El-Imam Ibrahim Ahmed, Koudjra Abra Rachida, Nampota-Nkomba Nginache, Mkandawire Felix, Nyirenda Osward, Masonga Rhoda, Cairo Cristiana, Gladstone Melissa, Laufer Miriam K, Buchwald Andrea G
University of Maryland.
University of Maryland School of Medicine.
Res Sq. 2025 Jul 8:rs.3.rs-6787028. doi: 10.21203/rs.3.rs-6787028/v1.
Both COVID-19 disease and HIV infection are associated with increased risk of adverse pregnancy outcomes. However, there is limited evidence on the impact of mild SARS-CoV-2 infection during pregnancy in sub-Saharan Africa, particularly among women living with HIV (WLWH), who may face heightened risk of adverse effects due to immune dysregulation and elevated obstetric risks.
We conducted a prospective cohort study of pregnant women enrolled at 20-36 weeks gestation at two health facilities in southern Malawi between 2018 and 2022. SARS-CoV-2 infection was determined via serologic testing at enrollment and delivery. Participants were enrolled into three groups based on HIV status and viral suppression: (1) WLWH with detectable viral load (VL), (2) WLWH with undetectable VL, and (3) HIV-negative women. We used multivariable logistic regression with adjustment for confounding to evaluate the impact of SARS-CoV-2 infection on the following adverse birth outcomes: low birth weight (LBW), preterm birth, small-for-gestational-age (SGA), stillbirth or early neonatal death, and a composite outcome. We further assessed any interaction between SARS-CoV-2 infection and HIV infection on adverse birth outcomes.
Among 905 women, 29% tested positive for SARS-CoV-2 during pregnancy. Most (87%) infections were mild or asymptomatic. In the total population, SARS-CoV-2 infection was significantly associated with SGA births (adjusted OR [aOR]: 1.49, 95% CI: 1.03-2.13) but was not associated with other adverse outcomes. Among WLWH, SARS-CoV-2 positivity was significantly associated with increased odds of LBW (aOR: 2.07, 95% CI: 1.10-3.91) and SGA births (aOR: 1.73, 95% CI: 1.01-2.91). The effect of SARS-CoV-2 infection among WLWH did not differ based on VL.
Mild SARS-CoV-2 infection during pregnancy was associated with adverse birth outcomes, particularly among WLWH, suggesting HIV-related immune modulation may heighten vulnerability to adverse pregnancy outcomes in the context of other infectious exposures. These findings underscore the need for integrated antenatal care and targeted infection prevention strategies for pregnant women with HIV in high-burden settings. Additionally, in light of recent changes in recommendations for COVID-19 vaccinations, these findings highlight the ongoing need for infection prevention among pregnant women globally.
COVID-19疾病和HIV感染均与不良妊娠结局风险增加相关。然而，关于撒哈拉以南非洲地区孕期轻度SARS-CoV-2感染的影响，证据有限，尤其是在感染HIV的女性（WLWH）中，她们可能因免疫失调和产科风险升高而面临更高的不良反应风险。
我们对2018年至2022年间在马拉维南部两家医疗机构入组的妊娠20 - 36周的孕妇进行了一项前瞻性队列研究。通过入组时和分娩时的血清学检测确定SARS-CoV-2感染情况。根据HIV状态和病毒抑制情况将参与者分为三组：（1）病毒载量（VL）可检测到的WLWH，（2）病毒载量不可检测到的WLWH，以及（3）HIV阴性女性。我们使用多变量逻辑回归并对混杂因素进行调整，以评估SARS-CoV-2感染对以下不良出生结局的影响：低出生体重（LBW）、早产、小于胎龄儿（SGA）、死产或早期新生儿死亡以及一个综合结局。我们进一步评估了SARS-CoV-2感染与HIV感染之间在不良出生结局方面的任何相互作用。
在905名女性中，29%在孕期SARS-CoV-2检测呈阳性。大多数（87%）感染为轻度或无症状。在总体人群中，SARS-CoV-2感染与小于胎龄儿出生显著相关（调整后的比值比[aOR]：1.49，95%置信区间[CI]：1.03 - 2.13），但与其他不良结局无关。在WLWH中，SARS-CoV-2阳性与低出生体重几率增加显著相关（aOR：2.07，95% CI：1.10 - 3.91）以及小于胎龄儿出生（aOR：1.73，95% CI：1.01 - 2.91）。SARS-CoV-2感染在WLWH中的影响并不因病毒载量而有所不同。
孕期轻度SARS-CoV-2感染与不良出生结局相关，尤其是在WLWH中，这表明在其他感染暴露的背景下，HIV相关的免疫调节可能会增加不良妊娠结局的易感性。这些发现强调了在高负担环境中为感染HIV的孕妇提供综合产前护理和针对性感染预防策略的必要性。此外，鉴于近期COVID-19疫苗接种建议的变化，这些发现凸显了全球孕妇持续进行感染预防的必要性。
