News & Analysis

Pregnant people in Sub-Saharan Africa are at higher risk of complications and death from COVID-19

Preg­nant peo­ple who are hos­pi­tal­ized with COVID-19 in Sub-Saha­ran Africa are dying at a rate far greater than preg­nant peo­ple with­out COVID-19 and non-preg­nant peo­ple with COVID-19, accord­ing to a new mul­ti­cen­ter study encom­pass­ing six African coun­tries. The research was pub­lished today in Clin­i­cal Infec­tious Dis­eases and led by a Uni­ver­si­ty of Pitts­burgh School of Pub­lic Health infec­tious dis­eases epidemiologist.

The effects of COVID-19 on preg­nan­cy have been stud­ied in detail in high-income coun­tries, such as the U.S., but stud­ies of sim­i­lar size and scope are lack­ing in low- and mid­dle-income coun­tries and non-West­ern set­tings. The new find­ings con­firm that preg­nant peo­ple are at high­er risk of com­pli­ca­tions and death from COVID-19 and, there­fore, should be pri­or­i­tized with oth­er high-risk peo­ple for COVID-19 vac­ci­na­tion in Sub-Saha­ran Africa.

Our find­ings indi­cate that hos­pi­tal­ized preg­nant women with COVID-19 in Sub-Saha­ran Africa have two to five times greater risk of need­ing inten­sive care and dying than unin­fect­ed, hos­pi­tal­ized preg­nant women. We must urgent­ly pri­or­i­tize preg­nant women among at-risk pop­u­la­tions in COVID-19 vac­cine pro­grams in Africa.”

Jean B. Nachega, M.D., Ph.D., M.P.H., lead author, asso­ciate pro­fes­sor of infec­tious dis­eases and micro­bi­ol­o­gy and epi­demi­ol­o­gy at Pitt Pub­lic Health

The large study looked at out­comes of over 1,300 female patients of child-bear­ing age who were hos­pi­tal­ized between March 2020 and March 2021 in one of six coun­tries: the Demo­c­ra­t­ic Repub­lic of the Con­go, Ghana, Kenya, Nige­ria, South Africa and Ugan­da. Specif­i­cal­ly, this study looked at three cat­e­gories: preg­nant women with COVID-19, non-preg­nant women with COVID-19 and preg­nant women with­out COVID-19.

Researchers found that the rates of inten­sive care unit (ICU) admis­sion and use of sup­ple­men­tal oxy­gen were at least two-fold high­er and the death toll increased five-fold in the preg­nant women with SARS-CoV­‑2.

Relat­ed Sto­ries­Sub-Saha­ran Africa also has high­er rates of tuber­cu­lo­sis (TB) and HIV than the U.S., and pub­lished stud­ies on COVID-19 among peo­ple with these chron­ic infec­tions have had con­flict­ing results, so the team also inves­ti­gat­ed the impact of these infec­tions on their study pop­u­la­tion. Among the par­tic­i­pants, both preg­nant and non-preg­nant women with HIV or a pri­or his­to­ry of TB had a two-fold increased risk of ICU admission.

“The bur­den of TB and HIV infec­tions in Africa adds to the risk of severe COVID-19 dur­ing preg­nan­cy,” said coau­thor John W. Mel­lors, M.D., chief of the Divi­sion of Infec­tious Dis­eases in Pit­t’s School of Med­i­cine. “This fur­ther under­scores the impor­tance of COVID-19 vac­ci­na­tion as part of pre­na­tal care.”

Nachega, who splits his time between Pitt Pub­lic Health and a fac­ul­ty posi­tion at Stel­len­bosch Uni­ver­si­ty in South Africa, not­ed recent progress on increas­ing the COVID-19 vac­cine sup­ply in Africa but empha­sized that COVID-19 vac­cine hes­i­tan­cy and mis­in­for­ma­tion about pub­lic health guid­ance is a glob­al issue, and Africa is no excep­tion. In an edi­to­r­i­al pub­lished along­side the study, Nachega and fel­low researchers empha­sized that tar­get­ing COVID-19 vac­ci­na­tions to this pop­u­la­tion is key in improv­ing moth­er and infant outcomes.

“COVID-19 vac­cine hes­i­tan­cy and low vac­cine uptake in preg­nan­cy include mis­in­for­ma­tion and dis­in­for­ma­tion pro­mot­ed on social media and oth­er plat­forms, which mis­lead the pub­lic about side effects, such as infer­til­i­ty and poten­tial fetal harm,” Nachega said. “Along with devot­ing resources to pro­mot­ing vac­ci­na­tion, we must also work to stop the spread of misinformation.”
Uni­ver­si­ty of Pitts­burghJour­nal reference:Clinical Infec­tious Dis­eases. DOI: doi.org/10.1093/cid/ciac294