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

被引：13

作者：

Nachega, Jean B. ^{[1
,2
,3
,4
]}

Sam-Agudu, Nadia A. ^{[5
,6
,7
,8
]}

Machekano, Rhoderick N. ^{[9
]}

Rosenthal, Philip J. ^{[10
]}

Schell, Sonja ^{[11
,12
]}

de Waard, Liesl ^{[11
,12
]}

Bekker, Adrie ^{[13
]}

Gachuno, Onesmus W. ^{[14
]}

Kinuthia, John ^{[14
,15
]}

Mwongeli, Nancy ^{[15
]}

Budhram, Samantha ^{[16
]}

Vannevel, Valerie ^{[17
]}

Somapillay, Priya ^{[18
]}

Prozesky, Hans W. ^{[1
]}

Taljaard, Jantjie ^{[1
]}

Parker, Arifa ^{[1
]}

Agyare, Elizabeth ^{[19
,20
]}

Opoku, Akwasi Baafuor ^{[21
]}

Makarfi, Aminatu Umar ^{[22
,23
]}

Abdullahi, Asara M. ^{[23
,24
]}

Adirieje, Chibueze ^{[5
]}

Ishoso, Daniel Katuashi ^{[25
]}

Pipo, Michel Tshiasuma ^{[26
]}

Tshilanda, Marc B. ^{[26
]}

Nswe, Christian Bongo-Pasi ^{[27
,28
]}

Ditekemena, John ^{[25
]}

Sigwadhi, Lovemore Nyasha ^{[9
]}

Nyasulu, Peter S. ^{[9
]}

Hermans, Michel P. ^{[29
]}

Sekikubo, Musa ^{[30
]}

Musoke, Philippa ^{[31
]}

Nsereko, Christopher ^{[32
]}

Agbeno, Evans K. ^{[20
,33
]}

Yeboah, Michael Yaw ^{[22
,23
]}

Umar, Lawal W. ^{[34
,35
]}

Ntakwinja, Mukanire ^{[36
,37
]}

Mukwege, Denis M. ^{[36
,37
]}

Birindwa, Etienne Kajibwami ^{[38
,39
]}

Mushamuka, Serge Zigabe ^{[38
,39
]}

Smith, Emily R. ^{[40
]}

Mills, Edward J. ^{[41
]}

Otshudiema, John Otokoye ^{[42
]}

Mbala-Kingebeni, Placide ^{[43
]}

Tamfum, Jean-Jacques Muyembe ^{[43
]}

Zumla, Alimuddin ^{[44
,45
]}

Tsegaye, Aster ^{[46
]}

Mteta, Alfred ^{[47
]}

Sewankambo, Nelson K. ^{[48
]}

Suleman, Fatima ^{[49
]}

Adejumo, Prisca ^{[50
]}

机构：

[1] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Med, Div Infect Dis, Cape Town, South Africa

[2] Univ Pittsburgh, Ctr Global Hlth, Dept Epidemiol Infect Dis & Microbiol, Pittsburgh, PA 15261 USA

[3] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[4] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA

[5] Inst Human Virol Nigeria, Int Res Ctr Excellence, Abuja, Nigeria

[6] Univ Cape Coast, Dept Paediat & Child Hlth, Sch Med Sci, Cape Coast, Ghana

[7] Univ Maryland, Sch Med, Inst Human Virol, Baltimore, MD 21201 USA

[8] Univ Maryland, Sch Med, Dept Pediat, Baltimore, MD 21201 USA

[9] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Global Hlth, Div Epidemiol & Biostat, Cape Town, South Africa

[10] Univ Calif San Francisco, Dept Med, Div Infect Dis, San Francisco, CA 94143 USA

[11] Stellenbosch Univ, Tygerberg Teaching Hosp, Dept Obstet & Gynecol, Cape Town, South Africa

[12] Stellenbosch Univ, Fac Med & Hlth Sci, Cape Town, South Africa

[13] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Paediat & Child Hlth, Cape Town, South Africa

[14] Univ Nairobi, Dept Obstet & Gynaecol, Nairobi, Kenya

[15] Kenyatta Natl Hosp, Dept Res, Dept Reprod Hlth, Nairobi, Kenya

[16] Univ KwaZulu Natal, Dept Obstet & Gynecol, Durban, South Africa

[17] Univ Pretoria, Kalafong Hosp, Dept Obstet & Gynecol, Pretoria, South Africa

[18] Univ Pretoria, Maternal Foetal Med, Steve Biko Hosp, Pretoria, South Africa

[19] Univ Cape Coast, Sch Med Sci, Dept Microbiol, Cape Coast, Ghana

[20] Cape Coast Teaching Hosp, Cape Coast, Ghana

[21] Komfo Anokye Teaching Hosp, Dept Obstet & Gynaecol, Kumasi, Ghana

[22] Ahmadu Bello Univ, Coll Hlth Sci, Dept Obstet & Gynaecol, Zaria, Nigeria

[23] Ahmadu Bello Univ Teaching Hosp, Zaria, Nigeria

[24] Ahmadu Bello Univ, Coll Hlth Sci, Dept Med, Zaria, Nigeria

[25] Univ Kinshasa, Sch Med, Kinshasa, DEM REP CONGO

[26] Monkole Hosp Ctr, Kinshasa, DEM REP CONGO

[27] Univ Notre Dame du Kasayi, Ctr Interdisciplinaire Rech Ethnopharmacol, Dept Publ Hlth, Fac Med, Kananga, DEM REP CONGO

[28] Univ Moderne Kinkole, Fac Publ Hlth, Kinshasa, DEM REP CONGO

[29] Clin Univ St Luc, Dept Endocrinol & Nutr, Brussels, Belgium

[30] Makerere Univ, Coll Hlth Sci, Sch Med, Dept Obstet & Gynaecol, Kampala, Uganda

[31] Makerere Univ, Sch Med, Dept Paediat & Child Hlth, Kampala, Uganda

[32] Entebbe Reg Reference Hosp, Dept Med, Entebbe, Uganda

[33] Univ Cape Coast, Sch Med Sci, Dept Obstet & Gynecol, Cape Coast, Ghana

[34] Ahmadu Bello Univ, Coll Hlth Sci, Dept Pediat, Zaria, Nigeria

[35] Ahmadu Bello Teaching Hosp, Zaria, Nigeria

[36] Panzi Gen Referral Hosp, Gynaecol & Gen Surg, Bukavu, DEM REP CONGO

[37] Univ Evangel Afrique UEA, Bukavu, DEM REP CONGO

[38] Univ Catholique Bukavu UCB, Hop Prov Gen Reference Bukavu, Bukavu, DEM REP CONGO

[39] Univ Catholique Bukavu UCB, Fac Med, Bukavu, DEM REP CONGO

[40] George Washington Univ, Milken Inst Sch Publ Hlth, Dept Global Hlth, Washington, DC USA

[41] McMaster Univ, Fac Hlth Sci, Dept Hlth Res Evidence & Impact, Hamilton, ON, Canada

[42] WHO, Hlth Emergencies Program, Epidemiol Surveillance Team, COVID 19 Response, Kinshasa, DEM REP CONGO

[43] Univ Kinshasa, Fac Med, Natl Inst Biomed Res, Dept Med Microbiol & Virol, Kinshasa, DEM REP CONGO

[44] UCL, Ctr Clin Microbiol, Dept Infect, Div Infect & Immun, London, England

[45] Univ Coll London Hosp, Natl Inst Hlth Res, Biomed Res Ctr, London, England

[46] Addis Ababa Univ, Coll Hlth Sci, Dept Med Lab Sci, Addis Ababa, Ethiopia

[47] Kilimanjaro Christian Med Univ Coll, Moshi, Tanzania

[48] Makerere Univ, Coll Hlth Sci, Sch Med, Kampala, Uganda

[49] Univ KwaZulu Natal, Discipline Pharmaceut Sci, Durban, South Africa

[50] Univ Ibadan, Dept Nursing, Ibadan, Nigeria

来源：

CLINICAL INFECTIOUS DISEASES | 2022年 / 75卷 / 11期

基金：

美国国家卫生研究院;

关键词：

COVID-19; pregnancy; maternal; neonate; Africa; NEONATAL OUTCOMES; DISEASE; 2019; COVID-19; SAFETY; FETAL;

D O I：

10.1093/cid/ciac294

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

In hospitalized African women, both SARS-CoV-2 infection and pregnancy independently increased risks of morbidity and mortality. In addition, among pregnant and nonpregnant women with SARS-CoV-2 infection, HIV, prior tuberculosis, sickle cell anemia, and nongestational diabetes increased risk of ICU admission. 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.

引用

页码：1950 / 1961

页数：12

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