Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis
Authors: 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 , Somapillay 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 , Bongo-Pasi Nswe Christian , 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 ,   for the AFREhealth Research Collaboration on COVID-19 and Pregnancy
Published: April 2022

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.