Many African countries have no COVID-19 vaccination policy for pregnant women as a study in the BMJ Global Health journal shows pregnant women with COVID-19 are seven times more at risk of death.
COVID-19 in pregnancy could reverse the slow but steady gains made in maternal and neonatal mortality reduction in Africa and set back progress towards global goals, unless targeted policies are implemented, researchers say.
In January, researchers of a study published in BMJ Global Health analyzing the impact of COVID-19 on pregnant women, found that COVID-19 infection in pregnancy increases the risk of death more than sevenfold in pregnant women.
The researchers also found that babies born to mothers with COVID-19 were more likely to be admitted to neonatal intensive care units, born prematurely at or before 34 weeks, or born with low birth weight (below 2,500 grams).
There is risk of foregone care due to avoidance of going for medical checks-up during the epidemic and associated movement restrictions."
Abdhalah Ziraba, health systems research scientist from the Kenya-headquartered African Population and Health Research Center
He said most health systems have limited capacity to absorb increased numbers of sick newborn children and mothers, and a sudden increase in case load affects the quality of services.
In most African countries, few hospitals have fully functional neonatal intensive care units, and the cost in these hospitals are exorbitant, Ziraba tells SciDev.Net. He says long hospital stays have implications for other services and could weaken the ability to address pregnancy, labour and newborn health challenges.
Emily Smith, the study's lead author and assistant professor at the Milken Institute School of Public Health at the George Washington University in the United States, many countries in Africa do not currently have a vaccine policy that explicitly recommends vaccination for pregnant women.
"We wanted to know whether pregnant women faced extra risk when they got COVID-19. This is essential for creating good public health guidance and clinical guidance," explains Smith.
She says the study found that women with COVID-19 are more likely to suffer from pregnancy-induced hypertension and that babies born to women with COVID-19 were 37 per cent more likely to be born preterm compared with pregnant women without COVID-19.
The researchers assessed data from 12 studies in 12 countries where more than 13,000 pregnant women were screened. The countries included Democratic Republic of Congo, Ghana, Kenya, Nigeria, South Africa and Uganda.
The researchers compared the risk of death and adverse birth outcomes in pregnant women with COVID-19 infection and women without COVID-19 infection.
"Our study data are mostly from 2020, before COVID-19 vaccines were widely available and recommended for pregnant women," Smith tells SciDev.Net. "Now that vaccines and boosters are available and recommended for pregnant women, we recommend women to be fully vaccinated and up-to-date on boosters, especially if they are pregnant or planning to become pregnant."
"We hope this study illustrates the continued need for improving vaccine access for women globally," she says, adding that the findings are in line with those of an African study published last year, which showed COVID-19 infection increases the risk of intensive care admission and maternal death.
Smith adds that although stillbirth is rare, with only 78 cases identified among the 13,000 pregnancies studied, other studies have found an increased risk of stillbirth among women with COVID-19 later in pregnancy.
More research is needed to "understand the relationship between COVID-19 and hypertensive disorders of pregnancy", she says.
Ziraba believes that the results of the study are important and useful to push for policy changes, but not surprising as pregnancy "is a stressful condition and renders expectant women to have a relatively weaker immunity for the time they are pregnant".
"The good news is that the worst part of the epidemic is over and if we sustain vaccination campaigns, wide impact of COVID-19 on pregnant women and healthcare system is likely to be limited," he adds.