Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An International Network of Obstetric Survey Systems-based cohort study

Samantha Budhram; Valerie Vannevel; Tanita Botha; Lawrence Chauke; Shastra Bhoora; Gaynor M Balie; Natalie Odell; Hennie Lombaard; Amy Wise; Chrysanthi Georgiou; Nondumiso Ngxola; Emma Wynne; Unati Mbewu; Mfundo Mabenge; Sibusiso Phinzi; Nontsikelelo Gubu-Ntaba; Gareth Goldman; Kay Tunkyi; Sudhir Prithipal; Keshree Naidoo; Santhi Venkatachalam; Terence Moodley; Sean Mould; Mzuvele Hlabisa; Logie Govender; Charlene Maistry; John P Habineza; Priya Israel; Serantha Foolchand; Nomandla V Tsibiyane; Mala Panday; Priya Soma-Pillay; Sumaiya Adam; Felicia Molokoane; Matthew S Mojela; Elizabeth J van Rensburg; Tshililo Mashamba; Mushi Matjila; Sue Fawcus; Ayesha Osman; Mareli Venter; Gregory Petro; Ahminah Fakier; Eduard Langenegger; Catherine A Cluver; Adrie Bekker; Liesl de Waard; Chantal Stewart; Nnabuike C Ngene; Ongombe Lunda; Sylvia N Cebekhulu; Siva Moodley; Mama-Asu Koranteng-Peprah; Emmanuel M C Ati; Salome Maswime; Laura M Yates

doi:10.1002/ijgo.13917

Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An International Network of Obstetric Survey Systems-based cohort study

Int J Gynaecol Obstet. 2021 Dec;155(3):455-465. doi: 10.1002/ijgo.13917. Epub 2021 Sep 16.

Authors

Samantha Budhram^{1

2}, Valerie Vannevel^{3

4

5}, Tanita Botha⁶, Lawrence Chauke⁷, Shastra Bhoora^{7

8}, Gaynor M Balie⁷, Natalie Odell⁷, Hennie Lombaard⁹, Amy Wise⁹, Chrysanthi Georgiou⁹, Nondumiso Ngxola¹⁰, Emma Wynne¹⁰, Unati Mbewu¹⁰, Mfundo Mabenge¹¹, Sibusiso Phinzi¹², Nontsikelelo Gubu-Ntaba¹², Gareth Goldman², Kay Tunkyi¹³, Sudhir Prithipal¹³, Keshree Naidoo¹⁴, Santhi Venkatachalam¹⁴, Terence Moodley¹⁵, Sean Mould¹⁶, Mzuvele Hlabisa¹⁶, Logie Govender¹⁷, Charlene Maistry¹⁸, John P Habineza¹⁸, Priya Israel^{19

20}, Serantha Foolchand²¹, Nomandla V Tsibiyane²¹, Mala Panday²², Priya Soma-Pillay^{3

4

23}, Sumaiya Adam^{3

4

23}, Felicia Molokoane^{3

4

5}, Matthew S Mojela⁵, Elizabeth J van Rensburg⁵, Tshililo Mashamba²⁴, Mushi Matjila^{25

26}, Sue Fawcus²⁷, Ayesha Osman²⁷, Mareli Venter²⁷, Gregory Petro²⁸, Ahminah Fakier²⁸, Eduard Langenegger²⁹, Catherine A Cluver^{29

30}, Adrie Bekker³¹, Liesl de Waard²⁹, Chantal Stewart³², Nnabuike C Ngene^{33

34}, Ongombe Lunda^{33

34}, Sylvia N Cebekhulu³⁵, Siva Moodley², Mama-Asu Koranteng-Peprah³⁶, Emmanuel M C Ati¹⁶, Salome Maswime³⁷, Laura M Yates^{38

39}

Affiliations

¹ Maternal Foetal Medicine Unit, Department of Obstetrics and Gynaecology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
² Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
³ Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.
⁴ Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.
⁵ Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa.
⁶ Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa.
⁷ Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
⁸ Maternal Critical Care, Baylor College, Houston, Texas, USA.
⁹ Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa.
¹¹ Department of Obstetrics and Gynecology, Dora Nginza Hospital, Walter Sisulu University, Mthatha, South Africa.
¹² Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa.
¹³ Department of Obstetrics and Gynaecology, Addington Hospital, University of Kwazulu Natal, Durban, South Africa.
¹⁴ Department of Obstetrics and Gynecology, Mahatma Gandhi Memorial Regional Hospital, University of KwaZulu Natal, Durban, South Africa.
¹⁵ Department of Obstetrics and Gynecology, Prince Mshiyeni Memorial Hospital, University of Kwazulu Natal, Durban, South Africa.
¹⁶ Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa.
¹⁷ Department of Obstetrics & Gynecology, Queen Nandi Regional Hospital, University of Kwazulu Natal, Durban, South Africa.
¹⁸ Department of Obstetrics and Gynecology, Port Shepstone Regional Hospital, Port Shepstone, South Africa.
¹⁹ Department of Obstetrics and Gynecology, Edendale Hospital, Pietermaritzburg, South Africa.
²⁰ University of Kwazulu Natal, Durban, South Africa.
²¹ Maternal Fetal Unit: Department of Obstetrics and Gynecology, Greys Hospital, University of Kwazulu Natal, Durban, South Africa.
²² Department of Obstetrics and Gynaecology, King Dinizulu Hospital Complex, University of Kwazulu Natal, Durban, South Africa.
²³ Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
²⁴ Department of Obstetrics and Gynecology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.
²⁵ Department of Obstetrics and Gynecology, Groote Schuur Hospital, Cape Town, South Africa.
²⁶ MRC/UCT Receptor Biology Unit, Division of Medical Biochemistry, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
²⁷ Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
²⁸ Department of Obstetrics and Gynecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa.
²⁹ Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa.
³⁰ Translational Obstetrics Group, Mercy Perinatal, Department of Obstetrics and Gynaecology, Melbourne University, Melbourne, Victoria, Australia.
³¹ Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
³² Department of Obstetrics and Gynecology, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa.
³³ Department of Obstetrics and Gynecology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa.
³⁴ University of the Witwatersrand, Johannesburg, South Africa.
³⁵ Department of Obstetrics and Gynecology, Bongani Regional Hospital, University of Free State, Bloemfontein, South Africa.
³⁶ Department of Obstetrics and Gynaecology, Midlands/Eden Gardens private Hospital, Pietermaritzburg, South Africa.
³⁷ Global Surgery Division, Department of Surgery, University of Cape Town, South Africa.
³⁸ Clinical Genetics Unit, Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, Durban, South Africa.
³⁹ KwaZulu-Natal Research and Innovation Sequencing Platform, University of Kwazulu-Natal, Durban, South Africa.

Abstract

Objective: To describe risk factors and outcomes of pregnant women infected with SARS-CoV-2 admitted to South African healthcare facilities.

Methods: A population-based cohort study was conducted utilizing an amended International Obstetric Surveillance System protocol. Data on pregnant women with SARS-CoV-2 infection, hospitalized between April 14, 2020, and November 24, 2020, were analyzed.

Results: A total of 36 hospitals submitted data on 673 infected hospitalized pregnant women; 217 (32.2%) were admitted for COVID-19 illness and 456 for other indications. There were 39 deaths with a case fatality rate of 6.3%: 32 (14.7%) deaths occurred in women admitted for COVID-19 illness compared to 7 (1.8%) in women admitted for other indications. Of the women, 106 (15.9%) required critical care. Maternal tuberculosis, but not HIV co-infection or other co-morbidities, was associated with admission for COVID-19 illness. Rates of cesarean delivery did not differ significantly between women admitted for COVID-19 and those admitted for other indications. There were 179 (35.4%) preterm births, 25 (4.7%) stillbirths, 12 (2.3%) neonatal deaths, and 162 (30.8%) neonatal admissions. Neonatal outcomes did not differ significantly from those of infected women admitted for other indications.

Conclusion: The maternal mortality rate was high among women admitted with SARS-CoV-2 infection and higher in women admitted primarily for COVID-19 illness with tuberculosis being the only co-morbidity associated with admission.

Keywords: COVID-19; SARS-CoV-2; low- and middle-income country; perinatal; pregnancy.

MeSH terms

COVID-19*
Cohort Studies
Female
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical
Pregnancy
Pregnancy Complications, Infectious* / epidemiology
Pregnancy Outcome / epidemiology
Pregnant Women
Premature Birth*
SARS-CoV-2
South Africa / epidemiology

Grants and funding

South African Medical Research Council (SAMRC)