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

Avinash Kavi, Shivaprasad S. Goudar, Manjunath S. Somannavar, Janet L. Moore, Richard J. Derman, Sarah Saleem, Seemab Naqvi, Sk Masum Billah, Rashidul Haque, Lester Figueroa, Manolo Mazariegos, Adrien Lokangaka, Antoinette Tshefu, Fabian Esamai, Musaku Mwenechanya, Elwyn Chomba, Archana Patel, Prabirkumar Das, Melissa Bauserman, William A. PetriNancy F. Krebs, Waldemar A. Carlo, Sherri Bucher, Patricia L. Hibberd, Marion Koso-Thomas, Elizabeth M. McClure, Robert L. Goldenberg

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objective: To determine the relation of COVID-19 symptoms to COVID-19 antibody 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 prospective, 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 prospective, 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 significantly 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 differentiating pregnant women who have had a COVID-19 infection.

Original languageEnglish
Pages (from-to)140-148
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue numberS3
Publication statusPublished - Nov 2023


  • COVID-19 antibody
  • COVID-19 symptoms
  • low- and middle-income countries
  • pregnant women


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