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.

Sub-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."