Clinical presentation, pregnancy complications and maternal outcomes of SARS-CoV-2 infection in pregnant women during the third wave of COVID-19 in Mumbai, India

Abstract

Importance: Following the outbreak of SARS-CoV-2 infection, it is unclear whether there is any difference in clinical presentation, disease severity, pregnancy complications, and maternal outcomes in pregnant and postpartum women during the third wave of COVID-19 as compared to the earlier two waves of COVID-19. Objective: To assess the clinical presentation, disease severity, pregnancy complications, and maternal outcomes in women affected with COVID-19 during the third wave in India and compare these parameters with the first wave and second wave of COVID-19.Design: Retrospective observational cohort study Setting: Tertiary care, dedicated COVID-19 hospital catering to Mumbai Metropolitan Region, India Participants: A total of 2,028 pregnant and postpartum women were admitted during three-wave periods: first wave - 1st April 2020 to 31st January 2021, second wave - 1st February 2021 to 10th December 2021; and third wave - 18th December 2021 to 19th January 2022. Exposures: SARS-CoV-2 infection in pregnant and post-partum women confirmed by laboratory confirmation of COVID-19 Main Outcomes and Measures: The primary outcome measures were disease severity, pregnancy complications, and maternal mortality during the third wave compared to the first and second waves of COVID-19. Results: A total of 2028 pregnant and postpartum women with COVID-19 diagnosis were enrolled during the first, second, and third waves of COVID-19. The hospitalization rate of pregnant and post-partum women with COVID-19 during the first four weeks of the third wave was higher than the earlier two waves as 288 women got admitted within 33 days. The number of SARS-CoV-2 infected pregnant and post-partum women with symptoms of COVID-19 were five times higher during the third wave as compared to the first wave (OR=5.1, 95% CI, 3.8-6.7, p<.001). On the contrary, there was a significantly lower proportion of pregnant and postpartum women with moderate to severe COVID-19 during the third wave (0.3%, 1/288) as compared to those during the first wave (2.4%, 27/1143, p<.001) and second wave (14.4%, 86/597) [p<.001]. The ICU/HDU admissions during the third wave were significantly lower (2.4%,7/288) than those during the second wave (14.7%,88/597) [OR =0.1, 95% CI, 0.1-0.3, p<.001] but similar to the first wave (2.4%,27/1143). No maternal deaths were reported during the third wave till 19th January 2022. Eclampsia was observed four times higher during the third wave as compared to the second wave (OR=4.1, 95 % CI, 0.8-22.6, p =.19) and first wave (OR=4.4, 95% CI, 0.9-12.7, p=.15). Conclusions and Relevance: Decreased severity of COVID-19 and reduced maternal mortality and morbidity were reported in the third wave as compared to the first wave and second wave of COVID-19 in the Mumbai Metropolitan Region, India.Trial Registration: The study is registered with the Clinical Trial Registry of India (Registration no: CTRI/2020/05/025423).

Comparison of maternal and neonatal outcomes of COVID-19 before and after SARS-CoV-2 omicron emergence in maternity facilities in Malawi (MATSurvey): data from a national maternal surveillance platform

“… 24 More recently, a retrospective study from the USA reported an unadjusted OR of 0·20 (95% CI 0·05–0·83) for severe or critical illness in pregnant women during a period of omicron dominance compared with a period before delta dominance, 12 and a study from Mumbai, India reported an unadjusted OR of 0·2 (95% CI 0·1–0·3) of intensive or high dependency care being required in their omicron-associated wave compared with their delta-associated wave. 14 To our knowledge, our study is the first to compare the clinical profiles and outcomes of COVID-19 in pregnancy across multiple waves of distinctive variant dominance in sub-Saharan Africa and is the first report of omicron-associated COVID-19 in maternity facilities in a low-resource setting, contributing significantly to the limited data available for omicron infection in pregnancy globally.…”

“…Less virulent than previous variants of concern and wild-type SARS-CoV-2, 9 , 10 , 11 it is likely that omicron infection in pregnancy has different presentations and outcomes than those reported for preceding variants of concern. 12 , 13 , 14 , 15 , 16 , 17 However, to our knowledge at the time of writing, there are no published or pre-print manuscripts that either characterise the clinical presentation or report the clinical outcomes of COVID-19 in pregnancy during periods of omicron dominance from low-resource settings.…”

COVID-19 related maternal mortality cases in associated with Delta and Omicron waves and the role of lung ultrasound

“…Variants of concern have begun to be reported by the World Health Organization (WHO) ( 9 ) and the pace of the pandemic has increased. Data on maternal mortality associated with the increasing waves of the pandemic have been accumulated recently ( 7 , 10 , 11 , 12 ) . As the pandemic progressed, new genetic variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were identified in the second half of the 2020 ( 5 ) .…”