Maternal and neonatal outcomes of COVID-19 in a high-risk pregnant cohort with and without HIV

Abstract

Background. The impact of SARS-CoV-2 infection in pregnant women living with HIV (PLHIV) has not been described previously. Objectives. To describe the clinical presentation and outcomes of a cohort of women with high-risk pregnancies with confirmed COVID-19 to determine whether risk factors for disease severity and adverse outcomes of COVID-19 differed in pregnant women without HIV compared with PLHIV. Methods. We prospectively enrolled pregnant women with COVID-19 attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, South Africa, from 1 May to 31 July 2020, with follow-up until 31 October 2020. Women were considered high risk if they required specialist care for maternal, neonatal and/or anaesthetic conditions. Common maternal or obstetric conditions included hypertensive disorders, morbid obesity (body mass index (BMI) ≥40 kg/m 2 ) and diabetes. Information on demographics, clinical features, and maternal and neonatal outcomes was collected and compared for PLHIV v. pregnant women without HIV. Results. One hundred women (72 without HIV and 28 PLHIV) with high-risk pregnancies had laboratory-confirmed COVID-19. Among the 28 PLHIV, the median (interquartile range) CD4 count was 441 (317 -603) cells/µL, and 19/26 (73%) were virologically suppressed. COVID-19 was diagnosed predominantly in the third trimester (81%). Obesity (BMI ≥30 in n=61/81; 75%) and hypertensive disorders were frequent comorbidities. Of the 100 women, 40% developed severe or critical COVID-19, 15% required intensive care unit admission and 6% needed invasive ventilation. Eight women died, 1 from advanced HIV disease complicated by bacteraemia and urosepsis. The crude maternal mortality rate was substantially higher in women with COVID-19 compared with all other deliveries at our institution during this period (8/91 (9%) v. 7/4 058 (0.2%); p<0.001). Neonatal outcomes were favourable. No significant differences in COVID-19 risk factors, disease severity, and maternal/neonatal outcome were noted for PLHIV v. those without HIV. Conclusions. In this cohort of high-risk pregnant women, the impact of COVID-19 was severe, significantly increasing maternal mortality risk compared with baseline rates. Virally suppressed HIV infection was not associated with worse COVID-19 outcomes in pregnancy.

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

“… Abbreviations: COVID-19, coronavirus disease 2019; IQR, interquartile range; N/A, not applicable; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; WHO, World Health Organization. a Includes 12 women from the Democratic Republic of the Congo cohort in the Nachega et al [ 16 ] study and 100 women from the South Africa cohort in de Waard et al [ 6 ] study. b Median length of hospital stay between pregnant and nonpregnant women with SARS-CoV-2 infection was not significant; however, there was a statistically significant difference between hospital stay for SARS-CoV-2–infected vs –uninfected pregnant women ( P < .001).…”

“… a Includes 12 women from the Democratic Republic of the Congo cohort in the Nachega et al [ 16 ] study and 100 women from the South Africa cohort in de Waard et al [ 6 ] study. …”

“…Pregnant and nonpregnant women with SARS-CoV-2 infection who were living with HIV or had a prior history of TB had a nearly 2-fold increased risk of ICU admission compared with those without these chronic infections. Published data on the impact of HIV on SARS-CoV-2 infection outcomes have been conflicting [ 6 , 20 , 21 ]. However, a recent data analysis by the WHO found that HIV in hospitalized adults was independently associated with a 1.29 times higher risk of death from SARS-CoV-2 infection after adjusting for age, sex, and underlying conditions [ 22 ].…”

The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review

“…Specifically, there were declines in under-five vitamin A coverage, measles vaccination coverage, isoniazid preventive therapy coverage, and facility-based deliveries. Maternal and under-five deaths increased, and outreaches were rarely conducted in the lockdown period Chelo et al [ 43 ] Impact and projections of the COVID-19 epidemic on attendance and routine vaccinations at a pediatric referral hospital in Cameroon Archives de pédiatrie Cross-sectional study Cameroun Attendance and routine vaccinations The COVID-19 pandemic resulted in a significant decrease in in consultation and vaccination activities De Waard et al [ 44 ] Maternal and neonatal outcomes of COVID-19 in a high-risk pregnant cohort with and without HIV South African medical journal Prospective cohort South Africa Maternal and neonatal outcomes of COVID-19 Among high-risk pregnant women, those with COVID-19 had a significant increased risk of maternal mortality compared with other deliveries. There was no significant difference in maternal/neonatal outcomes for people living HIV compared with those without HIV Gebreegziabher et al [ 45 ] Assessment of maternal and child health care services performance in the context of COVID-19 pandemic in Addis Ababa, Ethiopia: evidence from routine service data Reproductive Health Cross-sectional study Ethiopia Maternal and child health care services (postnatal care visit, safe abortion care, vaccination, contraceptive acceptance) The period during the pandemic saw declines in maternal and child health care services (new family planning visits, antenatal care, safe abortion care, vaccination) Leight et al [ 46 ] Short-term effects of the COVID-19 state of emergency on contraceptive access and utilization in Mozambique PLoS ONE Cross-sectional study Mozambique Utilization of contraceptive health services The period following the imposition of COVID-19 related measures saw a temporary modest decline in reproductive health service provision and utilization Shapira et al [ 47 ] Disruptions in maternal and child health service utilization during COVID-19: analysis fro...…”

“…Disruption in service provision and utilization was a major theme illuminated in many of the included studies [28,29,32,36,37,39,[41][42][43][44][45][46][47][48][49][50]. Clinic attendance and hospital admissions were significantly reduced for children under the age of five [28].…”