COVID‐19 and Maternal–Neonatal Outcomes: A South African Retrospective Analysis

Background The maternal and neonatal outcomes of COVID‐19 in South Africa are under‐reported. This retrospective study therefore examined how the national COVID‐19 lockdown influenced access to antenatal care and its associated effects on maternal and neonatal outcomes at a South African tertiary hospital before and during the pandemic. Methods The study was based on data obtained from the birth registry records of a tertiary hospital in KwaZulu‐Natal between pre‐COVID‐19 (March 2019–February 2020) and during the pandemic (March 2020–December 2020). No COVID‐19 diagnostic data was recorded and only singleton pregnancies were included. Unpaired t ‐tests and Pearson’s chi‐square tests were used to compare continuous and categorical variables, respectively. Binary logistic regression was done to evaluate associations between maternal features and labour complications. Results A total of 8473 women accessed the hospital prior to ( n = 4866) and during the pandemic ( n = 3607). The majority of women attending the hospital during both time periods were aged between 19 and 35 years. Gestational age at delivery was significantly reduced during the pandemic (37.02 ± 4.10) versus the period prior (37.45 ± 3.74; p < 0.001). Additionally, during the pandemic, elective caesarean births increased significantly (10.31% vs. 6.33%), and the number of live births declined (3493 vs. 4705; p < 0.01). Rates of postpartum haemorrhage (1.95% vs. 0.56%), pre‐eclampsia (2.70% vs. 1.28%), sepsis (9.37% vs. 1.15%) and obstructed/prolonged childbirth (1.98% vs. 0.72%) increased significantly during the pandemic ( p < 0.01). Notably, during the pandemic, a 32‐fold increase in the risk of eclampsia (OR: 32.71; 95% CI: 4.31, 247.91; p = 0.001) was noted amongst primigravidae, with a higher risk of stillbirth in women aged between 19 and 35 (OR: 1.92; 95% CI: 1.14, 3.24; p < 0.05). Conclusion We report a significant rise in maternal and neonatal complications during the pandemic. Our findings can be utilised to assess the risks, benefits and impact of various health interventions on affected individuals in similar disease settings, to improve maternal and neonatal health and decrease disease burden in LMICs.