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^{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.

PMID: 34499750
PMCID: PMC9087659
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

Samantha Budhram et al. Int J Gynaecol Obstet. 2021 Dec.

. 2021 Dec;155(3):455-465.

doi: 10.1002/ijgo.13917. Epub 2021 Sep 16.

Authors

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.

PMID: 34499750
PMCID: PMC9087659
DOI: 10.1002/ijgo.13917

Erratum in

Erratum.
[No authors listed] [No authors listed] Int J Gynaecol Obstet. 2022 Jan;156(1):182. doi: 10.1002/ijgo.14027. Epub 2021 Nov 16. Int J Gynaecol Obstet. 2022. PMID: 34784054 Free PMC article. No abstract available.

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.

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Conflict of interest statement

The authors have no conflicts of interest.

References

1. World Health Organization . Rolling Updates on Coronavirus Disease (COVID‐19). World Health Organization; 2020. Accessed May 18, 2021. https://www.who.int/emergencies/diseases/novel‐coronavirus‐2019/events‐a...
1. Latest confirmed cases of COVID‐19 in South Africa. October 31, 2020. Accessed May 18, 2021. https://www.nicd.ac.za/latest‐confirmed‐cases‐of‐covid‐19‐in‐south‐afric...
1. Knight M, Bunch K, Vousden N, et al. UK Obstetric Surveillance System SARS‐CoV‐2 Infection in Pregnancy Collaborative Group. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS‐CoV‐2 infection in UK: national population based cohort study. BMJ. 2020;369:m2107. doi:10.1136/bmj.m2107. - DOI - PMC - PubMed
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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

Affiliations

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

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous