Six-country African study shows COVID-19 can be dangerous in pregnancy

A new study involving hospitalized women in six African countries from the University of Maryland School of Medicine’s (UMSOM) Institute of Human Virology (IHV) showed that pregnant women with SARS-CoV-2, the virus that causes COVID-19, had double the risk of being admitted to the intensive care unit (ICU) and four-times the risk of dying in-hospital than pregnant women who did not have COVID-19.

The researchers stated that their findings suggest that women who are pregnant or may become pregnant should avoid getting COVID-19 and protect themselves as best as they can with available vaccines.

The findings were published on June 8, 2022, in the Clinical Infectious Diseases journal, along with an accompanying viewpoint.

“If the mother does not do well, then the baby does not do well either. As we do not yet have vaccines for babies less than six months old, pregnant women should get the vaccine to protect their unborn children and newborns,” said Nadia Sam-Agudu, MD, Associate Professor of Pediatrics at UMSOM, Senior Technical Advisor for Pediatric and Adolescent HIV at the UMSOM’s Institute of Human Virology, and International Senior Technical Advisor of Pediatric and Adolescent HIV at the Institute of Human Virology Nigeria.

Dr. Sam-Agudu added that currently available evidence shows that COVID-19 vaccines indicated for use in pregnancy are safe, and emerging data show that they provide protection for newborns as well as mothers.

The new study was conducted by the African Forum for Research and Education in Health (AFREhealth) Research Collaboration on COVID-19 and Pregnancy. The study examined data on 1,315 women hospitalized in Ghana, Nigeria, Democratic Republic of the Congo, Uganda, Kenya, and South Africa, including 510 pregnant women with COVID-19, 403 non-pregnant women with COVID-19, and 402 pregnant women without COVID-19.

Women with other risk factors such as diabetes, HIV, history of tuberculosis, or sickle cell disease were at greater risk for severe COVID-19. About 32% of pregnant women with COVID-19 needed in-hospital oxygen therapy compared to 16% of pregnant women without COVID-19. Some 19% of pregnant women with COVID-19 were admitted to the ICU, compared to 6% of pregnant women who did not have COVID-19. Among the women hospitalized with COVID-19, 10% of those who were pregnant died compared to the 5% that were not pregnant.

“I would like to appeal to healthcare providers to consider the data with respect to vaccine safety for pregnant women, and to counsel women to help them consider the vaccine in light of the consequences of COVID-19,” said Dr. Sam-Agudu. “Knowing that we have tools to prevent this disease from progressing, we should be more intentional, educational, and supportive about vaccination in pregnancy, so that pregnant women or women who plan to become pregnant can access and receive vaccines.”

Overall, COVID-19 vaccination rates remain much lower in Africa compared to much of the rest of the world. As of today, with the exception of a few, full vaccination rates in African countries do not top 40%. According to the researchers, COVID-19 vaccination rates are likely to be much lower among pregnant women in these settings.

African countries still contend with low and inconsistent COVID-19 vaccine supplies, largely due to persistent inequity in access to global vaccine supply and manufacturing. Experts remain concerned that vaccine demand and acceptance may wane, and vaccine apathy may set in, as inconsistent access and supply persist.

“This study furthers confirms that pregnant women face special risks and potential complications from COVID-19,” said Man Charurat, PhD, MHS, Professor of Medicine at UMSOM and the Division Director of Epidemiology & Prevention at UMSOM’s Institute of Human Virology. “Public health experts and physicians need to make more effort to solve the problem of vaccine inequity in Africa.”

E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, University of Maryland Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, UMSOM, said, “We need to make every effort to ensure that all countries or regions have available access to resources such as COVID-19 vaccines to prevent any unnecessary suffering. It is imperative that we encourage pregnant women to use the tools we now have developed to prevent their own disability and promote healthy births.” 

This work was supported by the U.S. National Institutes of Health (NIH) Fogarty International Center (1R25TW011217-01) to AFREhealth.

Study author John Mellors, MD, of the University of Pittsburgh receives funding from Gilead Sciences, Inc; and Janssen Pharmaceuticals, and consults for Gilead Sciences, Inc (Scientific Advisory Board), Accelevir Diagnostics, Merck, and Xi’an Yufan Biotechnologies. He owns shares from Abound Bio, Inc, Co-Crystal Pharma, Inc, and Infectious Diseases Connect.

About the Institute of Human Virology

Formed in 1996 as a partnership between the State of Maryland, the City of Baltimore, the University System of Maryland, and the University of Maryland Medical System, the IHV is an institute of the University of Maryland School of Medicine and is home to some of the most globally-recognized and world-renowned experts in all of virology. The IHV combines the disciplines of basic research, epidemiology, and clinical research in a concerted effort to speed the discovery of diagnostics and therapeutics for a wide variety of chronic and deadly viral and immune disorders, most notably HIV, the virus that causes AIDS. For more information, visit ihv.org and follow us on Twitter @IHVmaryland.

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu