Data from Africa reporting the outcomes of COVID-19 infection in pregnancy are limited, particularly for women with high-risk pregnancies (hypertension, diabetes and obesity) and pregnant women living with HIV (PLHIV). We describe the clinical features, maternal and birth outcomes of COVID-19 high-risk pregnancies at a South African tertiary care referral hospital with a 24% antenatal HIV prevalence.
We prospectively collected data from COVID-19 infected pregnant women attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, between 1 May 2020 and 31 July 2020, and documented pregnancy and birth outcomes until 30 October 2020. Laboratory testing for SARS-CoV-2 infection was performed only in symptomatic pregnant women. Descriptive analysis was performed for all COVID-19 infected women with high-risk pregnancies; demographic and outcome variables were compared for PLHIV versus pregnant women without HIV.
One hundred pregnant women (72 without HIV and 28 PLHIV) had laboratory-confirmed COVID-19 infection (Table 1). Obesity, hypertensive disorders and gestational diabetes were frequent comorbidities. Among 28 PLHIV, the majority received antiretroviral treatment 27 (96%); median CD4 count was 441 (14-838) cell/mm³ for 21 (75%) and 19 (73%) were virologically suppressed. COVID-19 infection was diagnosed predominantly in the 3rd trimester (81%); 50% of women delivered within 2 weeks of infection onset. Forty women developed pneumonia; 13 developed adult respiratory distress syndrome (ARDS) and 6 required invasive ventilation. Eight women died, 7 from ARDS and 1 from advanced HIV disease with bacteraemia. Pregnancy outcomes included 91 live births (including 5 sets of twins), 5 stillbirths, 4 miscarriages, 2 mothers who died with the fetus in situ and 1 medical termination of pregnancy. Birth outcomes for 2 women were unknown. Outcome for the 91 liveborn neonates were good except for one who died from complications related to perinatal asphyxia. No significant differences for COVID-19 infection impact and outcome were noted for PLHIV versus those without HIV.
In this cohort of high-risk pregnant women with COVID-19 infection, no clinical differences in outcome attributable to HIV-infection were noted, however the majority of PLHIV were virally suppressed. The impact of COVID-19 infection in pregnancy was severe (40% complicated by pneumonia; 8% crude mortality rate); neonatal outcomes were favourable.