Prevalence of Covid 19 Infection, Maternal Characteristics and Neonatal Outcomes Among Pregnant and Postpartum Women Under Investigation for Covid 19 Infection at the Kenyatta National Hospital - a Cross-sectional Study

Abstract

Background: The risk of developing viral respiratory infections such as the novel Coronavirus (COVID-19) and progression to severe pneumonia has been shown to increase in pregnancy secondary to physiological, immunological, together with cardiopulmonary system changes. The pregnant state has also been shown to increase the incidence of kidney failure, intensive care unit admission and death. In Kenya, the perinatal outcomes of pregnancies of women under investigation for COVID-19 infection are under-explored. Owing to the current minimal understanding of COVID-19 effects during pregnancy, there is need to guide management decisions based on previous encounters and outcomes. This study sought to determine the maternal characteristics, admission and perinatal outcomes in COVID-19 disease. Study objective: To determine the maternal characteristics, prevalence of COVID-19 infection and the associated maternal and neonatal outcomes among women under investigation for COVID-19 at Kenyatta National Hospital (KNH) between April 2020-June 2021. Methodology: This was a cross-sectional study among pregnant and postpartum women under investigation for COVID-19 infection, admitted at KNH between April 2020-June 2021.The study included all patients under investigation for COVID-19 admitted during the study period for the determination of prevalence. In the other part of the study, the maternal and neonatal characteristics of 56 COVID positive mothers were compared with those of 62 COVID negative mothers. Data was abstracted from archived health records and uploaded to version 25 of the Statistical Software for Social Scientists (SPSS) for analysis. Prevalence was determined by calculating the proportion of COVID positive cases from the total samples and 95% confidence interval estimates determined using the Clopper Pearson method. Chi square test was used to compare categorical maternal characteristics and maternal and neonatal outcomes and odds ratio interpreted as measure of association. Independent samples t-test was used to compare length of hospital stay and oxygen saturation. Statistical significance was set at 95% confidence level with a p-Value <0.05 considered. Results: During the study period, 348 women were investigated for COVID-19 infection through RT-PCR testing. Of these patients, 56 were diagnosed with COVID-19 disease, translating to a prevalence of 16.1%. Data of 118 women (56-COVID positive and 62 COVID negative) was used for comparative analysis. The mean age of the COVID-19 positive patients was 29.66.4 years. Most women with COVID-19 disease were multigravida at 73.2% with 76% presenting in the third 13 trimester. The commonest co-morbidity was pre-eclampsia at 23.2%. The average length of hospital stay was 11.810.6 days with 17.9% being transferred to the ICU.76% of the COVID-19 positive women delivered via caesarean section, with 43.5% being preterm deliveries. In the comparative analysis, demographic data such as age, education level, and marital status of both arms were similar. Reproductive and medical data such as parity, presence of comorbidities such as HIV, diabetes, and hypertension were comparable between the two arms. Bivariate comparative analyses revealed that the odds of a caesarean delivery for COVID-19 positive women was comparable to that of COVID-19 negative women. The occurrence of maternal complications such as APH and PPH and the length of hospital stay were comparable between the two groups, but maternal deaths occurred at a higher degree if women had COVID-19 disease. The neonatal outcomes of COVID-19 positive and COVID-19 negative women were similar in most cases apart from preterm live births, with an odds ratio of 3.79 (95% CI=1.01-11.7) if women had COVID-19 disease. Conclusion: The prevalence of COVID-19 among expectant and postpartum women investigated for COVID-19 was 16.1%. The commonest symptoms of Covid-19 infection in pregnancy were cough and difficulty in breathing. Most women were in the third trimester. The risk of preterm birth was higher in the COVID positive arm before adjusting for demographic factors. There were no other significant differences in the demographic characteristics, maternal and neonatal outcomes