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February 14, 2022
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Study findings demonstrate risk to infants from maternal COVID-19, HIV

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Maternal COVID-19 was associated with an increased risk for adverse birth outcomes among infants born to mothers in Botswana, including a two-fold risk for stillbirth, researchers found.

Infants exposed to both COVID-19 and HIV infection had the highest risk for adverse outcomes, according to findings presented Monday at the virtual Conference on Retroviruses and Opportunistic Infections by Maya Jackson-Gibson, a fourth-year medical student at Northwestern University and a Fogarty Fellow in global health and population.

“Botswana has a high prevalence of women living with HIV and experienced a nationwide epidemic of COVID-19 that began in late 2020 and intensified during several waves in 2021,” Jackson-Gibson said.

Maya Jackson-Gibson

Together with institutions that included the Botswana-Harvard AIDS Institute Partnership and the Botswana health ministry, Jackson-Gibson and colleagues evaluated birth outcomes among women from 13 sites involved in the Tsepamo trial who were routinely tested for COVID-19 and HIV between Sept. 1, 2020, and Sept. 30, 2021.

They recorded 20,410 deliveries during the study period and excluded 44% of deliveries without a documented COVID-19 test. They specifically cataloged adverse birth outcomes that included preterm and very preterm delivery, being small or very small for gestational age, stillbirth, neonatal death and maternal death.

Of the 11,483 participants screened who had a known HIV status, 4.7% had COVID-19, including and 5.6% of women who were HIV-positive and 4.3% of women who were HIV-negative, Jackson-Gibson reported.

Maternal deaths were highest among COVID-19-positive women during the delta wave, with a prevalence of 5%, compared with 2% in the pre-delta era.

The rates of preterm delivery (21.4% vs. 13.4%) and stillbirth (5.6% vs. 2.7%) were higher among infants born to women with COVID-19. Infants born to women with COVID-19 and HIV had the highest prevalence of any adverse birth outcomes at 43.1%. The rate was 30.4% among women with HIV who did not have COVID-19.

“COVID infection just led to more adverse birth outcomes when added onto HIV infection,” Jackson-Gibson said.

“These outcomes are worse in most categories, demonstrating the detrimental effect of maternal COVID-19 infections for women living with HIV,” she said.