Antepartum SARS-CoV-2 infection and adverse birth outcomes in South African women

Nunes, Marta C; Jones, Stephanie; Strehlau, Renate; Baba, Vuyelwa; Ditse, Zanele; Silva, Kelly da; Bothma, Lané; Serafin, Natali; Baillie, Vicky; Kwatra, Gaurav; Burke, Megan; Wise, Amy; Adam, Mary; Mlandu, Philiswa; Melamu, Mpolokeng; Phelp, Juliette; Fraser, Wendy; Wright, Colleen A.; Zell, Elizabeth; Adam, Yasmin; Madhi, Shabir А.

doi:10.7189/jogh.12.05050

Cited by 4 publications

(2 citation statements)

References 41 publications

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“…Our study took place in part during the COVID-19 pandemic, but we did not have data on COVID-19 exposure or treatment. SARS-CoV-2 seroprevalence among pregnant people in South Africa is estimated at >60% and is typically asymptomatic [ 69–71 ]. Finally, we did not have data on cardiovascular medication during pregnancy and were unable to distinguish between chronic and pregnancy-induced hypertension.…”

Section: Discussionmentioning

confidence: 99%

Cardiometabolic Health in Pregnancy and Postpartum: Findings From a Prospective Cohort Study in South Africa

Bengtson,

Madlala,

Matjila

et al. 2024

Open Forum Infectious Diseases

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Background The cardiometabolic impact of HIV infection and treatment with antiretroviral therapy (ART) in pregnancy and the postpartum period remains unclear. Methods We enrolled pregnant persons with (PHIV) and without HIV in Cape Town, South Africa who were ≥18 years old at 24-28 weeks gestation and followed them up to 32 months postpartum. We estimated associations between HIV status and cardiometabolic risk including body mass index (BMI), obesity (BMI ≥ 30 kg/m2), blood pressure (BP, elevated systolic BP ≥130 and/or diastolic ≥85 mmHg; ), lipid levels, and metabolic syndrome according to the Joint Interim Statement criteria using multivariable log binomial or linear regression models. Sub-group analyses compared PHIV on efavirenz (EFV)- versus dolutegravir (DTG)-based ART. Results Among 400 participants (n = 200 without HIV, n = 200 PHIV), 52% had pre-pregnancy obesity and 9% elevated BP. By postpartum, 57% were classified with obesity, 31% had elevated BP, and 29% had metabolic syndrome. In multivariable analyses, HIV was associated with a lower BMI pre-pregnancy but not postpartum; however, mean indices were in the obese range regardless of HIV status. Neither BMI nor obesity pre-pregnancy or postpartum differed by ART regimen. Among PHIV, participants on DTG had higher levels of elevated BP in pregnancy and postpartum, compared to PHIV on EFV. Conclusions We observed high levels of obesity, elevated BP, and metabolic syndrome in the perinatal period but few differences by HIV status. Participants on DTG may be more likely to have elevated BP in pregnancy and postpartum. Monitoring of cardiometabolic health for pregnant persons on DTG is warranted.

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Section: Discussionmentioning

confidence: 99%

Cardiometabolic Health in Pregnancy and Postpartum: Findings From a Prospective Cohort Study in South Africa

Bengtson,

Madlala,

Matjila

et al. 2024

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Our study took place during the COVID-19 pandemic, but we did not have data on COVID-19 exposure or treatment. SARS-CoV-2 seroprevalence among pregnant women in South Africa is estimated more than 60% and is typically asymptomatic but may increase the risk of low birthweight [75][76][77].…”

Section: Discussionmentioning

confidence: 99%

Associations of HIV and antiretroviral therapy with gestational diabetes: findings from a prospective cohort in South Africa

Bengtson

Madlala

Matjila

et al. 2023

Aids

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Objective: To estimate associations of HIV-status and antiretroviral (ART) regimen with gestational diabetes (GDM) and postpartum glucose metabolism. Design: Prospective cohort study Methods: We enrolled pregnant persons living with HIV(PHIV) and without HIV in Cape Town, South Africa who were ≥18 years of age at 24–28 weeks gestation and followed up to 26 months postpartum. Participants were tested for GDM in pregnancy and for diabetes postpartum using a 75 g 2-hour oral glucose tolerance test and diagnosed via WHO criteria. We estimated associations of HIV-status and ART regime (efavirenz (EFV) vs dolutegravir (DTG)) with GDM and postpartum impaired glucose metabolism using multivariable log binomial or linear regression models. Results: Among 397 participants (median age 30 (IQR 25,34; n = 198 without HIV, n = 199 PHIV), the prevalence of GDM was 6.0% (9.0 PHIV vs 3.0% without HIV). In multivariable analyses, PHIV were at higher risk of GDM (RR 3.9 95% CI 1.4, 10.7) after adjustment for pre-pregnancy BMI and other confounders. GDM risk did not differ by ART regimen (unadjusted prevalence 8.1% DTG vs 5.6% EFV, adjusted RR 1.1, 95% CI 0.2, 6.6). Few participants had diabetes, impaired glucose tolerance, or impaired fasting glucose postpartum (n = 13, 6%) with no differences by HIV or ART status. Conclusions: In a setting of universal GDM testing, PHIV had an increased risk of impaired glucose metabolism during pregnancy but not postpartum. Among PHIV, GDM risk was similar regardless of EFV or DTG use. Given concerns about DTG and weight gain, diabetes risk should continue to be monitored.

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An Update on COVID-19-Associated Placental Pathologies

Schaumann,

Suhren

2024

Z Geburtshilfe Neonatol

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COVID-19 pregnancies are associated with increased rates of premature delivery and stillbirths. It is still a matter of debate whether there is a COVID-19-associated pattern of placenta pathology. We updated our previously published results on a systematic literature review and meta-analysis of COVID-19 pregnancies. In total, 38 reports on 3677 placentas were evaluated regarding histopathological changes. Maternal vascular malperfusion (32%), fetal vascular malperfusion (19%), acute and chronic inflammation (20% and 22%) were frequent pathologies. In non-COVID-19 pregnancies, placentas show similar histologic patterns and mainly similar frequencies of manifestation. It has to be taken into account that there might be an observation bias, because some findings are diagnosed as a “pathology” that might have been classified as minor or unspecific findings in non-COVID-19 placentas. COVID-19 placentitis occurs in 1–2% of cases at the most. In conclusion, this updated meta-analysis indicates that COVID-19 infection during pregnancy does not result in an increased rate of a specific placenta pathology and COVID-19 placentitis is rare.

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Antepartum SARS-CoV-2 infection and adverse birth outcomes in South African women

Cited by 4 publications

References 41 publications

Cardiometabolic Health in Pregnancy and Postpartum: Findings From a Prospective Cohort Study in South Africa

Cardiometabolic Health in Pregnancy and Postpartum: Findings From a Prospective Cohort Study in South Africa

Associations of HIV and antiretroviral therapy with gestational diabetes: findings from a prospective cohort in South Africa

An Update on COVID-19-Associated Placental Pathologies

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