Factors Associated With Adverse Perinatal Outcomes Among Covid 19 Positive Pregnant Women in Pumwani Maternity and Aga Khan University Hospitals From 2021-2022, a Case-control Study

Abstract

Background: Pregnancy-related changes in the immune system make pregnant women more vulnerable to infections, including viral infections such as COVID-19. Pregnant women who test positive for COVID-19 face a higher risk of negative maternal and perinatal outcomes (6.42%), including premature births, admission to NICU, stillbirths, and vertical transmission. Gestational age at diagnosis, birth weight, and need for mechanical ventilatory support among Covid-19 positive pregnant women were independently associated with adverse fetal outcomes in the United States. This relationship and its impact on perinatal outcomes have not been thoroughly studied in the local Kenyan context, which is a resource-limited setting. Study Objective: To evaluate the sociodemographic, obstetric, medical, and viral factors associated with selected adverse perinatal outcomes among neonates born by Covid 19 positive pregnant women in Pumwani Maternity and Aga-Khan University Hospitals, from 2021- 2022. Materials and Methods: This was a case-control study nested in a larger prospective cohort study in which 100 women with selected adverse composite perinatal outcomes (any ≥1 of stillbirth, low birth weight<2500gms, prematurity<37 weeks, admission to NBU/neonatal ICU, vertical transmission cases and birth asphyxia based on an Apgar score <7 in the 5th minute) were compared with 200 women without the composite outcome(controls) among a cohort of covid-19 pregnant or postpartum women receiving care at the two facilities between July 2021 and July 2022. Data from patient files were collected using a data abstraction tool. To examine associations between categorical variables and outcomes, either the Chi-square test or Fisher's exact test was employed. Continuous variables were compared using an independent samples t-test. The crude odds ratio (OR) was calculated to determine the association between the various risk factors and adverse perinatal outcomes. The adjusted odds ratio (aOR) was determined through multivariable logistic regression, accounting for gestational age, maternal education level, and body mass index. Data analysis was conducted using Stata version 14, with a p-value of less than 0.05 deemed statistically significant...