Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis-Reference-Cited by-同舟云学术

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis

Published:2022-06-08 Issue:11 Volume:75 Page:1950-1961
ISSN:1058-4838
Container-title:Clinical Infectious Diseases
language:en
Short-container-title:

Author:

Nachega Jean B¹²³⁴,Sam-Agudu Nadia A⁵⁶⁷,Machekano Rhoderick N⁸,Rosenthal Philip J⁹,Schell Sonja¹⁰,de Waard Liesl¹⁰,Bekker Adrie¹¹,Gachuno Onesmus W¹²,Kinuthia John¹²¹³,Mwongeli Nancy¹³,Budhram Samantha¹⁴,Vannevel Valerie¹⁵,Somapillay Priya¹⁶,Prozesky Hans W¹^ORCID,Taljaard Jantjie¹,Parker Arifa¹,Agyare Elizabeth¹⁷,Opoku Akwasi Baafuor¹⁸,Makarfi Aminatu Umar¹⁹,Abdullahi Asara M²⁰,Adirieje Chibueze⁵,Ishoso Daniel Katuashi²¹,Pipo Michel Tshiasuma²²,Tshilanda Marc B²²,Bongo-Pasi Nswe Christian²³²⁴,Ditekemena John²¹,Sigwadhi Lovemore Nyasha⁸,Nyasulu Peter S⁸,Hermans Michel P²⁵,Sekikubo Musa²⁶,Musoke Philippa²⁷,Nsereko Christopher²⁸,Agbeno Evans K²⁹,Yeboah Michael Yaw¹⁹,Umar Lawal W³⁰,Ntakwinja Mukanire³¹,Mukwege Denis M³¹,Birindwa Etienne Kajibwami³²,Mushamuka Serge Zigabe³²,Smith Emily R³³,Mills Edward J³⁴,Otshudiema John Otokoye³⁵,Mbala-Kingebeni Placide³⁶,Tamfum Jean-Jacques Muyembe³⁶,Zumla Alimuddin³⁷³⁸,Tsegaye Aster³⁹,Mteta Alfred⁴⁰,Sewankambo Nelson K⁴¹,Suleman Fatima⁴²,Adejumo Prisca⁴³,Anderson Jean R⁴⁴,Noormahomed Emilia V⁴⁵,Deckelbaum Richard J⁴⁶,Stringer Jeffrey S A⁴⁷,Mukalay Abdon⁴⁸,Taha Taha E³,Fowler Mary Glenn⁴⁹,Wasserheit Judith N⁵⁰,Masekela Refiloe⁵¹,Mellors John W⁵²,Siedner Mark J⁵³⁵⁴^ORCID,Myer Landon⁵⁵,Kengne Andre-Pascal⁵⁶,Yotebieng Marcel⁵⁷,Mofenson Lynne M⁵⁸,Langenegger Eduard¹⁰,

Affiliation:

1. Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences , Cape Town , South Africa

2. Department of Epidemiology, Infectious Diseases, and Microbiology, and Center for Global Health, University of Pittsburgh , Pittsburgh, Pennsylvania , USA

3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA

4. Department of International Health, Johns Hopkins University, Bloomberg School of Public Health , Baltimore, Maryland , USA

5. International Research Center of Excellence, Institute of Human Virology Nigeria , Abuja , Nigeria

6. Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences , Cape Coast , Ghana

7. Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine , Baltimore, Maryland , USA

8. Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa

9. Department of Medicine, Division of Infectious Diseases, University of California , San Francisco, California , USA

10. Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa

11. Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa

12. Department of Obstetrics and Gynaecology, University of Nairobi , Nairobi , Kenya

13. Department of Research, Department of Reproductive Health, Kenyatta National Hospital , Nairobi , Kenya

14. Department of Obstetrics and Gynecology, University of KwaZulu Natal , Durban , South Africa

15. Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria , Pretoria , South Africa

16. Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria , Pretoria , South Africa

17. Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital , Cape Coast , Ghana

18. Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital , Kumasi , Ghana

19. Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital , Zaria , Nigeria

20. Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital , Zaria , Nigeria

21. University of Kinshasa School of Medicine , Kinshasa , Democratic Republic of the Congo

22. Monkole Hospital Center , Kinshasa , Democratic Republic of the Congo

23. Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi , Kananga , Democratic Republic of the Congo

24. Faculty of Public Health, Université Moderne de Kinkole , Kinshasa , Democratic Republic of the Congo

25. Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc , Brussels , Belgium

26. Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University , Kampala , Uganda

27. Department of Paediatrics and Child Health, School of Medicine, Makerere University , Kampala , Uganda

28. Department of Medicine, Entebbe Regional Reference Hospital , Entebbe , Uganda

29. Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital , Cape Coast , Ghana

30. Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital , Zaria , Nigeria

31. Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA) , Bukavu , Democratic Republic of the Congo

32. Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB) , Bukavu , Democratic Republic of the Congo

33. Department of Global Health, Milken Institute School of Public Health, The George Washington University , Washington, DC , USA

34. Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University , Hamilton , Canada

35. Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization , Kinshasa , Democratic Republic of the Congo

36. Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research , Kinshasa , Democratic Republic of the Congo

37. Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London , London , United Kingdom

38. National Institute for Health Research Biomedical Research Centre, University College London Hospitals , London , United Kingdom

39. Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University , Addis Ababa , Ethiopia

40. Kilimanjaro Christian Medical University College , Moshi , United Republic of Tanzania

41. School of Medicine, College of Health Sciences, Makerere University , Kampala , Uganda

42. Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal , Durban , South Africa

43. Department of Nursing, University of Ibadan , Ibadan , Nigeria

44. Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine , Baltimore, Maryland , USA

45. Faculty of Medicine, Eduardo Mondlane University , Maputo , Mozambique

46. Department of Pediatrics, Columbia University Irving Medical Center , New York, New York , USA

47. Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine , Chapel Hill, North Carolina , USA

48. Faculty of Medicine, University of Lubumbashi , Lubumbashi , Democratic Republic of the Congo

49. Department of Pathology, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA

50. Departments of Global Health and Medicine, Schools of Medicine and Public Health, University of Washington , Seattle, Washington , USA

51. Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal , Durban , South Africa

52. Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA

53. Harvard Medical School and Massachusetts General Hospital , Boston, Massachusetts , USA

54. Mbarara University of Science and Technology , Mbarara , Uganda

55. Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa

56. Non-Communicable Diseases Research Unit, South African Medical Research Council , Cape Town , South Africa

57. Department of Medicine, Albert Einstein College of Medicine , New York, New York , USA

58. Elizabeth Glaser Pediatric AIDS Foundation , Washington, DC , USA

Abstract

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.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Link

https://academic.oup.com/cid/article-pdf/75/11/1950/47466320/ciac294.pdf

Reference40 articles.

1. Effect of SARS-CoV-2 infection in pregnancy on maternal and neonatal outcomes in Africa: An AFREhealth call for evidence through multicountry research collaboration;Nachega;Am J Trop Med Hyg,2020

2. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status - United States, January 22-October 3, 2020;Zambrano;MMWR Morb Mortal Wkly Rep,2020

3. Are clinical outcomes worse for pregnant women at ≥20 weeks’ gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching;Badr;Am J Obstet Gynecol,2020

4. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis;Allotey;BMJ,2020

5. Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An international network of obstetric survey systems-based cohort study;Budhram;Int J Gynaecol Obstet,2021

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