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 June 8, 2022, in the Clinical Infectious Diseases journal, along with an accompanying viewpoint.

Nadia Sam-Agudu, MD

“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 6 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 UMSOM’s IHV, and international senior technical advisor of Pediatric and Adolescent HIV at the Institute of Human Virology Nigeria.

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

The 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 percent of pregnant women with COVID-19 needed in-hospital oxygen therapy compared to 16 percent of pregnant women without COVID-19. About 19 percent of pregnant women with COVID-19 were admitted to the ICU, compared to 6 percent of pregnant women who did not have COVID-19. Among the women hospitalized with COVID-19, 10 percent of those who were pregnant died compared to the 5 percent who were not pregnant.

“I would like to appeal to health care 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,” Sam-Agudu said. “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 percent. 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 because of 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 further 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 and prevention at UMSOM’s IHV. “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 Fogarty International Center (1R25TW011217-01) to AFREhealth.