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

Int J Gynaecol Obstet. 2021 Dec;155(3):455-465. doi: 10.1002/ijgo.13917. Epub 2021 Sep 16.


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.

MeSH terms

  • COVID-19*
  • Cohort Studies
  • Female
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical
  • Pregnancy
  • Pregnancy Complications, Infectious* / epidemiology
  • Pregnancy Outcome / epidemiology
  • Pregnant Women
  • Premature Birth*
  • SARS-CoV-2
  • South Africa / epidemiology