Clinical Features and Outcomes of COVID-19 Infection among Pregnant Women in South Africa

Abstract

Background and Objective: Studies among COVID positive pregnant women are limited. Previous studies reported high rate of symptoms, comorbidities, and poor fetal/neonatal outcome among women of different ethnicity. To date, no study was reported among pregnant African women. This study was conducted to determine the clinical features and outcomes of COVID-19 positive pregnant women in Ekurhuleni District in South Africa.

Methods: Retrospective record review of 103 COVID-19 infected pregnant women during the period of April to September 2020 was performed. Clinical features, symptoms, comorbidities, laboratory results, maternal, and neonatal outcomes were analyzed. Descriptive statistics (mean + standard deviation, number, and percentages) and inferential statistics (Chi-square test) were calculated. Ethical clearance was obtained from the Human Research Ethics Committee of the University of Witwatersrand, South Africa.

Results: Majority of patients (90%) were of African ethnicity and symptomatic (53%). The most common symptom, comorbidity, and laboratory abnormality was cough (62%), hypertension (23%), and high LDH (20%), respectively. Thrombocytopenia and lymphocytopenia occurred among 9% and 15% of the women, respectively. Although association was not significant, symptoms were more common among women who were HIV positive, had comorbidity, and had abnormal results. The most common complications were preterm labor (8%) and macerated stillbirths (6%). Six (6%) mothers died.

Conclusion and Global Health Implications: COVID-positive pregnant South African women were commonly symptomatic, but incidence of adverse fetal outcomes was low. High rate of preterm labor, macerated stillbirths, and maternal deaths was a concern. This study has several strengths. It included all COVID-positive women over a 6-month period at all healthcare facility levels, such as clinics, community health centers/midwifery units, district, and regional/tertiary hospitals conducted in an African country. Previous studies primarily included hospitals, which increased a high probability of mainly including severelyill women. The study might benefit the health care workers in other African countries.