Developing COVID-19 during a high-risk pregnancy is a bad combination for mother and child, but having HIV infection on top of that doesn't appear to make it any worse, a study in South Africa indicated.
Of 100 women diagnosed with COVID-19 while receiving care from the high-risk obstetric care service at Tygerberg Hospital in Cape Town, South Africa, there were eight deaths: six among the 72 women (8%) with COVID-19, and two among the 28 women (7%) co-infected with HIV, said Liesl De Waard, MBChB, of Stellenbosch University in suburban Cape Town.
Of those women who died during the study -- conducted during the height of the COVID-19 pandemic -- only two of the babies they were carrying survived, de Waard said in her oral presentation at the .
"South Africa has the highest COVID-19 infection rates in Africa," de Waard said. "COVID-19 disease severity and mortality are increased in pregnancy. We wanted to describe the clinical presentation and outcomes of women with high-risk pregnancies who were diagnosed with COVID-19 illness."
She said that Tygerberg Hospital, a large public referral hospital in Cape Town, dedicated an obstetric unit for treating pregnant women with suspected or confirmed cases of COVID-19. The observational cohort was recruited from May 1 to July 31 of last year and followed until October 31 to allow all the pregnant women to deliver.
Of the 28 women living with HIV in the cohort, 27 were on antiretroviral therapy and three-quarters had undetectable viral loads. Median ages for women who did and did not have HIV were 34 and 31, respectively. Nearly all were overweight (a major reason for having pregnancies considered high risk) and 44% were classified as morbidly obese. About 22% had been diagnosed with hypertension, and another 18% had gestational hypertension; 6% had diabetes, and 14% had gestational diabetes. About 81% of COVID-19 infections occurred during the third trimester of their pregnancies.
"Overall," de Waard said, "neonatal outcomes were good, with 30% of births preterm." The 100 pregnancies resulted in 91 live births, including five sets of twins; 12 fetal deaths were recorded and outcomes were unknown for two pregnancies.
In commenting on the study, Sharon Hillier, PhD, of the University of Pittsburgh School of Medicine, told 51˶, "Women who were pregnant were excluded from COVID-19 clinical trials, but I do think that these data suggest that a lot of the initiative in the United States to offer women who are pregnant COVID-19 vaccines is really merited. It is a very high-risk situation for these women and these appear to be very safe vaccines."
"Although these vaccines are not recommended or tested yet in pregnant women, many of us who work in the women's health space really feel strongly that women should be able to decide for themselves whether they want to take those vaccines when they are pregnant," Hillier said.
"Certainly many healthcare workers who are pregnant have decided to take the vaccine and many people I know who are not healthcare workers who are pregnant have elected to take the vaccine," she said. "I think that is probably the lesson from these really interesting data that have been presented from South Africa."
Disclosures
Hillier has disclosed relationships with Becton, Dickinson and Company, Cepheid, Curatek, Dare Biosciences, Hologic, Merck, and Pfizer.
De Waard disclosed no relationships with industry.
Primary Source
Conference on Retroviruses and Opportunistic Infections
De Waard L, et al "COVID-19 infection in high-risk South African pregnancies with and without HIV" CROI 2021.