Abstract:
Objectives: To determine COVID-19 antibody positivity rates over time and rela tionships to pregnancy outcomes in low- and middle-income countries (LMICs).Design: With COVID-19 antibody positivity at delivery as the exposure, we per formed a prospective, observational cohort study in seven LMICs during the early
COVID-19 pandemic.
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 pro spective, population-based study in Kenya, Zambia, the Democratic Republic of the
Congo (DRC), Bangladesh, Pakistan, India (two sites), and Guatemala.
Population: Pregnant women enrolled in an ongoing pregnancy registry at study sites.
Methods: From October 2020 to October 2021, standardised COVID-19 antibody
testing was performed at delivery among women enrolled in MNHR. Trained staff
masked to COVID-19 status obtained pregnancy outcomes, which were then com pared with COVID-19 antibody results.
Main Outcome Measures: Antibody status, stillbirth, neonatal mortality, maternal
mortality and morbidity.
Results: At delivery, 26.0% of women were COVID-19 antibody positive. Positivity
increased over the four time periods across all sites: 13.8%, 15.4%, 21.0% and 40.9%.
In the final period, positivity rates were: DRC 27.0%, Kenya 33.1%, Pakistan 32.8%,
Guatemala 37.0%, Zambia 37.8%, Bangladesh 47.2%, Nagpur, India 57.4% and Belagavi,
India 62.4%. Adjusting for site and maternal characteristics, stillbirth, neonatal mortal ity, low birthweight and preterm birth were not significantly associated with COVID-19.
The adjusted relative risk (aRR) for stillbirth was 1.27 (95% CI 0.95–1.69). Postpartum
haemorrhage was associated with antibody positivity (aRR 1.44; 95% CI 1.01–2.07).
Conclusions: In pregnant populations in LMICs, COVID-19 antibody positivity has
increased. However, most adverse pregnancy outcomes were not significantly associ ated with antibody positivity
