COVID‐19 symptoms and antibody positivity among unvaccinated pregnant women: An observational study in seven countries from the Global Network

Abstract

Objective: To determine the relation of COVID-19 symptoms to COVID-19 anti-body positivity among unvaccinated pregnant women in low- and middle-income countries (LMIC).Design: COVID-19 infection status measured by antibody positivity at delivery was compared with the symptoms of COVID-19 in the current pregnancy in a prospec-tive, observational cohort study in seven LMICs. Setting: The study was conducted among women in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry (MNHR), a prospec-tive, population-based study in Kenya, Zambia, the Democratic Republic of the Congo (DRC), Bangladesh, Pakistan, India (Belagavi and Nagpur sites) and Guatemala.Population: Pregnant women enrolled in the ongoing pregnancy registry at study sites.Methods: Data on COVID-19 symptoms during the current pregnancy were collected by trained staff between October 2020 and June 2022. COVID-19 antibody testing was performed on samples collected at delivery. The relation between COVID-19 antibody positivity and symptoms was assessed using generalised linear models with a binomial distribution adjusting for site and symptoms.Main outcome measures: COVID-19 antibody status and symptoms of COVID-19 among pregnant women.Results: Among 19 218 non-vaccinated pregnant women who were evaluated, 14.1% of antibody-positive women had one or more symptoms compared with 13.4% in antibody-negative women. Overall, 85.3% of antibody-positive women reported no COVID-19 symptoms during the present pregnancy. Reported fever was signifi-cantly associated with antibody status (relative risk [RR] 1.10, 95% CI 1.03–11.18; P = 0.008). A multiple variable model adjusting for site and all eight symptoms during pregnancy showed similar results (RR 1.13, 95% CI 1.04–1.23; P= 0.012). None of the other symptoms was significantly related to antibody positivity.Conclusions: In a population-based cohort in LMICs, unvaccinated pregnant women who were antibody-positive had slightly more symptoms during their pregnancy and a small but significantly greater increase in fever. However, for prevalence studies, evaluating COVID-19-related symptoms does not appear to be useful in differentiat-ing pregnant women who have had a COVID-19 infection.