Association between COVID-19 and adverse pregnancy outcomes in Cape Town: A retrospective study

Background: Adverse pregnancy outcomes significantly contribute to maternal morbidity and mortality. Despite substantial global evidence, data on the effects of coronavirus disease 2019 (COVID-19) on maternal and neonatal outcomes in South Africa remain limited. Aim: To investigate the association between COVID-19 and adverse pregnancy outcomes. Setting: Tygerberg Hospital, Cape Town, South Africa. Methods: We performed a retrospective analysis of pregnant women tested for COVID-19 (categorised as positive or negative), admitted to Tygerberg Hospital between 01 March 2020 and 31 March 2021. The primary outcome was a composite of stillbirth, preterm birth, neonatal death, low birth weight, and maternal death. Binary logistic regression models were used to evaluate predictors of adverse pregnancy outcomes. Variables with p < 0.1 in the univariate model, along with clinically relevant covariates (maternal age, parity, COVID-19, human immunodeficiency virus [HIV], and preeclampsia), were included in the final multivariable model. Statistical analyses were performed via Stata/SE® (version 17.0) at α = 0.05. Results: Of 350 pregnant women (mean age: 29.8 years, [standard deviation {s.d.}: 6.99]), majority were in the third trimester (77.4%) and nulliparous (51.4%). Adverse outcomes occurred in 167 (47.7%) participants, with a higher prevalence among those without COVID-19 (51.4% vs. 43.6%) and those with preeclampsia (68.3% vs. 33.3%) compared to their counterparts. Preeclampsia was significantly associated with a higher risk of adverse pregnancy outcomes (adjusted odds ratio [AOR]: 2.87; 95% confidence interval [CI]: 1.62–5.09), whereas COVID-19 was not (AOR: 0.79; 95% CI: 0.42–1.46). Conclusion: COVID-19 was not associated with increased risk of adverse pregnancy outcomes. Conversely, preeclampsia significantly predicted adverse outcomes. Contribution: These findings underscore the importance of targeted antenatal interventions to mitigate maternal and neonatal morbidity during future pandemics.