Clinical and Epidemiological aspects of SARS-CoV-2 infection among pregnant and postpartum women in Mozambique: a prospective cohort study

Abstract Background Although there is a significant increase of evidence regarding the prevalence and impact of COVID-19 on maternal and perinatal outcomes, data on the effects of the pandemic on the obstetric population in sub-Saharan African countries are still scarce. Therefore, the study aims were to assess the prevalence and impact of COVID-19 on maternal and neonatal outcomes in the obstetric population at Central Hospital of Maputo (HCM), Mozambique. Methods Prospective cohort study conducted at teaching and referral maternity, HCM, from 20 October 2020 to 22 July 2021. We collected maternal and perinatal outcomes up to six weeks postpartum of eligible women (pregnant and postpartum women - up to the 14th day postpartum) screened for COVID-19 (individual test for symptomatic participants and pool testing for asymptomatic). The primary outcome was maternal death, SARS and UCI admission. We estimated the COVID-19 prevalence and the unadjusted RR (95% CI) for maternal and perinatal outcomes. We used the chi-square or Fisher's exact test to compare qualitative variables (two-sided p-value < 0.05 for statistical significance). Results We included 239 participants. The overall prevalence of COVID-19 was 9.2% (22/239) and in the symptomatic group was 32.4 % (11/34). About 48% of the participants with COVID-19 were asymptomatic. Moreover, the most frequent symptoms were dyspnoea (33.3%), cough (28.6%), anosmia (23.8%), and fever (19%). Not having a partner, being pregnant, and consuming alcohol were vulnerability factors for SARS-CoV-2 infection. COVID-19 among pregnant and postpartum women was associated with an increased risk of adverse maternal outcome, foetal death (RR = 4.0 [1.19–13.48]) and abortion/stillbirth 12.0 [7.7–18.7]). Conversely, we did not observe a significant difference in the primary outcomes between exposed and non-exposed groups. Conclusion The prevalence of COVID-19 in the obstetric population is higher than in the general population, and most pregnant and postpartum women with COVID-19 infection are asymptomatic. Being pregnant, not having a partner and alcohol consumption were factors of greatest vulnerability to SARS-COV-2 infection. Data suggest that pregnant women with COVID-19 may have a higher risk of adverse gestational outcomes, reinforcing the need for universal testing and monitoring of this population group. However, more prospective and robust studies are needed to assess these outcomes.