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Association of antepartum and intrapartum SARS-CoV-2 infection on pregnancy outcomes in South African women, two observational studies
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  • Marta Nunes,
  • Stephanie Jones ,
  • Renate Strehlau,
  • Vuyelwa Baba,
  • Zanele Ditse,
  • Kelly Da Silva,
  • Lane Bothma,
  • Natali Serafin,
  • Vicky Baillie ,
  • Gaurav Kwatra,
  • Megan Burke,
  • Amy Wise,
  • Mary Adam,
  • Philiswa Mlandu,
  • Mpolokeng Melamu,
  • Juliette Phelp ,
  • Wendy Fraser,
  • Colleen Wright ,
  • Elizabeth Zell ,
  • Yasmin Adam,
  • Shabir Madhi
Marta Nunes
University of the Witwatersrand Faculty of Health Sciences
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Stephanie Jones
University of the Witwatersrand Faculty of Health Sciences
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Renate Strehlau
University of the Witwatersrand Faculty of Health Sciences
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Vuyelwa Baba
University of the Witwatersrand Faculty of Health Sciences
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Zanele Ditse
University of the Witwatersrand Faculty of Health Sciences
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Kelly Da Silva
University of the Witwatersrand Faculty of Health Sciences
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Lane Bothma
University of the Witwatersrand Faculty of Health Sciences
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Natali Serafin
University of the Witwatersrand Faculty of Health Sciences
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Vicky Baillie
University of the Witwatersrand Faculty of Health Sciences
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Gaurav Kwatra
University of the Witwatersrand Faculty of Health Sciences
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Megan Burke
University of the Witwatersrand Faculty of Health Sciences
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Amy Wise
University of the Witwatersrand Faculty of Health Sciences
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Mary Adam
University of the Witwatersrand Faculty of Health Sciences
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Philiswa Mlandu
Chris Hani Baragwaneth Academic Hospital, University of the Witwatersrand, Johannesburg
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Mpolokeng Melamu
Chris Hani Baragwaneth Academic Hospital, University of the Witwatersrand, Johannesburg
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Juliette Phelp
Chris Hani Baragwaneth Academic Hospital, University of the Witwatersrand, Johannesburg
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Wendy Fraser
Lancet Laboratories
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Colleen Wright
Lancet Laboratories
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Elizabeth Zell
Stat-Epi Associates, Inc.
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Yasmin Adam
Chris Hani Baragwanath Academic Hospital and the University of the Witwatersrand
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Shabir Madhi
University of the Witwatersrand Faculty of Health Sciences
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Abstract

Objective: Evaluate the impact of the timing of SARS-CoV-2 infection on pregnancy outcomes in a low-middle income setting. Design: two parallel, observational studies. Setting and population: pregnant women or women presenting for labour, enrolled between April-September 2020, in South Africa. Methods: i) longitudinal follow-up study of symptomatic or asymptomatic pregnant women investigated for SARS-CoV-2 infection antenatally, ii) cross-sectional study of SARS-CoV-2 infection at time of labour. SARS-CoV-2 infection was investigated by nucleic acid amplification test (NAAT). Main Outcome Measures: association of SARS-CoV-2 infection on nasal swab and birth outcomes. Results: Antenatally, 793 women were tested for SARS-CoV-2. Overall SARS-CoV-2 infection was confirmed in 138 women, including 119/275 with symptomatic illness (COVID-19) and 19/518 asymptomatic women; 493 women were asymptomatic and SARS-CoV-2 non-reactive. Women with COVID-19 were 1.66-times (95%CI: 1.02, 1.71) more likely to have a low-birthweight newborn (30%) compared to asymptomatic women without SARS-CoV-2 (21%). Overall, 3117 women were tested for SARS-CoV-2 infection at delivery, including 1560 healthy women with an uncomplicated term delivery. Adverse birth outcomes or pregnancy-related complications were not associated with infection at delivery. Among women with SARS-CoV-2 infection at delivery, NAAT was reactive on 6/98 of maternal blood samples, 8/93 of cord-blood, 14/54 of placentas and 3/22 of nasopharyngeal swabs from newborns collected within 72-hours of birth. Conclusions: Antenatal, but not intrapartum, SARS-CoV-2 infection was associated with low-birthweight delivery. Maternal infection at the time of labour was associated with in utero foetal and placental infection, and possible vertical and/or horizontal viral transfer to the newborn.

Peer review status:UNDER REVIEW

14 Nov 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
17 Nov 2021Assigned to Editor
17 Nov 2021Submission Checks Completed
18 Nov 2021Reviewer(s) Assigned
29 Nov 2021Review(s) Completed, Editorial Evaluation Pending