Association Between Hypertensive Disorders in Pregnancy and Adverse Pregnancy Outcomes Among Women With Sars-cov-2 at Pumwani Maternity and Aga Khan University Hospitals in Kenya, 2021-2022

Abstract

BACKGROUND Studies in high-income countries demonstrate that patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have a 2-fold risk of developing hypertensive disorders in pregnancy (HDP). In these settings, up to 38.9% of patients with SARS-CoV-2 and HDP versus 23.5% with SARS-CoV-2 alone develop adverse pregnancy outcomes including preterm labour, IUFD, IUGR, poor APGAR scores at 5 minutes and stillbirths. This is thought to be due to an exaggerated inflammatory response triggered by the SARS-CoV-2 infection which may directly contribute to the development of HDP and synergistically compound the effect of HDP on adverse pregnancy outcomes. The association between SARSCoV- 2, HDP and adverse pregnancy outcomes has not been comprehensively evaluated in Kenya and the region, yet in this setting, there is a predominance of medical comorbidities, coinfections, and poor health systems that all adversely affect pregnancy outcomes. BROAD OBJECTIVE To determine the association between HDP and adverse pregnancy outcomes among women with SARS-CoV-2 at Pumwani Maternity Hospital (PMH) and Aga Khan University Hospital (AKUH) from 2021-2022. METHODOLOGY This study was a case-control analysis embedded within a larger prospective cohort study aimed at investigating maternal, pregnancy, and neonatal outcomes in women and newborns infected with SARS-CoV-2 at PMH and AKUH. The cases comprised pregnant or postpartum women diagnosed with SARS-CoV-2 who experienced a composite of adverse outcomes, such as hospital admission due to SARS-CoV-2, evidence of end-organ damage, the requirement for supplemental or advanced oxygen support, referral or admission to HDU/ICU, maternal mortality, preterm delivery, birth asphyxia or an APGAR score of 5 or less at 5 minutes, fetal loss, stillbirth, referral or admission to NHDU or NICU, and neonatal mortality. In contrast, controls were pregnant or postpartum women with SARS-CoV-2 who did not exhibit these outcomes. The exposure of interest was hypertensive disorders of pregnancy (HDP), which included pre-eclampsia, chronic hypertension, chronic hypertension with superimposed preeclampsia, and gestational hypertension. Data collection involved first identifying cases and controls that met the inclusion criteria, followed by assessing exposure to HDP, which was then compared between the two groups. A total of 72 cases were identified and compared with 144 controls to evaluate HDP exposure. Data were abstracted using a standardized tool, verified for completeness, and entered into Microsoft Excel 2020, before being exported to the Statistical Package for Social Sciences (SPSS) version 23.0 for analysis. Baseline characteristics between cases and controls were compared, and the relationship between HDP and adverse pregnancy outcomes was assessed using multivariable logistic regression to calculate the adjusted odds ratio (aOR). A p-value of <0.05 was considered to indicate statistical significance.