To date, studies have generated conflicting findings on how COVID-19 affects pregnant women and their babies. AKU researchers in Nairobi and Karachi aim to shed new light on the subject.
In Nairobi, a team led by Professor Marleen Temmerman have been engaged in a major study of placental disorders (pregnancy hypertension, foetal growth restriction, etc.) in multiple African countries, using a biobank of samples collected from women throughout their pregnancy. The study, known as PRECISE, has now been expanded to investigate the impact of the novel coronavirus on pregnant women and their babies.
The team will conduct regular COVID testing on more than 1,000 pregnant women and 250 non-pregnant women, assess outcomes among those infected and collect and analyse biological samples to determine whether and for how long SARS-CoV-2 is present in blood, urine, umbilical cord blood, amniotic fluid and other samples, as well as determine the presence of antibodies in cord blood and breast milk.
Their study involves women in Kenya, Uganda, Mozambique, Malawi and The Gambia. It will shed light on whether women infected with the virus are at a greater risk of pre-term births or pregnancy complications, and how pregnancy affects the progression of the disease in women.
“The novel nature of COVID-19 means there are many areas where we have no answers,” said Dr Temmerman, Director of the Centre of Excellence in Women and Child Health, East Africa. “Our project will be one of the largest studies to date of these issues.”
Dr Temmerman brings to the study decades of experience in studying HIV/AIDS in pregnant women.
In Pakistan, AKU Associate Professor Dr Fyezah Jehan and her team will be using the AMANHI biobank to understand the spread, severity and spectrum of COVID-19 in pregnant women and their newborns. The AMANHI biobank is part of a World Health Organization study of maternal and child health outcomes that spans eight countries in South Asia and Africa, with AKU being responsible for sample collection and analysis in Pakistan.
The biobank has enrolled more than 2,500 women and 2,300 children who live in the area of Ibrahim Hyderi in Karachi. The University has been providing low-cost primary care health services in the area for a number of years and has earned the trust of the local community.
Since approximately 10 per cent of the cohort is pregnant at any point in time, the AMANHI biobank is likely to be a valuable tool in understanding how COVID-19 affects maternal and child health in the area.
Researchers will contact women enrolled in the study to ascertain whether they have experienced symptoms of the disease. Samples will also be collected from a cohort of pregnant women with COVID-19 until 42 days after birth to ascertain the course of the disease through pregnancy. COVID-19 antibody tests will be conducted on study participants to understand the burden of COVID-19 and to ascertain the immune system’s response to the disease.
Indirect impacts of the pandemic
AKU researchers in Pakistan and Kenya are also examining the indirect impact of the pandemic on mother and child health. In Pakistan, as part of the AMANHI project, researchers will be looking to understand how the pandemic has impacted nutrition, breastfeeding and immunisation of newborns.
Data will be compared with findings from other AMANHI countries to shed light on the best strategies to prevent disruptions to essential services during pandemics.
In Kenya, Dr Temmerman and her fellow researchers will consult data from the Ministry of Health and from health facilities in Kilifi, Mombasa and Nairobi to assess trends in healthcare utilisation. They will also conduct interviews with service providers to assess the reasons for changes in health-seeking behaviour. This will aid researchers in understanding the pandemic’s impact on antenatal and postnatal care, facility deliveries, family planning and adolescent health.
As a member of a Ministry of Health working group that is looking at the delivery of essential health services during the pandemic, Dr Temmerman will present the study’s findings to decision-makers to inform efforts to improve pandemic preparedness.