Preterm Birth Outcomes Among Women with and without SARS-CoV-2 Infection in Six sub-Saharan African CountriesAlicea, Gabriella (2023) Preterm Birth Outcomes Among Women with and without SARS-CoV-2 Infection in Six sub-Saharan African Countries. Master Essay, University of Pittsburgh.
AbstractBackground: Prior research, mostly from Europe and the United States, reported adverse outcomes associated with SARS-CoV-2 infection in pregnant women including higher need for oxygen, intensive care admission, mechanical ventilation, and obstetrical complications such as preeclampsia, preterm birth, and even death. However, little data are available regarding maternal and neonatal outcomes among pregnant women with vs. without SARS-CoV-2 infection in the Democratic Republic of Congo, Ghana, Kenya, Nigeria, Uganda, and South Africa. We aimed to investigate the association between SARS-CoV-2 infection status and preterm birth outcomes among pregnant women in 6 sub–Saharan African countries. Methods: We conducted a secondary analysis from the AFREhealth COVID-19 and pregnancy database, including women of childbearing age between 1 March 2020 and 31 March 2021. The sample included pregnant women tested for SARS-CoV-2 infection and delivered within the set time. Pregnant individuals who never tested positive for SARS-CoV-2 within the specified time served as the comparison group. Univariable and multivariable logistic regression were conducted to assess the independent risk factors for preterm birth. Results: A total of 515 pregnant women had a documented preterm birth outcome (term birth or preterm birth), of whom 163 had a preterm birth. A total of 94 women who had a preterm birth were infected with SARS-CoV-2 vs. 69 women without SARS-CoV-2 infection (p=0.86). In multivariate logistic regression, pregnant women with SARS-CoV-2 infection had a non-significant higher odds of preterm birth (OR=1.12, 95% CI 0.49-2.58; p=0.78). Furthermore, only diabetes was an independent factor for the association of preterm birth and SARS-CoV-2 infection (OR: 2.35; 95% CI:1.18-4.67; p=0.015). Finally, residing in Southern Africa (OR: 8.01; 95% CI: 1.70-37.82; p=0.009) was independently associated with maternal mortality but not SARS-CoV-2 (OR:3.44; 95% CI:0.39-30.17, p=0.266). Conclusions: We found a higher risk of preterm birth among pregnant women with SARS-CoV-2 infection (vs. uninfected), but this finding did not reach statistical significance. In addition, residence in Southern Africa was associated with higher odds of maternal mortality, calling for prioritization of public health efforts surrounding COVID-19 vaccination of pregnant women. Share
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