebieng, Marcel
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - 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.
AB - 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.
KW - Africa
KW - COVID-19
KW - maternal
KW - neonate
KW - pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85135450510&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85135450510&partnerID=8YFLogxK
U2 - 10.1093/cid/ciac294
DO - 10.1093/cid/ciac294
M3 - Article
C2 - 36130257
AN - SCOPUS:85135450510
SN - 1058-4838
VL - 75
SP - 1950
EP - 1961
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -
